Abstract
Introduction: In 2020, the European Society of Cardiology-Acute Cardio Vascular Care (ESC-ACVC) updated the 2017 Quality Indicators (QI) for the management of acute myocardial infarction (AMI). We compared 2017 vs 2020 indicators in terms of feasibility, potential for improvement, association with outcomes, and suitability for center benchmarking. Methods: Data were extracted from three French nationwide cohorts (FAST-MI 2005, 2010 and 2015), using data from AMI survivors at discharge. Applicability and potential for improvement were estimated for each QI by the denominator and numerator. The association between the composite QIs and 1 year mortality were assessed using multivariate logistic regressions. Center benchmarking was based on the mean of the opportunity-based composite QIs (CQI) and the All or None Composite QI. Results: The 2017 and 2020 QIs were measured in 12,660 /13,130 patients discharged alive, respectively. The rates of attainment ranged from 15% to 96% (Figure, left). The mean value of the Composite QI was 0.71 in 2017 versus 0.64 in 2020 (p<0.01). Quartiles of CQI were significantly associated with risk-adjusted 1 year mortality for 2017 and 2020 CQI (Figure, right). Addition of the quartiles of the 2020 CQI improved the discrimination indices. Attainment of the 2020 All-or-None Composite QI was observed in 12% of cases, and was associated with a 63% lower odds of death. The opportunity-based Composite QI and the All-or-None QI were suitable for center benchmarking. Conclusion: Compared to the 2017 QIs, the 2020 updated QIs for AMI can be measured in existing registries, and show greater potential for improvement, a comparable association with mortality and similar suitability for center benchmarking.
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