Clinical Performance and Quality Measures for Adults With Acute ST-Elevation Myocardial Infarction in China

Study Overview
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Brief Summary
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This study aims to investigate and evaluate clinical performance and quality measures for adults with acute ST-elevation myocardial infarction (STEMI) in China. Further more, the investigates like to develop quality improvement strategies and relevant tools focusing on treatment and clinical outcome in patients with STEMI. This is a annually survey , through consecutively recruiting all eligible inpatients and collecting relevant medical information, the performance of all participating hospitals. Further, quality improvement strategies including summary of clinical performance and quality measures, clinical pathways and team building will be organized for the purpose of quality improvement. All hospitals will consecutively recruit qualified patients in the same method adopted in baseline period. Then the reperfusion rates and other performance measures will be compared annually.

Detailed Description
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Cardiovascular disease (CVD) is a major concern in public health globally, as well as in China, and remarkable variations of resources available and health system performance have been noted. Acute myocardial infarction is one of the leading causes of mortality and morbidity, both in rural and urban area. This study aims to investigate and evaluate clinical performance and quality measures for adults with acute ST-elevation myocardial infarction (STEMI) in China. Further more, the investigates like to develop quality improvement strategies and relevant tools focusing on treatment and clinical outcome in patients with STEMI. This is a annually survey , through consecutively recruiting all eligible inpatients and collecting relevant medical information, the performance of all participating hospitals. Demographic characteristics, clinical features, diagnostic tests, medications, procedures, and in-hospital outcomes of patients will be obtained and then, the treatment pattern and outcomes will be evaluated. Further, quality improvement strategies including summary of clinical performance and quality measures, clinical pathways and professional training will be organized for the purpose of quality improvement. All hospitals will consecutively recruit qualified patients in the same method adopted in baseline period. Then the reperfusion rates and other performance measures will be compared annually. New knowledge will be generated about STEMI management in China, to improve STEMI patients prognosis in future.

Official Title
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Clinical Performance and Quality Measures for Adults With Acute ST-Elevation Myocardial Infarction in China

Conditions
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ST Elevation Myocardial Infarction

Intervention / Treatment
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* Behavioral: Quality improvement strategies and tools


