美国心脏病学会胸痛中心认证对指南推荐的急性心肌梗死管理的影响。
The Impact of American College of Cardiology Chest Pain Center Accreditation on Guideline Recommended Acute Myocardial Infarction Management.
机构信息
From the Baylor College of Medicine, Houston, TX.
Wayne State School of Medicine, Detroit, MI.
出版信息
Crit Pathw Cardiol. 2021 Dec 1;20(4):173-178. doi: 10.1097/HPC.0000000000000266.
BACKGROUND
Whether American College of Cardiology (ACC) Chest Pain Center (CPC) accreditation alters guidelines adherence rates is unclear.
METHODS
We analyzed patient-level, hospital-reported, quality metrics for myocardial infarction (MI) patients from 644 hospitals collected in the ACC's Chest Pain-MI Registry from January 1, 2019, to December 31, 2020, stratified by CPC accreditation for >1 year.
RESULTS
Of 192,374 MI patients, 67,462 (35.1%) received care at an accredited hospital. In general, differences in guideline adherence rates between accredited and nonaccredited hospitals were numerically small, although frequently significant. Patients at accredited hospitals were more likely to undergo coronary angiography (98.6% vs. 97.9%, P < 0.0001), percutaneous coronary intervention for NSTEMI (55.4% vs. 52.3%, P < 0.0001), have overall revascularization for NSTEMI (63.5% vs. 61.0%, P < 0.0001), and receive P2Y12 inhibitor on arrival (63.5% vs. 60.2%, P < 0.0001). Nonaccredited hospitals more ECG within 10 minutes (62.3% vs. 60.4%, P < 0.0001) and first medical contact to device activation ≤90 minutes (66.8% vs. 64.8%, P < 0.0001). Accredited hospitals had uniformly higher discharge medication guideline adherence, with patients more likely receiving aspirin (97.8% vs. 97.4%, P < 0.0001), angiotensin-converting enzyme inhibitor (46.7% vs. 45.3%, P < 0.0001), beta blocker (96.6% vs. 96.2%, P < 0.0001), P2Y12 inhibitor (90.3% vs. 89.2%, P < 0.0001), and statin (97.8% vs. 97.5%, P < 0.0001). Interaction by accredited status was significant only for length of stay, which was slightly shorter at accredited facilities for specific subgroups.
CONCLUSIONS
ACC CPC accreditation was associated with small consistent improvement in adherence to guideline-based treatment recommendations of catheter-based care (catheterization and PCI) for NSTEMI and discharge medications, and shorter hospital stays.
背景
美国心脏病学会（ACC）胸痛中心（CPC）认证是否能改变指南的依从率尚不清楚。
方法
我们分析了 2019 年 1 月 1 日至 2020 年 12 月 31 日期间，ACC 的胸痛-MI 注册中心收集的来自 644 家医院的 192374 例心肌梗死（MI）患者的患者水平、医院报告的质量指标，按 CPC 认证时间>1 年进行分层。
结果
在 192374 例 MI 患者中，有 67462 例（35.1%）在认证医院接受治疗。一般来说，认证医院和非认证医院之间的指南依从率差异虽然经常显著，但数值上很小。在认证医院就诊的患者更有可能接受冠状动脉造影（98.6% vs. 97.9%，P < 0.0001）、非 ST 段抬高型心肌梗死的经皮冠状动脉介入治疗（55.4% vs. 52.3%，P < 0.0001）、非 ST 段抬高型心肌梗死的总体血运重建（63.5% vs. 61.0%，P < 0.0001）和入院时使用 P2Y12 抑制剂（63.5% vs. 60.2%，P < 0.0001）。非认证医院更有可能在 10 分钟内进行更多的心电图检查（62.3% vs. 60.4%，P < 0.0001）和首次医疗接触至设备激活<90 分钟（66.8% vs. 64.8%，P < 0.0001）。认证医院出院时药物治疗指南的依从性普遍较高，患者更有可能接受阿司匹林（97.8% vs. 97.4%，P < 0.0001）、血管紧张素转换酶抑制剂（46.7% vs. 45.3%，P < 0.0001）、β受体阻滞剂（96.6% vs. 96.2%，P < 0.0001）、P2Y12 抑制剂（90.3% vs. 89.2%，P < 0.0001）和他汀类药物（97.8% vs. 97.5%，P < 0.0001）。仅在住院时间方面，认证状态的交互作用具有显著意义，特定亚组的认证机构的住院时间略短。
结论
ACC CPC 认证与基于指南的治疗建议的依从性略有持续改善相关，包括 NSTEMI 的经皮冠状动脉介入治疗（导管化和 PCI）和出院药物治疗，以及住院时间缩短。
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