Acute Coronary Syndrome In China Research Articles

National survey of doctor-reported secondary preventive treatment for patients with acute coronary syndrome in China

Background Long-term use of antiplatelet agents, statins, beta-blockers and angiotensin-converting enzyme inhibitors are proven therapies for secondary prevention in acute coronary syndrome. However, little is known of physicians’ opinion about their use in China. Methods In 2010, standard questionnaires were posted to chief cardiologists in 1397 geographically diverse and representative sample of tertiary and secondary hospitals in China, collecting information about their opinions on the recommended treatments for acute coronary syndrome. Results A total of 1009 (72%) cardiologists responded with a valid questionnaire. Of them, 77% reported routine use of all the four main secondary preventive treatments, with little difference between secondary and tertiary hospitals (75% vs. 79%, P=0.16). Of the cardiologists reporting routine or selective use of aspirin, beta-blockers, statins and angiotensin-converting enzyme inhibitors, 94%, 85%, 73% and 86% would recommend indefinite use respectively. For all the 4 treatments combined, only 63.5% reported indefinite use at the same time, with no significant difference between secondary and tertiary hospitals (62% vs. 65%, P=0.17), nor between hospitals with or without fast track for primary percutaneous coronary intervention (66% vs. 61%, P=0.50). Conclusions Although Chinese cardiologists seem well informed about the value of main secondary preventive treatments for acute coronary syndrome, there is still gap in their understanding of the need for combined and prolonged use of these treatments.

Doctor-reported hospital management of acute coronary syndrome in China: A nationwide survey of 1029 hospitals in 30 provinces

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.

A Hospital Quality Improvement Initiative for Patients with Acute Coronary Syndromes in China: A Cluster Randomised Controlled Trial

A Hospital Quality Improvement Initiative for Patients with Acute Coronary Syndromes in China: A Cluster Randomised Controlled Trial

Prehospital Delay for Acute Coronary Syndrome in China

Despite the effectiveness of timely reperfusion therapy for acute coronary syndrome, prehospital delay remains a global concern. This article assesses the state-of-the-science regarding prehospital delay for acute coronary syndrome in China. Electronic databases and hand searching were undertaken using key words such as prehospital delay, care-seeking delay, coronary heart disease, heart disease, acute coronary syndrome, unstable angina pain, acute myocardial infarction, cardiovascular disease, chest pain, and Chin (China/Chinese). The Chinese search was supervised by a Chinese health librarian. Based on the search criteria, 28 studies were identified and reviewed using a standardized data extraction tool. Older age, attribution of symptoms to noncardiac causes, lack of health insurance coverage, poor access to transportation, and female sex were identified as contributing to prehospital delay. Health system reforms in China are necessary, particularly with regard to addressing the needs of older people, women, and other vulnerable populations in the context of the rising number of people with coronary heart disease. Developing targeted strategies, learned from both national and international experience, are required to develop targeted interventions.

Clinical Pathways for Acute Coronary Syndromes in China

Clinical pathways have been shown to be effective in improving quality of care for patients admitted to hospital for acute coronary syndromes (ACS) in high-income countries. However, their utility has not formally been evaluated in low- or middle-income countries. The Clinical Pathways for Acute Coronary Syndromes in China program is a 7-year study with the overall goal of reducing evidence-practice gaps in the management of patients admitted to hospitals in China with suspected ACS. The program comprises 2 phases: a prospective survey of current management of ACS patients to identify the areas that evidence-based patient care can be potentially improved, and a quality care initiative to maximize the use of evidence-based investigations and treatments for ACS patients in China. In this article, we outline the details of the study protocol, including key aspects of the development, implementation, and evaluation of the quality improvement initiative (clinical pathway) for management of patients with suspected ACS.