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with STEMI who arrive at the hospital within 48 hours from the symptoms onset. Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| All hospitals<br>All hospitals will take the treatment quality improvement strategies and tools into implementation. Intervention: Behavioral: Quality improvement strategies and tools | Behavioral: Quality improvement strategies and tools<br>* Quality improvement strategies and tools<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Aspirin at arrival | Proportion of aspirin use within 24 hours of admission among eligible patients | 24 hours after admission | 
| Clopidogrel (or ticagrelor) at arrival | Proportion of Clopidogrel (or ticagrelor) use within 24 hours of admission among eligible patients | 24 hours after admission | 
| β-blockers at arrival | Proportion of β-blockers use within 24 hours of admission among eligible patients | 24 hours after admission | 
| ECG at arrival | Proportion of ECG test within 10 minutes of admission among eligible patients | 24 hours after admission | 
| Reperfusion therapy rate | Reperfusion therapy rate is defined as utilization rate of thrombolytic therapy or primary PCI treatment among patients indicated with the reperfusion therapy. | 24 hours after admission | 
| Time delay from failure of fibrinolysis to angiography(The time from start of fibrinolysis to evaluation of its efficacy is 60-90min) | The proportion of failure of fibrinolysis to balloon within 90 minutes among all patients receiving PCI. | 10 days on average (during hospitalization) | 
| Time delay from start of fibrinolysis to angiography(if fibrinolysis is successful) | The proportion of from fibrinolysis to balloon (if fibrinolysis is successful) within 2-24hours among all patients receiving PCI. | 10 days on average (during hospitalization) | 
| Timeliness of thrombolytic therapy | The proportion of door to needle time (D2N) within 30 minutes among all patients receiving fibrinolytic therapy. | 24 hours after admission | 
| Timeliness of primary PCI | The proportion of door to balloon (D2B) within 90 minutes among all patients receiving primary PCI. | 24 hours after admission | 
| Door-in-Door-Out Time | Percentage of patients whose median time from the emergency department arrival at STEMI referral facility to emergency department discharge from STEMI referral facility is equal or less than 30 min. discharge from STEMI referral facility is 30 min. | 24 hours after admission | 
| Time to Primary PCI Among Transferred Patients | Percentage of patients whose median time from first medical contact (at or before emergency department arrival to the STEMI referral facility [e.g., non-PCI-capable facility]) to primary PCI at the STEMI receiving facility (PCI-capable facility) is equal or less than 120 min | 24 hours after admission | 
| Evaluation of LDL-C | Percentage of patients with documentation in the hospital record that LDL-C is evaluated during hospitalization | 10 days on average (during hospitalization) | 
| Evaluation of left ventricular ejection fraction | Percentage of patients with documentation in the hospital record that left ventricular ejection fraction is evaluated during hospitalization | 10 days on average (during hospitalization) | 
| Aspirin use during hospitalization | Proportion of Aspirin use during hospitalization among eligible patients. | 10 days on average (during hospitalization) | 
| Clopidogrel (or ticagrelor) use during hospitalization | Proportion of Clopidogrel (or ticagrelor) use during hospitalization among eligible patients. | 10 days on average (during hospitalization) | 
| β-blockers use during hospitalization | Proportion of β-blockers use during hospitalization among eligible patients. | 10 days on average (during hospitalization) | 
| Angiotensin-converting enzyme inhibitor /angiotensin II receptor blocker use during hospitalization | Proportion of Angiotensin-converting enzyme inhibitor /angiotensin II receptor blocker use during hospitalization among eligible patients. | 10 days on average (during hospitalization) | 
| Statins use during hospitalization | Proportion of statins use during hospitalization among eligible patients. | 10 days on average (during hospitalization) | 
| Aspirin use at discharge | Proportion of aspirin use at discharge among eligible patients. | 10 days on average (during hospitalization) | 
| Clopidogrel (or ticagrelor) use at discharge | Proportion of Clopidogrel (or ticagrelor) use at discharge among eligible patients. | 10 days on average (during hospitalization) | 
| β-blockers use at discharge | Proportion of β-blockers use at discharge among eligible patients. | 10 days on average (during hospitalization) | 
| angiotensin-converting enzyme inhibitor /angiotensin II receptor blocker use at discharge | Proportion of angiotensin-converting enzyme inhibitor /angiotensin II receptor blocker use at discharge among eligible patients. | 10 days on average (during hospitalization) | 
| Statins use at discharge | Proportion of statins use at discharge among eligible patients. | 10 days on average (during hospitalization) | 
| Aldosterone Antagonist at Discharge | Proportion of Aldosterone Antagonist use at discharge among eligible patients. | 10 days on average (during hospitalization) | 
| Smoking cessation advice/ counseling at Discharge | Proportion of patients received smoking cessation advice/ counseling | 10 days on average (during hospitalization) | 
| all-cause mortality during hospitalization | Proportion of patients who were all-cause death during hospitalization | 10 days on average (during hospitalization) | 
| Cardiac mortality during hospitalization | Proportion of patients who were cardiac death during hospitalization | 10 days on average (during hospitalization) | 
| 30-day all-cause mortality | Proportion of patients who were all-cause death from admission to 30days | From admission to 30days | 
| 30-day cardiac mortality | Proportion of patients who were cardiac death from admission to 30days | From admission to 30days | 
| 30-day readmission rates | Proportion of patients readmission from hospital discharge to 30days | From hospital discharge to 30 days | 
| Cost during hospitalization | Cost during hospitalization | 10 days on average (during hospitalization) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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clinical performance, quality measures, ST-Elevation myocardial infarction