Performance of hospitals according to the ESC ACCA quality indicators and 30-day mortality for acute myocardial infarction: national cohort study using the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) register

Abstract

AimsTo investigate the application of the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QI) for acute myocardial infarction for the study of hospital performance and 30-day mortality.Methods and resultsNational cohort study (n = 118,075 patients, n = 211 hospitals, MINAP registry), 2012-13. Overall, 16 of the 20 QIs could be calculated. Eleven QIs had a significant inverse association with GRACE risk adjusted 30-day mortality (all P < 0.005). The association with the greatest magnitude was high attainment of the composite opportunity-based QI (80-100%) vs. zero attainment (odds ratio 0.04, 95% confidence interval 0.04-0.05, P < 0.001), increasing attainment from low (0.42, 0.37- 0.49, P < 0.001) to intermediate (0.15, 0.13-0.16, P < 0.001) was significantly associated with a reduced risk of 30-day mortality. A 1% increase in attainment of this QI was associated with a 3% reduction in 30-day mortality (0.97, 0.97-0.97, P < 0.001). The QI with the widest hospital variation was ′fondaparinux received among NSTEMI′ (interquartile range 84.7%) and least variation ′centre organisation′ (0.0%), with seven QIs depicting minimal variation (<11%). GRACE risk score adjusted 30-day mortality varied by hospital (median 6.7%, interquartile range 5.4-7.9%).ConclusionsEleven QIs were significantly inversely associated with 30-day mortality. Increasing patient attainment of the composite quality indicator was the most powerful predictor; a 1% increase in attainment represented a 3% decrease in 30-day standardised mortality. The ESC QIs for acute myocardial infarction are applicable in a large health system and have the potential to improve care and reduce unwarranted variation in death from acute myocardial infarction.

Invasive and antiplatelet treatment of patients with non‐ST‐segment elevation myocardial infarction: Understanding and addressing the global risk‐treatment paradox

“…We recommend consulting the quality indicators recommended by Schiele et al, which are included in Table . In a national cohort study using the MINAP registry, Bebb et al assessed the performance of hospitals according to the European Society of Cardiology Acute Cardiovascular Care Association quality indicators and 30‐day mortality for acute MI. Eleven quality indicators had a significant inverse association with 30‐day mortality (all P < .001), suggesting that quality indicators have the potential to improve patient healthcare and reduce varied mortality from acute MI (Figure ).…”

“…Association between the European Society of Cardiology Acute Cardiovascular Care Association quality indicators for acute myocardial infarction and crude 30‐day mortality. Adapted from Bebb et al The composite opportunity QI was divided into the following categories: zero, received no interventions out of those eligible for; low, received <40% of interventions eligible for; intermediate, received ≥40% to <80% of interventions eligible for; and high, received ≥80% of interventions eligible for. Abbreviations: ACEI; angiotensin‐converting enzyme inhibitor; ARB; angiotensin receptor blocker; BB, β‐blocker; CI, confidence interval; DAPT, dual antiplatelet therapy; EF, ejection fraction; HF, heart failure; LV, left ventricular; NSTEMI, non‐ST‐segment elevation myocardial infarction; PCI, percutaneous coronary intervention; QI, quality indicator; STEMI, ST‐segment elevation myocardial infarction…”

Assessment of quality performance measures in patients with acute coronary syndromes: Data from the Portuguese Registry of Acute Coronary Syndromes (ProACS), a nationwide registry

“…However, most registries do not have more recent data for data comparison. A recent publication with data from The Myocardial Ischaemia National Audit Project showed that, in our registry, we have similar rates of timely reperfusion in STEMI, particularly in primary PCI centres (a little longer in nonprimary PCI hospitals) and more NSTACS patients submitted to coronary angiography in the first 72 hours . Left ventricular function is more often assessed.…”

“…A recent publication with data from The Myocardial Ischaemia National Audit Project showed that, in our registry, we have similar rates of timely reperfusion in STEMI, particularly in primary PCI centres (a little longer in nonprimary PCI hospitals) and more NSTACS patients submitted to coronary angiography in the first 72 hours. 23 Left ventricular function is more often assessed. In our registry, the use of DAPT and statins is similar and a better rate of use of ACEI/ARB and beta blocker in patients with heart failure of left ventricular dysfunction.…”

International comparison of acute myocardial infarction care and outcomes using quality indicators

“…Patients achieved the composite score whether the received all of the care interventions they were eligible for. The opportunity composite score originally consisted of 12 measures; however, MINAP data only allows assessment of nine measures combined using an equal weight method 9. QI inclusion and qualification is shown in the online supplementary table S2.…”