Assessment of quality indicators for acute myocardial infarction management in 28 countries and use of composite quality indicators for benchmarking

Rosselló, Xavier; Medina, Jesús; Pocock, Stuart J.; Werf, Frans Van de; Chin, Chee Tang; Danchin, Nicolás; Lee, Stephen W-L; Huo, Yong; Bueno, Héctor

doi:10.1177/2048872620911853

Cited by 29 publications

(14 citation statements)

References 35 publications

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“…12 For AMI, a suite of QIs exist which are valid, 13 internationally recognised 14 and have built on earlier indicators that have an inverse association with mortality. [15][16][17][18][19] We used the UK national cardiovascular registries to investigate the quality of AMI care according to these indicators during the first national lockdown in the COVID-19 pandemic. This may help understand changes in the processes of AMI care during the time of national crisis and identify areas for improvement.…”

Section: Introductionmentioning

confidence: 99%

Quality of acute myocardial infarction care in England and Wales during the COVID-19 pandemic: linked nationwide cohort study

Aktaa

Yadegarfar

et al. 2021

BMJ Qual Saf

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Background and objectiveThe impact of the COVID-19 pandemic on the quality of care for patients with acute myocardial infarction (AMI) is uncertain. We aimed to compare quality of AMI care in England and Wales during and before the COVID-19 pandemic using the 2020 European Society of Cardiology Association for Acute Cardiovascular Care quality indicators (QIs) for AMI.MethodsCohort study of linked data from the AMI and the percutaneous coronary intervention registries in England and Wales between 1 January 2017 and 27 May 2020 (representing 236 743 patients from 186 hospitals). At the patient level, the likelihood of attainment for each QI compared with pre COVID-19 was calculated using logistic regression. The date of the first national lockdown in England and Wales (23 March 2020) was chosen for time series comparisons.ResultsThere were 10 749 admissions with AMI after 23 March 2020. Compared with before the lockdown, patients admitted with AMI during the first wave had similar age (mean 68.0 vs 69.0 years), with no major differences in baseline characteristics (history of diabetes (25% vs 26%), renal failure (6.4% vs 6.9%), heart failure (5.8% vs 6.4%) and previous myocardial infarction (22.9% vs 23.7%)), and less frequently had high Global Registry of Acute Coronary Events risk scores (43.6% vs 48.6%). There was an improvement in attainment for 10 (62.5%) of the 16 measured QIs including a composite QI (43.8% to 45.2%, OR 1.06, 95% CI 1.02 to 1.10) during, compared with before, the lockdown.ConclusionDuring the first wave of the COVID-19 pandemic in England and Wales, quality of care for AMI as measured against international standards did not worsen, but improved modestly.

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Section: Introductionmentioning

confidence: 99%

Quality of acute myocardial infarction care in England and Wales during the COVID-19 pandemic: linked nationwide cohort study

Aktaa

Yadegarfar

et al. 2021

BMJ Qual Saf

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“…There are several limitations to this analysis of data from the EPICOR and EPICOR Asia studies [19,27,[37][38][39][40][41][45][46][47][48][49][50][51][52]. First, considerations inherent to the analysis of observational data must be taken into account, such as a potential patient selection bias in terms of differences in DAPT patterns and clinical outcomes across the eGFR groups.…”

Section: Discussionmentioning

confidence: 99%

“…Third, the study did not track how renal function changes over time nor, therefore, the degree to which this impacted on further treatment decisions (e.g., stopping DAPT or undergoing subsequent intervention) or long-term outcomes. Finally, the use of quality indicators [52] in this patient subgroup has not been validated and may be challenging.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Antithrombotic Therapy and Clinical Outcomes in Patients with Acute Coronary Syndrome and Renal Impairment: Insights from EPICOR and EPICOR Asia

