Abstract
Background
This study aimed to clarify the variations in the quality of care provided to patients
with acute coronary syndrome (ACS) and to investigate the association between quality
of care and mortality at both hospital and patient levels with the use of a nationwide
database.
Methods
Patients with ACS who underwent percutaneous coronary intervention (PCI) from April
2014 to March 2018 were included from the National Database of Health Insurance Claims
and Specific Health Checkups of Japan. Twelve quality indicators (QIs) available from
administrative data and the association of the QIs with all-cause mortality were investigated.
Results
From the analysis of 216,436 patients from 1215 hospitals, adherence to PCI on admission
day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment
were high (median proportion > 90%), and adherence to outpatient cardiac rehabilitation
was low (median proportion < 10%). At the hospital level, acute-phase composite QI
score was associated with reduced risk-adjusted 30-day mortality (β = −0.92 [95% confidence
interval −1.19 to −0.65]; P < 0.001). At the patient level, all acute-phase and subacute-phase QIs were inversely
associated with 30-day and 2-year mortalities, respectively (all P < 0.001).
Conclusions
Substantial variations in ACS care were observed in the current nationwide database.
High adherence to the QI sets was associated with significant survival gains at both
hospital and patient levels. Multilevel approach in QI assessment may be effective
for improvement of survival in this population.
Résumé
Contexte
L’étude présentée ici visait à mieux comprendre les variations dans la qualité des
soins prodigués aux patients atteints d’un syndrome coronarien aigu (SCA) et à examiner,
à l’aide d’une base de données nationale, l’association entre la qualité des soins
et la mortalité à l’échelle des hôpitaux et des patients.
Méthodologie
Ont été inclus dans l’étude les patients atteints d’un SCA qui ont subi une intervention
coronarienne percutanée (ICP) entre avril 2014 et mars 2018, selon la base de données
japonaise sur les demandes de remboursement d’assurance maladie et des bilans de santé
particuliers. Douze indicateurs de la qualité (IQ) tirés des données administratives
de même que l’association entre ces IQ et la mortalité toutes causes confondues ont
fait l’objet d’un examen.
Résultats
L’analyse des données de 216 436 patients traités dans 1215 hôpitaux a révélé que
la réalisation d’une ICP le jour de l’admission, l’administration d’aspirine à l’arrivée,
l’emploi d’un inhibiteur du récepteur P2Y12 et l’évaluation de la fonction ventriculaire
gauche étaient des mesures fréquentes (proportion médiane > 90 %), tandis que le recours
à la réadaptation cardiaque en consultation externe était rare (proportion médiane
< 10 %). En ce qui concerne les hôpitaux, l’indice composite pour les IQ relatifs
aux soins de phase aiguë a été associé à une réduction de la mortalité à 30 jours
ajustée en fonction du risque (β = −0,92 [intervalle de confiance à 95 % : −1,19 à −0,65];
p < 0,001). Chez les patients, tous les IQ relatifs aux soins de phase aiguë ou subaiguë
étaient inversement associés à la mortalité à 30 jours et à 2 ans (p < 0,001 dans les deux cas).
Conclusions
L’analyse des renseignements tirés d’une base de données nationale à jour révèle des
variations importantes dans les soins prodigués aux patients atteints d’un SCA. Une
forte observance des mesures correspondant aux ensembles d’IQ était associée à des
gains importants sur le plan de la survie, tant à l’échelle des hôpitaux que des patients.
Une approche multiniveau de l’évaluation des IQ pourrait donc permettre d’améliorer
la survie dans cette population de patients.
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Article info
Publication history
Published online: December 07, 2022
Accepted:
December 1,
2022
Received:
August 2,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
See editorial by Vervoort et al., pages xxx-xxx of this issue.
See page 8 for disclosure information.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
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