Abstract 14403: Hospital- and Patient-Level Quality Indicators for Acute Coronary Syndrome Using Nationwide Database

Abstract

Introduction: The efficacy of the quality indicators (QIs) using administrative data was unclear. Hypothesis: The use of QIs is associated with lower mortality in patients with acute coronary syndrome (ACS) at both hospital and patient levels. Methods: Patients with ACS who underwent percutaneous coronary intervention (PCI) between April 2014 and March 2018 in the National Database of Health Insurance Claims and Specific Health Checkups of Japan were included. Twelve quality indicators (QIs) were extracted from the administrative data and the association of the QIs with all-cause mortality was investigated. Results: A total of 221,267 patients from 1,220 hospitals were analyzed. The adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment was high (median proportion >90%), and adherence to outpatient cardiac rehabilitation was low (median proportion <10%) among all the QIs. Higher acute phase composite QI score was associated with reduced risk-adjusted 30-day mortality at hospital level (β=-0.92 [95% confidence interval -1.19 to -0.66], P<0.001). Four acute-phase and six subacute-phase QIs were inversely associated with 30-day and long-term mortalities at patient-level, respectively (all P<0.001). Conclusions: There were substantial variations in the care of ACS in the current nationwide database. A higher adherence to the QI sets was associated with survival gains at both hospital and patient levels. Multilevel approach using QI may be effective for improvement of survival among these populations.