中国非 ST 段抬高型急性冠脉综合征住院患者中 I 级推荐和 A 级证据管理策略的表现：来自改善中国心血管疾病治疗-急性冠脉综合征（CCC-ACS）项目的研究结果。
Performance on management strategies with Class I Recommendation and A Level of Evidence among hospitalized patients with non-ST-segment elevation acute coronary syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome (CCC-ACS) project.
机构信息
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, the Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Department of Cardiology, Peking University First Hospital, Beijing, China.
出版信息
Am Heart J. 2019 Jun;212:80-90. doi: 10.1016/j.ahj.2019.02.012. Epub 2019 Mar 4.
BACKGROUND
This study aimed to examine hospital performance on evidence-based management strategies for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and variations across hospitals.
METHODS
Improving Care for Cardiovascular Disease in China (CCC)-ACS project is an ongoing registry and quality improvement project, with 150 tertiary hospitals recruited across China. We examined hospital performance on nine management strategies (Class I Recommendations with A Level of Evidence) based on established guidelines. We also evaluated the proportion of patients receiving defect-free care, which was defined as the care that included all the required management strategies for which the patient was eligible. The hospital-level variations in the performance were examined.
RESULTS
From 2014 to 2018, 28,170 NSTE-ACS patients were included. Overall, 16% of patients received defect-free care. Higher-performing metrics were statin at discharge (93%), cardiac troponin measurement (92%), dual antiplatelet therapy (DAPT) within 24 hours (90%), and DAPT at discharge (85%). These were followed by metrics of β-blocker at discharge (69%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) at discharge (59%), and risk stratification (56%). Lower-performing metrics were smoking cessation counseling (35%) and percutaneous coronary intervention (PCI) within recommended times (33%). The proportion of patients receiving defect-free care substantially varied across hospitals, ranging from 0% to 58% (Median (interquartile range):12% (7%-21%)). There were large variations across hospitals in performance on risk stratification, smoking cessation counseling, PCI within recommended times, ACEI/ARB at discharge and β-blocker at discharge.
CONCLUSIONS
About one in six NSTE-ACS patients received defect-free care, and the performance varied across hospitals.
背景
本研究旨在考察医院在非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）的循证管理策略方面的表现及其在医院间的差异。
方法
正在进行的“改善中国心血管疾病管理（CCC-ACS）项目”是一项注册和质量改进项目，在中国招募了 150 家三级医院。我们根据既定指南，考察了医院在 9 项管理策略上的表现（I 级推荐，A级证据）。我们还评估了接受无缺陷护理的患者比例，即包括所有符合条件的患者所需管理策略的护理。考察了医院间表现的差异。
结果
2014 年至 2018 年期间，共纳入 28170 例 NSTE-ACS 患者。总体而言，16%的患者接受了无缺陷护理。表现较好的指标是出院时使用他汀类药物（93%）、肌钙蛋白检测（92%）、24 小时内双联抗血小板治疗（DAPT）（90%）和出院时 DAPT（85%）。其次是出院时使用β受体阻滞剂（69%）、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）（59%）和风险分层（56%）。表现较差的指标是戒烟咨询（35%）和在推荐时间内进行经皮冠状动脉介入治疗（PCI）（33%）。接受无缺陷护理的患者比例在医院间差异很大，从 0%到 58%（中位数（四分位距）：12%（7%-21%））。医院间在风险分层、戒烟咨询、在推荐时间内进行 PCI、出院时使用 ACEI/ARB 和β受体阻滞剂方面的表现存在较大差异。
结论
约六分之一的 NSTE-ACS 患者接受了无缺陷护理，而且医院间的表现存在差异。
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