Abstract
Background
Quality indicators in coronary heart disease (CHD) measure the practice gap between
optimal care and current clinical practice. However, the potential impact of achieving
quality indicator benchmarks remains unknown.
Methods
Using a validated, epidemiologic model of CHD in Ontario, Canada, we estimated the
potential impact on mortality of improved utilization on CHD quality indicators from
2005 levels to recommend benchmark utilization of 90%. Eight CHD disease subgroups
were evaluated, including inpatients with acute myocardial infarction (AMI), acute
coronary syndromes, and heart failure, in addition to ambulatory patients who were
post-acute myocardial infarction survivors, or had heart failure, chronic stable angina,
hypertension, or hyperlipidemia. The primary outcome was the predicted mortality reduction
associated with meeting quality indicator targets for each CHD subgroup-treatment
combination.
Results
In 2005, there were 10,060 CHD deaths in Ontario, representing an age-adjusted CHD
mortality of 191 per 100,000 people. By meeting quality indicator utilization benchmarks,
mortality could be potentially reduced by approximately 20% (95% confidence interval
17.8-21.1), representing approximately 1960 avoidable deaths. The bulk of this potential
benefit was in ambulatory patients with chronic stable angina (36% of reduction) and
heart failure (31% of reduction). The biggest drivers were optimizing angiotensin-converting
enzyme inhibitor use in chronic stable angina patients (approximately 440 avoidable
deaths) and β-blocker use in heart failure (approximately 400 avoidable deaths).
Conclusions
These findings reinforce the importance of quality indicators and could aid policy
makers in prioritizing strategies to meet the goals outlined in the Canadian Heart
Health Strategy and Action Plan for reducing cardiovascular mortality.
Résumé
Introduction
Les indicateurs de qualité dans la maladie coronarienne (MC) mesurent l'écart entre
les soins optimaux et la pratique clinique actuelle. Cependant, les conséquences potentielles
d'atteindre les indicateurs de qualité restent inconnues.
Méthodes
En utilisant un modèle épidémiologique validé de MC en Ontario, au Canada, nous avons
estimé les conséquences potentielles sur la mortalité de l'utilisation améliorée d'indicateurs
de qualité sur la MC à partir des niveaux de 2005 pour recommander l'utilisation de
repères de 90 %. Huit (8) sous-groupes de patients ayant une MC ont été évalués, incluant
les patients hospitalisés présentant un infarctus aigu du myocarde (AM), un syndrome
coronarien aigu et une insuffisance cardiaque, en plus des patients ambulatoires ayant
survécu à un infarctus du myocarde aigu, ou ayant une insuffisance cardiaque, une
angine chronique stable, de l'hypertension ou une hyperlipidémie. Le résultat principal
a été la réduction prévue de mortalité associée à l'atteinte des cibles d'indicateurs
de qualité pour chacune des combinaisons de traitement des sous-groupes présentant
une MC.
Résultats
En 2005, il y a eu 10 060 décès liés à la MC en Ontario, ce qui représente une mortalité
liée à la MC ajustée selon l'âge de 191 personnes sur 100 000. Par l'atteinte de repères
d'utilisation des indicateurs de qualité, la mortalité pourrait être réduite d'approximativement
20 % (intervalle de confiance de 95 %, 17,8-21,1), ce qui représente environ 1 960
décès évitables. L'avantage potentiel a surtout été chez les patients ambulatoires
présentant une angine chronique stable (36 % de réduction) et une insuffisance cardiaque
(31 % de réduction). Les principaux moteurs ont été l'optimisation de l'utilisation
de l'inhibiteur de l'enzyme de conversion de l'angiotensine chez les patients ayant
une angine chronique stable (environ 440 décès évitables) et l'utilisation de β-bloquants
pour les cas d’insuffisance cardiaque (environ 400 décès évitables).
Conclusions
Ces découvertes renforcent l'importance des indicateurs de qualité et pourraient aider
les responsables dans la priorisation de stratégies pour atteindre les objectifs définis
dans la Stratégie canadienne de santé cardiovasculaire et Plan d'action pour la réduction
de la mortalité cardiovasculaire.
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Article info
Publication history
Published online: September 15, 2011
Accepted:
June 13,
2011
Received:
June 6,
2011
Footnotes
See page 761 for disclosure information.
Identification
Copyright
© 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
