Assessment of Hospital Performance Using Quality of Care Indicators in Patients with Acute Coronary Syndrome

Beshoy Sedra; Mohamed Fakher; Sherif Sabri; Ahmed Elsherif; Lamiaa Abu Kamer

doi:10.3889/oamjms.2022.8594

Authors

Beshoy Sedra Department of Critical Care Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0003-1455-9721
Mohamed Fakher Department of Critical Care Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0003-1455-9721
Sherif Sabri Department of Critical Care Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0003-1455-9721
Ahmed Elsherif Department of Critical Care Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0003-1455-9721
Lamiaa Abu Kamer Department of Critical Care Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0003-1455-9721

DOI:

https://doi.org/10.3889/oamjms.2022.8594

Keywords:

Acute coronary syndrome, Care, Quality, Indicator

Abstract

BACKGROUND: Global researchers have found a wide practice gap between the optimal care and actual care of patients with acute coronary syndrome (ACS).

AIM: The main objective of the present study was to evaluate the quality of care provided to patients with ACS and compare our results to that of other similar studies and international standards.

METHODS: A descriptive study was conducted using review of medical records and medical charts of new patients admitted and treated as ACS at the Department of Critical Care Medicine, Cairo University, from January 1, 2015, to December 31, 2020. For the purpose of the analysis, a set of highly predictive quality indicators was used.

RESULTS: 967 patients were divided into two groups: 621 patients with acute ST-segment elevation myocardial infarction (STEMI) (mean age: 58.49 ± 11.45 years, 81.8% of males) and 34.9% presented to hospital in <4 h of symptom onset. Primary percutaneous coronary interventions (PCIs) were applied on 71.3% of cases (N = 443) and the mean “door-to-balloon” time was 78.8 min. In the first 24 h, acetylsalicylic acid (ASA), β-blockers, and angiotensin-converting enzyme inhibitors (ACE-I) or AR-blockers were administered in 100%, 65.9%, and 73.4% of the total eligible cases, respectively. At discharge, ASA, β-blockers, ACE-I/ARBs, and statins were prescribed in 90.8%, 78.3%, 82.8%, and 90.8%, respectively. 346 patients were with UA/NSTEMI (mean age 63±25.7 years, 69.4% male), while 21.7% of patients were presented to hospital after less than 4 hours of symptoms onset. Early PCIs were applied on 28.1% of cases (N = 97). In the first 24 h, ASA, β-blockers, and ACE-I or AR-blockers were administered in 100%, 78.3%, and 78.6% of the total eligible cases, respectively. At discharge, ASA, β-blockers, ACE-I/ARBs, and statins were prescribed in 93.4%, 83.2%, 81.2%, and 92.8%, respectively. In this study, a relation between different quality indicators with inhospital major adverse cardiac event and outcome was observed.

CONCLUSION: There is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. We found some disparities between guidelines and clinical practice for ACS patients and a significant association between process indicators and inhospital outcomes. Our findings are potentially helpful for assessing and improving the quality of care for ACS patients in Egypt.

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References

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics 2014 update: A report from the American Heart Association. Circulation. 2014;129(3):e28-92. PMid:24352519

Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, Vasileva EY. Task force for the universal definition of myocardial infarction. third universal definition of myocardial infarction. Nat Rev Cardiol. 2012;9(11):620-33. https://doi.org/10.1038/nrcardio.2012.122 PMid:22922597 DOI: https://doi.org/10.1038/nrcardio.2012.122

Fox KA, Steg PG, Eagle KA, Goodman SG, Anderson FA, Granger CB, et al. Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006. JAMA. 2007;297(17):1892-900. https://doi.org/10.1001/jama.297.17.1892 PMid:17473299 DOI: https://doi.org/10.1001/jama.297.17.1892

Fox KA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, et al. Management of acute coronary syndromes. Variations in practice and outcome. Findings from the global registry of acute coronary events (GRACE). Eur Heart J. 2002;23(15):1177-89. https://doi.org/10.1053/euhj.2001.3081 PMid:12127920 DOI: https://doi.org/10.1053/euhj.2001.3081

Spertus JA, Eagle KA, Krumholz HM, Mitchell KR, Normand SL. American College of Cardiology and American Heart Association methodology for the selection and creation of performance measures for quantifying the quality of cardiovascular care. Circulation. 2005;111(13):1703-12. https://doi.org/10.1161/01.cir.0000157096.95223.d7 PMid:15811870 DOI: https://doi.org/10.1161/01.CIR.0000157096.95223.D7

