Department of Cardiology, Hospital Universitari Son Espases (HUSE), Spain.
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.
Eur Heart J Acute Cardiovasc Care. 2020 Dec;9(8):911-922. doi: 10.1177/2048872620911853. Epub 2020 Mar 11.
The European Society of Cardiology established a set of quality indicators for the management of acute myocardial infarction. Our aim was to evaluate their degree of attainment, prognostic value and potential use for centre benchmarking in a large international cohort.
Quality indicators were extracted from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) (555 hospitals, 20 countries in Europe and Latin America, 2010-2011) and EPICOR Asia (218 hospitals, eight countries, 2011-2012) registries, including non-ST-segment elevation acute myocardial infarction (=6558) and ST-segment elevation acute myocardial infarction (=11,559) hospital survivors. The association between implementation rates for each quality indicator and two-year adjusted mortality was evaluated using adjusted Cox models. Composite quality indicators were categorized for benchmarking assessment at different levels.
The degree of attainment of the 17 evaluated quality indicators ranged from 13% to 100%. Attainment of most individual quality indicators was associated with two-year survival. A higher compliance with composite quality indicators was associated with lower mortality at centre-, country- and region-level. Moreover, the higher the risk for two-year mortality, the lower the compliance with composite quality indicators.
When EPICOR and EPICOR Asia were conducted, the European Society of Cardiology quality indicators would have been attained to a limited extent, suggesting wide room for improvement in the management of acute myocardial infarction patients. After adjustment for confounding, most quality indicators were associated with reduced two-year mortality and their prognostic value should receive further attention. The two composite quality indicators can be used as a tool for benchmarking either at centre-, country- or world region-level.
欧洲心脏病学会为急性心肌梗死的管理制定了一套质量指标。我们的目的是在一个大型国际队列中评估这些指标的达标程度、预后价值和中心基准比较的潜在用途。
质量指标是从抗血栓治疗模式的长期随访中提取出来的，包括急性冠状动脉综合征患者的长期随访（EPICOR）（欧洲和拉丁美洲 20 个国家的 555 家医院，2010-2011 年）和 EPICOR 亚洲（8 个国家的 218 家医院，2011-2012 年）登记处，包括非 ST 段抬高型急性心肌梗死（=6558 例）和 ST 段抬高型急性心肌梗死（=11559 例）的住院幸存者。使用调整后的 Cox 模型评估每个质量指标的实施率与两年调整死亡率之间的关系。对不同水平的基准评估，对综合质量指标进行分类。
17 个评估指标的达标程度从 13%到 100%不等。大多数单个质量指标的达标与两年生存率有关。复合质量指标的达标率越高，中心、国家和地区的死亡率越低。此外，两年死亡率越高，复合质量指标的达标率越低。
当 EPICOR 和 EPICOR 亚洲进行时，欧洲心脏病学会的质量指标的达标程度有限，表明急性心肌梗死患者的管理还有很大的改进空间。调整混杂因素后，大多数质量指标与降低两年死亡率相关，其预后价值应得到进一步关注。这两个综合质量指标可作为中心、国家或世界区域水平的基准比较工具。