A cross-sectional study on health care for acute coronary syndromes in China

A cross-sectional study on health care for acute coronary syndromes in China

Evidence-based medication use among Chinese patients with acute coronary syndromes at the time of hospital discharge and 1 year after hospitalization: Results from the Clinical Pathways for Acute Coronary Syndromes in China (CPACS) study

Coronary heart disease has emerged as a leading cause of death in China. Although there is strong evidence for the use of antiplatelet, blood pressure-lowering, and lipid-lowering therapy in patients with acute coronary syndromes, the extent to which these medications are used in China remains uncertain. We conducted a multicenter prospective study using data from consecutive patients diagnosed with suspected acute myocardial infarction or unstable angina pectoris admitted to the inpatient wards during the recruitment period. Medication adherence and reasons for nonadherence were reported using standardized questionnaires. Logistic regression was used to identify important patient and hospital characteristics associated with use of medication at 6 and 12 months after hospital discharge. The use of drug therapy was high (above 90% for aspirin, 70% for beta-blockers and angiotensin-converting enzyme inhibitors, 80% for statin) at the time of hospital discharge but decreased during follow-up. However, fewer than half (48%) of patients were discharged on 4-drug combination therapy (antiplatelet, beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin), and the proportion remaining on this treatment 1 year after discharge was even lower (41%). In adjusted logistic regression analyses, medical insurance, dyslipidemia, hypertension, and administration of invasive therapy (percutaneous coronary intervention or coronary artery bypass graft) were important in determining use of treatment at discharge and during follow-up. In a substantial proportion of patients, medication was considered "not indicated" by the treating physician. The findings highlight opportunities to improve the use and maintenance of appropriate combinations of evidence-based treatment among patients with acute coronary syndromes presenting to hospitals in China.

Prospective observational study of acute coronary syndromes in China: practice patterns and outcomes

Objective: To describe the investigation and management of patients admitted to hospitals in China with suspected acute coronary syndromes (ACS) and to identify potential areas for improvement in practice. Design:...

The influencing factors of surviving time of patients with non-ST elevation acute coronary syndromes in China

To identify the influencing factors of surviving time of patients with non-ST elevation acute coronary syndromes in China. The data of patients with non-ST elevation acute coronary syndromes hospitalized in 38 hospitals in China, including clinical characteristics, therapeutic procedure, and major events at hospitalization and two years' follow-up period, were collected and analyzed as part of an international multicentre registry--OASIS. No particular intervention was needed in patients' therapy. The needed data were recorded by filling in the Case Report Forms offered by Canadian Cardiovascular Collaboration according to the protocol. Cox regression model was used to analyze the association with survival and multiple factors recorded. From April 1999 to December 2001, 2294 patients with non-ST elevation acute coronary syndromes were enrolled in 38 Chinese hospitals nationwide, two years' follow-up had been finished among 2188 of which with a mean age of 62.8 +/- 8.3 and 62.3% being male. The clinical diagnosis at admission was unstable angina in 88.5% of the patients and was non Q-wave myocardial infarction in the remaining 11.5%. The number of death totaled up to 174 with a mortality of 7.6% by the end of the two years' follow-up. The most common cause of death was severe arrhythmia or sudden death (92 cases, 52.9%). More than 70 factors had been analyzed by Cox regression model in order to determine which might influence survival. Risk factors that reduced lifetime were: frequencies of myocardial infarction during follow-up period, stroke during hospitalization, thrombolysis during hospitalization, frequencies of heart failure during follow-up period, heart failure during hospitalization, frequencies of stroke during follow-up period, history of myocardial infarction, times of hospitalization because of non-cardiovascular disease during follow-up period, history of diabetes mellitus, duration of the first hospitalization, and age by the first hospitalization. Protective factors that prolonged lifetime were the frequencies of using oral anticoagulant, anti-platelet medicine, nitrate, and lipid lowering agents during follow-up period. The most common cause of death in patients with non-ST elevation acute coronary syndromes is severe arrhythmias or sudden death in China. Several factors influence the survival of patients. The effects of most factors in this study are similar to those founded by previous evidence based medical study.