24 Jun Heart Attack Admissions In China Quadrupled Over 10 Years
MedicalResearch.com Interview with:
Professor Lixin Jiang MD, PhD, F.A.C.C.
National Clinical Research Center of Cardiovascular Diseases
State Key Laboratory of Cardiovascular Disease
Fuwai Hospital, National Center for Cardiovascular Diseases
Beijing , China
MedicalResearch: What are the main findings of the study?
Professor Jiang: In this first representative nationwide assessment of quality of care in China, we studied 13,815 hospital admissions for STEMI in 162 hospitals across China over the past decade. We found that the incidence of hospital admission for STEMI quadrupled from 3.7 per 100,000 in 2001 to 15.8 per 100,000 in 2011.
There were substantial changes in testing and treatment patterns. Over the study period, the rate of testing for troponin increased from 21.4% in 2001 to 66.5% in 2011. Additionally, based at the ideal patients’ analysis, the use of several highly effective treatments for STEMI, including aspirin, clopidogrel and statins, improved over the study period. However, other therapies known to reduce mortality in STEMI patients – such as β-blockers and ACE inhibitors – were underused with only 57.7% of patients receiving beta-blockers and 66.1% ACE inhibitors respectively in 2011.
While the proportion of patients receiving reperfusion therapy remained constant, there was a notable shift away from fibrinolysis, which was the primary means of reperfusion in 2001, towards primary PCI. However, in 2011, only 27.6% of patients admitted to Chinese hospitals for STEMI received primary PCI, the gold standard of treatment, while 27.4% received fibrinolytic therapy in the ideal patients.
Despite increasing overall intensity of treatment, procedure use, and testing, no significant change in the rate of in-hospital death from STEMI was seen over the study period.
MedicalResearch: Were any of the findings unexpected?
Professor Jiang: There were several unexpected findings of the study. The quadrupling of the incidence of hospitalizations for STEMI was particularly notable.
Also, despite a sharp rise in the use of primary PCI, only 55% of patients received any reperfusion therapy – a proportion that remained constant over our decade-long study period. Improvements in other aspects of the management of STEMI were not uniform. While the growing use of biomarkers and several important medications was encouraging, there was little change in the use of reperfusion, beta-blockers and ACE inhibitors. Even though there were some notable improvements in the quality of care, we did not find a significant change in in-hospital mortality.
MedicalResearch: What should clinicians and patients take away from your report?
Professor Jiang: Clinicians should recognize the power of direct measurement in illuminating clinical care and outcomes – and the importance of such studies in identifying targets for improvement. Improving access and addressing cost are important, but clinical quality is also a facet of health care that must be measured and made transparent. Providing health care is not enough. All nations must seek to provide access to the highest quality health care. Studies such as these are essential to focus everyone in the health care system on what is being accomplished and what goals need to be set for the future. Clinicians everywhere need to seek knowledge of health system performance for patients – and patients should encourage efforts to raise quality. The paper is about China, which has 20% of the world’s population, but the results and approach have implications for every country.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Professor Jiang: To address the identified opportunities to further improve acute myocardial infarction care in China, the government has already committed funds to support the National Center for Cardiovascular Disease to initiate the China-PEACE Improvement Study. This initiative will pioneer innovative strategies to elevate the quality of cardiovascular care throughout China and augments an ongoing commitment to cardiovascular care by the Chinese government. (Yang Z, Jiang L. Building clinical research capacity in China: the National Clinical Research Centres. Lancet November 28, 2013). To support these efforts there is a need for studies to understand better the obstacles to high quality care, the disparities in quality, patient and institutional characteristics associated with quality of care, and the lessons from the best performers. We need continuing good science to inform efforts to improve.
Moreover, the ongoing China-PEACE Prospective studies will help us understand outcomes from the patient perspective over time, including information about symptoms, function, stress and other domains.
ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data
or the China PEACE Collaborative Group