Abstract
Variations across regions for managing acute myocardial infarction (AMI) in China are little understood. To evaluate geographic variation and its change with time in treatment process and outcomes for patients with AMI. This cross-sectional study used data from the Patient-Centered Evaluative Assessment of Cardiac Events-Retrospective AMI project in 2001, 2006, 2011, and 2015 in 153 randomly selected hospitals across China. Patients were hospitalized for AMI. Data were analyzed from October 1 to October 31, 2019. Hospitalization in 3 geographic regions (Eastern, Central, and Western) stratified according to China's official definition. Process of care measures included reperfusion therapies, aspirin, clopidogrel, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were clinically eligible without contraindications (considered as ideal candidates for treatments). Outcome measures included in-hospital mortality and 5-day mortality. Mixed models were used to assess the regional disparities and time-region interactions in those measures, adjusting for patient characteristics. In 153 hospitals across China, 27 046 patient hospitalizations for AMI were sampled. There was a significant difference across regions in process of care and the odds ratio (OR) of delivering any 1 of the 6 treatments to an ideal patient was 0.83 (95% CI, 0.76-0.91; P < .001) for the lowest region compared with the highest region. The variation between the 2 higher regions narrowed (time-by-Eastern region interaction: OR, 0.83; 95% CI, 0.76-0.91; P < .001). The region with the highest in-hospital mortality had 1.46 times greater in-hospital mortality (95% CI, 1.07-2.00; P < .001) than the lowest region and the region with the highest 5-day mortality had 1.52 times greater 5-day mortality (95% CI, 1.09-2.11; P = .04) than the lowest region. The geographic variation in mortality did not change over time. In this study, significant geographic variations in process of care and outcomes were found to persist in China; further targeted and region-based approaches to AMI management are warranted.
Highlights
The burden of cardiovascular disease in China has increased during the past 2 decades
There was a significant difference across regions in process of care and the odds ratio (OR) of delivering any 1 of the 6 treatments to an ideal patient was 0.83 for the lowest region compared with the highest region
The region with the highest in-hospital mortality had 1.46 times greater in-hospital mortality than the lowest region and the region with the highest 5-day mortality had 1.52 times greater 5-day mortality than the lowest region
Summary
The burden of cardiovascular disease in China has increased during the past 2 decades. Between 2002 and 2015, mortality of acute myocardial infarction (AMI) increased from 28.5 per 100 000 people to 126.5 per 100 000 people.[1] Timely delivery of evidence-based in-hospital treatments[2,3,4,5,6,7,8] has been considered as essential for positive outcomes after acute cardiac events.[9,10] close monitoring of the quality of care for patients with AMI has become a priority. Providing high-quality care to all individuals in different regions is challenging, especially in a country such as China with varied geographic settings. Economic status and regional practices may impact the treatment patterns and outcomes.[11,12] China developed national programs to support and facilitate the improvement of the quality of care. Understanding regional pattern of care in China may benefit the government’s layout planning and reform
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