International comparison of acute myocardial infarction care and outcomes using quality indicators

Abstract

ObjectiveTo compare temporal changes in European Society of Cardiology (ESC) acute myocardial infarction (AMI) quality indicator (QI) attainment in the UK and Israel.MethodsData cross-walking using information from the Myocardial Ischaemia National Audit Project and the Acute Coronary Syndrome in Israel Survey for matching 2-month periods in 2006, 2010 and 2013 was used to compare country-specific attainment of 14 ESC AMI QIs.ResultsPatients in the UK (n=17 068) compared with Israel (n=5647) were older, more likely to be women, and had less diabetes, dyslipidaemia and heart failure. Baseline ischaemic risk was lower in Israel than the UK (Global Registry of Acute Coronary Events (GRACE) risk, 110.5 vs 121.0). Overall, rates of coronary angiography (87.6% vs 64.8%) and percutaneous coronary intervention (70.3% vs 41.0%) were higher in Israel compared with the UK. Composite QI performance increased more in the UK (1.0%–86.0%) than Israel (70.2%–78.0%). Mortality rates at 30 days declined in each country, with lower rates in Israel in 2013 (4.2% vs 7.6%). Composite QI adherence adjusted for GRACE risk score was inversely associated with 30-day mortality (OR 0.95; CI 0.95 to 0.97, p<0.001).ConclusionsInternational comparisons of guideline recommended AMI care and outcomes can be quantified using the ESC AMI QIs. International implementation of the ESC AMI QIs may reveal country-specific opportunities for improved healthcare delivery.

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

“…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.…”

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

“…Proper evaluation of clinical healthcare quality requires the assessment of structures, and evaluating care processes and outcomes in large unselected populations in routine clinical practice. 4 Although the ESC-ACCA QIs have been evaluated in a number of national registries in France, 12 the UK 13,23 and Israel, 14 no international evaluation to assess trans-national differences in patterns and quality of care has been performed. Our study included >18,000 patients from 28 countries and three continents, reflecting a variety of clinical practices from different economies, cultures and healthcare systems.…”

“…They could help in QIs definition updates and influence the design of future registries to capture this information. Future revisions of the QI set should consider the feasibility of assessing QIs in already available data sets (QIs such as 3.1 and 3.2 are consistently not recorded in most reports [12][13][14] and update some QIs to remain aligned with current guidelines (i.e. QI2.1 refers to reperfusion rate within 12h symptom onset, whereas the 2017 STEMI guidelines 24 refer to the percentage of patients arriving in the first 12h who are reperfused).…”

“…Although quality assessment through these QIs would ideally require specific surveys, existing registries are suitable for a 'reality checkpoint'. QI evaluations at a national level 12,13 or comparing two countries 14 have been conducted, but there has not been a thorough assessment in an international registry including patients from different continents.…”

Global lessons for quality care: a tale of two countries

“…In this observational study involving two large national ACS databases from Israel (Acute Coronary Syndrome in Israel Survey, ACSIS) and UK (Myocardial Ischaemia National Audit Project, MINAP), Zusman et al compare the temporal changes in ACS care at three timepoints (2006, 2010 and 2013) using the ESC ACS QI, including composite QI scores calculated both by opportunity and all-or-none methodologies 13. Over time, both countries saw an increase in invasive coronary management, with a greater increase in the UK.…”