Performance of hospitals according to the ESC ACCA quality indicators and 30-day mortality for acute myocardial infarction: national cohort study using the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) register.
To investigate the application of the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QI) for acute myocardial infarction for the study of hospital performance and 30-day mortality.



National cohort study (n = 118,075 patients, n = 211 hospitals, MINAP registry), 2012-13. Overall, 16 of the 20 QIs could be calculated. Eleven QIs had a significant inverse association with GRACE risk adjusted 30-day mortality (all P < 0.005). The association with the greatest magnitude was high attainment of the composite opportunity-based QI (80-100%) vs. zero attainment (odds ratio 0.04, 95% confidence interval 0.04-0.05, P < 0.001), increasing attainment from low (0.42, 0.37- 0.49, P < 0.001) to intermediate (0.15, 0.13-0.16, P < 0.001) was significantly associated with a reduced risk of 30-day mortality. A 1% increase in attainment of this QI was associated with a 3% reduction in 30-day mortality (0.97, 0.97-0.97, P < 0.001). The QI with the widest hospital variation was 'fondaparinux received among NSTEMI' (interquartile range 84.7%) and least variation 'centre organisation' (0.0%), with seven QIs depicting minimal variation (<11%). GRACE risk score adjusted 30-day mortality varied by hospital (median 6.7%, interquartile range 5.4-7.9%).



Eleven QIs were significantly inversely associated with 30-day mortality. Increasing patient attainment of the composite quality indicator was the most powerful predictor; a 1% increase in attainment represented a 3% decrease in 30-day standardised mortality. The ESC QIs for acute myocardial infarction are applicable in a large health system and have the potential to improve care and reduce unwarranted variation in death from acute myocardial infarction.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.|York Teaching Hospital NHS Foundation Trust, York, UK.
Owen
O
Bebb
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Marlous
M
Hall
Centre for Cardiovascular Science, University of Edinburgh, UK.
Keith A A
KAA
Fox
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Tatendashe B
TB
Dondo
NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, London.
Adam
A
Timmis
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.|Instituto de investigación and Cardiology Department, Hospital Universitario, Spain.|Universidad Complutense de Madrid, Spain.
Hector
H
Bueno
Department of Cardiology, University Hospital Jean Minjoz, Besancon, France.
François
F
Schiele
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.|York Teaching Hospital NHS Foundation Trust, York, UK.
Chris P
CP
Gale
D000368:Aged; D017023:Coronary Angiography / Q000592:standards; D004739:England; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006760:Hospitalization; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D015425:Myocardial Reperfusion / Q000401:mortality / Q000706:statistics & numerical data; D000072658:Non-ST Elevated Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care / Q000592:standards; D011787:Quality of Health Care / Q000592:standards; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D055502:Secondary Prevention; D014852:Wales
D005343:Fibrinolytic Agents
Acute myocardial infarction; Hospital performance; Mortality; Quality indicators