Tu JV, Khalid L, Donovan LR, Ko DT. Indicators of quality of care for patients with acute myocardial infarction. CMAJ. 2008;179(9):909-15. https://doi.org/10.1503/cmaj.080749 PMid:18936456 DOI: https://doi.org/10.1503/cmaj.080749

Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282(15):1458-65. https://doi.org/10.1001/jama.282.15.1458 PMid:10535437 DOI: https://doi.org/10.1001/jama.282.15.1458

Panel AM, Cox J, Holder D, Tanser P, Thompson C, Mrcpuk ET, et al. CCORT/CCS quality indicators for acute myocardial infarction care. Can J Cardiol 2003;19:38-45. https://doi.org/10.1148/cases.20214145 DOI: https://doi.org/10.1148/cases.20214145

Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). J Am Coll Cardiol. 2004;44(3):E1-211. https://doi.org/10.1161/01.cir.0000134791.68010.fa DOI: https://doi.org/10.1161/01.CIR.0000134791.68010.FA

Gibler WB, Cannon CP, Blomkalns AL, Char DM, Drew BJ, Hollander JE, et al. Practical implementation of the guidelines for unstable angina/non ST-segment elevation myocardial infarction in the emergency department: A scientific statement from the American Heart Association Council on Clinical Cardiology (subcommittee on acute cardiac care), Council on Cardiovascular Nursing, and Quality of Care and Outcomes Research Interdisciplinary Working Group, in collaboration with the Society of Chest Pain Centers. Circulation. 2005;111(20):2699-710. https://doi.org/10.1161/01.cir.0000165556.44271.be PMid:15911720 DOI: https://doi.org/10.1161/01.CIR.0000165556.44271.BE

Jha AK, Li Z, Orav EJ, Epstein AM. Care in US hospitals the hospital quality alliance program. N Engl J Med. 2005;353(3):265- 74. https://doi.org/10.1056/nejmsa051249 PMid:16034012 DOI: https://doi.org/10.1056/NEJMsa051249

Mohamed MA. Predictors and Impact of No Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction [MD Thesis]. Giza, Egypt: Cairo University; 2014. https://doi.org/10.11648/j.ccr.20190302.11 DOI: https://doi.org/10.11648/j.ccr.20190302.11

Ibrahim A. Short Term Outcome of Primary Percutaneous Coronary Interventions; Ten Year Registry. Cairo: Cairo University; 2009.

Ganova-Iolovska M, Kalinov K, Geraedts M. Quality of care of patients with acute myocardial infarction in Bulgaria: A cross-sectional study. BMC Health Serv Res. 2009;9(1):1. https://doi.org/10.1186/1472-6963-9-15 DOI: https://doi.org/10.1186/1472-6963-9-15

Wang Y, Fu R, Wang Z, Bao H, Chen Y, Yang F, et al. Assessing the quality of care for patients with acute myocardial infarction in China. Clin Cardiol. 2015;38(6):327-32. https://doi.org/10.1002/clc.22405 PMid:26074496 DOI: https://doi.org/10.1002/clc.22405

Flotta D, Rizza P, Coscarelli P, Pileggi C, Nobile CG, Pavia M. Appraising hospital performance by using the JCHAO/CMS quality measures in Southern Italy. PLoS One. 2012;7(11):e48923. https://doi.org/10.1371/journal.pone.0048923 PMid:23145023 DOI: https://doi.org/10.1371/journal.pone.0048923

Jencks SF, Cuerdon T, Burwen DR, Fleming B, Houck PM, Kussmaul AE, et al. Quality of medical care delivered to Medicare beneficiaries: A profile at state and national levels. JAMA. 2000;284(13):1670-6. https://doi.org/10.1001/jama.284.13.1670 PMid:11015797 DOI: https://doi.org/10.1001/jama.284.13.1670

Hassan AM. Prevalence of Metabolic syndroMe in Patients with Acute Myocardial Infarction in Correlation to Myocardial Infarction Compications [Master Thesis]. Cairo: Cairo University; 2013.

Tang EW, Wong CK, Herbison P. Global Registry of Acute Coronary Events (GRACE) hospital discharge risk score accurately predicts long-term mortality post-acute coronary syndrome. Am Heart J. 2007;153(1):29-35. https://doi.org/10.1016/j.ahj.2006.10.004 PMid:17174633 DOI: https://doi.org/10.1016/j.ahj.2006.10.004

Tawfik H. Registry of Acute Coronary Syndrome Patients Admitted to Critical Care Center, Cairo University [Master Thesis]. Cairo: Cairo University; 2014.