Clinical characteristics and improvement of the guideline-based management of acute myocardial infarction in China: a national retrospective analysis.
OBJECTIVE
This study is to document the clinical characteristics and improvement in management of acute myocardial infarction (AMI) in Chinese population.


RESULTS
This study included 64,654 patients (23,805 patients in 2011, 40,849 patients in 2013), of which STEMI and NSTEMI account for 85.09% and 14.91%, respectively. From 2011 to 2013, significant improvement has been achieved in the recanalization rate of PCI (96.01% vs. 98.63%, P < 0.001) and in-hospital deaths (4.52% vs. 3.55%, P = 0.038). Although the time of door-to-balloon and the duration of PCI were satisfactorily controlled within 90min and 60min, respectively, the onset-to-FMC time (≈3.5h) and door-to-thrombolysis time (≈1.1h) limited the efficiency of management. The total cost of medical care showed no increase from 2011 to 2013, but the patient's paid Portion decreased from 20.33% to 13.96%.


METHODS
The AMI patients admitted in the general hospitals in 2011 and 2013 were retrospectively analyzed according to the data reported to the Single Disease Quality Control Information Systemissued by Chinese Hospital Association.


CONCLUSIONS
Compared to the Western countries, STEMI accounted for a larger portion of AMI, and the AMI management in China basically meets the standards of the quality control of guidelines. With improvement of management, there was no increase in the total medical cost, while the patient's paid portion was actually reduced. In future, improvement of transportation strategy and the public medical education are recommended to shorten the onset-to-FMC time to further improve the outcome of AMI patients.
Department of Cardiology, Zhongnan Hospital of Wuhan University & the Medical Research Institute of Wuhan University, Wuhan University, Wuhan, China.
Lechen
L
Wang
Department of Cardiology, Zhongnan Hospital of Wuhan University & the Medical Research Institute of Wuhan University, Wuhan University, Wuhan, China.
You
Y
Zhou
Department of Cardiology, Zhongnan Hospital of Wuhan University & the Medical Research Institute of Wuhan University, Wuhan University, Wuhan, China.
Cheng
C
Qian
Department of Cardiology, Zhongnan Hospital of Wuhan University & the Medical Research Institute of Wuhan University, Wuhan University, Wuhan, China.
Yanggan
Y
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002681:China / Q000453:epidemiology; D019468:Disease Management; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011159:Population Surveillance; D017410:Practice Guidelines as Topic; D011786:Quality Control; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D063189:Symptom Assessment; D055815:Young Adult
D015415:Biomarkers
China; acute myocardial infarction; epidemiology; quality of care