Performance on management strategies with Class I Recommendation and A Level of Evidence among hospitalized patients with non–ST-segment elevation acute coronary syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC-ACS) project

Yang, Na; Liu, Jing; Liu, Jun; Hao, Yongchen; Huo, Yong; Smith, Sidney C.; Ge, Junbo; Ma, Changsheng; Han, Yaling; Fonarow, Gregg C.; Taubert, Kathryn A.; Morgan, Louise; Zhou, Ming-Sheng; Xing, Yueyan; Zhao, Dong; Investigators, Ccc‐Acs

doi:10.1016/j.ahj.2019.02.012

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…Quality metrics are utilised in quality improvement initiatives of various countries to continuously monitor and enhance the quality of care provided to patients undergoing PCI. 32 Inohara et al. previously reported that the performance rates for DTB time ≤90 min in patients with STEMI and the use of preprocedural noninvasive stress testing in Japan were lower than those in the Unites States, whereas the use of TRA was substantially higher, 2 and these trends were consistent with previous studies.…”

Section: Discussionsupporting

confidence: 78%

Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan

Shoji

Yamaji

Sandhu

et al. 2022

The Lancet Regional Health - Western Pacific

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Section: Discussionsupporting

confidence: 78%

Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan

Shoji

Yamaji

Sandhu

et al. 2022

The Lancet Regional Health - Western Pacific

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“…29 The CCC-ACS project found that the statin prescription rate of patients with non-ST-segment elevation ACS before discharge was 93%. 30 One previous study in 14 large comprehensive hospitals in Beijing shows that 96.3% of patients diagnosed with acute myocardial infarction were prescribed statin 22 and 80.5% of the patients discharged alive from 53 hospitals across China were prescribed statins. 31 These studies show that for the same group of patients with the same disease, statin treatment rates may vary greatly due to different research designs and procedures.…”

Section: Discussionmentioning

confidence: 99%

Lipid-Lowering Therapy and Low-Density Lipoprotein Cholesterol (LDL-C) Goal Achievement in High-Cardiovascular-Risk Patients in Fuzhou, China

Wang

et al. 2020

J Cardiovasc Pharmacol Ther

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Purpose: This study aims to analyze the treatment patterns and goal attainment of low-density lipoprotein cholesterol (LDL-C) among patients with atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus (DM) in the real-world setting in Fuzhou, China. Methods: Patients aged ≥20 years with a valid LDL-C measurement (index date) in 2016 were selected from National Healthcare Big Data in Fuzhou, China. Patients were stratified into mutually exclusive cardiovascular risk categories: ASCVD (including recent acute coronary syndrome [ACS], chronic coronary heart disease [CHD], stroke, and peripheral arterial disease [PAD]), and DM alone (without ASCVD). Lipid-modifying medication and LDL-C attainment at the index date were assessed. Results: A total of 21 989 patients met the inclusion criteria, including 17 320 (78.8%) with ASCVD and 4669 (21.2%) with DM alone; 47.7% of patients received current statin therapy in the overall cohort (53.5% in ASCVD, 26.5% for DM); 20.5% ASCVD population achieved LDL-C target with the highest in patients with recent ACS (33.8%), followed by chronic CHD (21.2%), PAD (20.9%), and ischemic stroke (17.3%); 49.0% of patients with DM achieved LDL-C target. Higher LDL-C attainment was observed in high-intensity statin and a combination of statin and nonstatin groups. Atorvastatin was the most commonly used statin with the highest LDL-C attainment, followed by rosuvastatin. Conclusion: Compared with previous studies in China, our study found a relatively low statin use and LDL-C target attainment, but higher than similar studies in Europe. Guidelines should be well complied and more prescription of high-intensity statin or statin and nonstatin combination should be advocated.

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“…The role of implementation science is to provide the mechanism by which interventions affect outcomes via formative evaluations [ 23 ]. To the best of our knowledge, most evaluation studies of quality improvement programs have focused on endpoint health outcomes [ 24 – 26 ], with little research into influencing factors within the implementation process, particularly in China, which has one of the highest IHD disease burden in the world and various healthcare reforms aimed at improving care quality [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research

Zhou

Dong

et al. 2022

Implementation Sci

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Background Ischemic heart disease causes a high disease burden globally and numerous challenges in treatment, particularly in developing countries such as China. The National Chest Pain Centers Program (NCPCP) was launched in China as the first nationwide, hospital-based, comprehensive, continuous quality improvement (QI) program to improve early diagnosis and standardized treatment of acute coronary syndromes (ACS) and improve patients’ clinical outcomes. With implementation and scaling up of the NCPCP, we investigated barriers and enablers in the NCPCP implementation process and provided examples and ideas for overcoming such barriers. Methods We conducted a nationally representative survey in six cities in China. A total of 165 key informant interviewees, including directors and coordinators of chest pain centers (CPCs) in 90 hospitals, participated in semi-structured interviews. The interviews were transcribed verbatim, translated into English, and analyzed in NVivo 12.0. We used the Consolidated Framework for Implementation Research (CFIR) to guide the codes and themes. Results Barriers to NCPCP implementation mainly arose from nine CFIR constructs. Barriers included the complexity of the intervention (complexity), low flexibility of requirements (adaptability), a lack of recognition of chest pain in patients with ACS (patient needs and resources), relatively low government support (external policies and incentives), staff mobility in the emergency department and other related departments (structural characteristics), resistance from related departments (networks and communications), overwhelming tasks for CPC coordinators (compatibility), lack of available resources for regular CPC operations (available resources), and fidelity to and sustainability of intervention implementation (executing). Enablers of intervention implementation were inner motivation for change (intervention sources), evidence strength and quality of intervention, relatively low cost (cost), individual knowledge and beliefs regarding the intervention, pressure from other hospitals (peer pressure), incentives and rewards of the intervention, and involvement of hospital leaders (leadership engagement, engaging). Conclusion Simplifying the intervention to adapt routine tasks for medical staff and optimizing operational mechanisms between the prehospital emergency system and in-hospital treatment system with government support, as well as enhancing emergency awareness among patients with chest pain are critically important to NCPCP implementation. Clarifying and addressing these barriers is key to designing a sustainable QI program for acute cardiovascular diseases in China and similar contexts across developing countries worldwide. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR 2100043319), registered 10 February 2021.

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Performance on management strategies with Class I Recommendation and A Level of Evidence among hospitalized patients with non–ST-segment elevation acute coronary syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC-ACS) project

Cited by 10 publications

References 23 publications

Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan

Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan

Lipid-Lowering Therapy and Low-Density Lipoprotein Cholesterol (LDL-C) Goal Achievement in High-Cardiovascular-Risk Patients in Fuzhou, China

Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research

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