Abstract
Background: Despite recent improvements in the hospital treatment of ACS, little is known about current cardiological practice in China or use of evidence-based approach in Chinese hospitals. Methods: A questionnaire about doctor-reported hospital management of ACS was posted to the head of the cardiology department of 1397 hospitals across 30 provinces of China. Reported use of various clinical procedures and treatments were analysed and compared between different types of hospital. Results: Of the 1029 (74%) hospitals that responded, 43% were tier III (tertiary) hospitals. For STEMI, primary PCI was used as the main reperfusion therapy by 50.2% of tier III and 9.3% of tier II/I (secondary) hospitals. Most of hospitals also used various proven therapy routinely for STEMI and NSTEMI/UA, including anti-platelet therapy (98% and 93%), anticoagulant (96% and 90%), statin (97% and 94%), oral β-blockers (87% and 86%) and ACE-I (88% and 83%). However, certain therapies with little or no proven value (eg, G.I.K., magnesium and Chinese tradition medicine) remained used routinely by 25% - 40% of tier II/I hospitals. After discharge, statin, antiplatelet, β-blockers and ACE-I were reportedly used routinely by 85% - 95% of the responders for secondary prevention. Conclusions: With a few exceptions, doctor-reported hospital management of ACS in China is largely consistent with that recommended by current guidelines. Large nationwide registries are needed to assess long-term adherence to treatments after hospital discharge.
Highlights
During the past few decades the population mortality rate from cardiovascular disease has declined substantially in most developed countries, due partly to changes in risk factors and partly to improved treatment and medical care for patients [1,2,3]
The proportions who reported providing routine advice to acute coronary syndromes (ACS) patients on prevention of depression and the flu vaccination was relatively low (61% and 14% respectively). This is one of the largest surveys on the doctor-reported hospital management of ACS ever conducted in China
The survey did not involve a nationally representative sample, it included more than 1000 large and secondary sized hospitals from 30 regions in China, which are responsible for the care of most of ACS patients in the population
Summary
During the past few decades the population mortality rate from cardiovascular disease has declined substantially in most developed countries, due partly to changes in risk factors and partly to improved treatment and medical care for patients [1,2,3]. In China, various proven treatments for ACS (e.g., statin, aspirin, clopidogrel, β-blocker, ACE-I) have become widely available, and there are national guidelines to facilitate implementation of evidence-based patient care [5,6,7,8,9]. Despite recent improvements in the hospital treatment of ACS, little is known about current cardiological practice in China or use of evidencebased approach in Chinese hospitals. Conclusions: With a few exceptions, doctor-reported hospital management of ACS in China is largely consistent with that recommended by current guidelines. Large nationwide registries are needed to assess long-term adherence to treatments after hospital discharge
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