Huo

Werf

Han

et al. 2021

Am J Cardiovasc Drugs

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Background Information is lacking on long-term management of patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m 2 ). Objectives Our objectives were to describe antithrombotic management patterns and outcomes in patients with ACS with varying renal function from the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients; NCT01171404) and EPICOR Asia (NCT01361386) studies. Methods EPICOR and EPICOR Asia were prospective observational studies of patients who survived hospitalization for ACS and were enrolled at discharge in 28 countries across Europe, Latin America, and Asia. The studies were conducted from 2010 to 2013 and from 2011 to 2014, respectively. This analysis evaluated patient characteristics and oral antithrombotic management patterns and outcomes up to 2 years post-discharge according to admission eGFR: ≥ 90, 60-89, 30-59, or < 30 mL/min/1.73 m 2 . Results Among 22,380 patients with available data, eGFR < 60 mL/min/1.73 m 2 was observed in 16.7%. Patients with poorer renal function were older, were at greater cardiovascular risk, and had more prior cardiovascular disease and bleeding. Patients with CKD underwent fewer cardiovascular interventions and had more in-hospital cardiovascular and bleeding events. Dual antiplatelet therapy was less likely at discharge in patients with eGFR < 30 (82.3%) than in those with ≥ 90 (91.3%) mL/min/1.73 m 2 and declined more sharply during follow-up in patients with low eGFR (p < 0.0001). An adjusted proportional hazards model showed that patients with lower eGFR levels had a higher risk of cardiovascular events and bleeding. Conclusions The presence of CKD in patients with ACS was associated with less aggressive cardiovascular management and an increased risk of cardiovascular events.

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“…The Association of Acute CardioVascular Care of the European Society of Cardiology has proposed and retrospectively validated a set of ACS-specific QIs with the intention of facilitating programme to improve QoC for patients with ACS across Europe. [5][6][7] In Italy, some studies with this goal have been conducted by national cardiovascular societies. [8][9][10] However, their interpretation has been challenged, to various extent by: (1) the enrolment of time-limited cohorts (mostly with cross-sectional design), (2) the uncertain consecutiveness of included patients, (3) the lack of systematic adjudication of study outcome, (4) a limited assessment of the numerous dimensions of care integrating diagnostic, therapeutic and systemlevel domains and finally (5) the exclusion of patients with ACS at admission but without myocardial infarction (MI) or unstable angina (UA) at discharge.…”

Section: How Might This Impact On Clinical Practice?mentioning

confidence: 99%

Clinical governance programme in patients with acute coronary syndrome: design and methodology of a quality improvement initiative

Leonardi¹,

Montalto

Casella

et al. 2020

Open Heart

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IntroductionDespite the availability of diverse evidence-based diagnostic and treatment options, many patients with acute coronary syndrome (ACS) still fail to receive effective, safe and timely diagnoses and therapies. The Association of Acute CardioVascular Care of the European Society of Cardiology has proposed and retrospectively validated a set of ACS-specific quality indicators. Combining these indicators with the principles of clinical governance—a holistic, patient-centred approach intended to promote continuous quality improvement—we designed the clinical governance programme in patients with ACS.Methods and analysisThis is a multicentre quality improvement initiative exploring multiple dimensions of care, including diagnosis, therapy, patient satisfaction, centre organisation and efficiency in all comers patients with ACS.The study will enrol ≈ 5000 patients prospectively (ie, at the time of the first objective qualifying ACS criterion) with a 1-year follow-up. Consecutive inclusion will be promoted by a simplified informed consent process and quantified by the concordance with corresponding hospital administrative records using diagnosis-related group codes of ACS.Coprimary outcome measures are (1) timely reperfusion in patients with ST-elevation ACS and (2) optimal medical therapy at discharge in patients with confirmed acute myocardial infarction. Secondary outcomes broadly include multiple indicators of the process of care. Clinical endpoints (ie, death, myocardial infarction, stroke and bleeding) will be adjudicated by a clinical event committee according to predefined criteria.Ethics and disseminationThe study has been approved by local ethics committee of all study sites. As a quality improvement initiative and to promote consecutive inclusion of the population of interest, a written informed consent will be requested only to patients who are discharged alive. Dissemination will be actively promoted by (1) the registration site (ClinicalTrials.Gov ID NCT04255537), (2) collaborations with investigators through open data access and sharing.

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Assessment of quality indicators for acute myocardial infarction management in 28 countries and use of composite quality indicators for benchmarking

Cited by 29 publications

References 35 publications

Quality of acute myocardial infarction care in England and Wales during the COVID-19 pandemic: linked nationwide cohort study

Quality of acute myocardial infarction care in England and Wales during the COVID-19 pandemic: linked nationwide cohort study

Long-Term Antithrombotic Therapy and Clinical Outcomes in Patients with Acute Coronary Syndrome and Renal Impairment: Insights from EPICOR and EPICOR Asia

Clinical governance programme in patients with acute coronary syndrome: design and methodology of a quality improvement initiative

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