title: Treatment and outcomes of acute coronary syndromes in women: An analysis of a multicenter quality improvement Chinese study.
abstract: BACKGROUND
  Variations in care and outcomes by sex in patients with acute coronary syndrome (ACS) have been reported worldwide. The aims of this study are to describe ACS management according to sex in China and the effects of a quality improvement program in Chinese male and female ACS patients.
  
  
  RESULTS
  Clinical Pathways for Acute Coronary Syndromes - Phase 2 (CPACS-2) was a cluster randomized trial to test whether a clinical pathways-based intervention would improve ACS management in China. The study enrolled 15,141 hospitalized patients [4631 (30.6%) were women] from 75 hospitals throughout China between October 2007 and August 2010. The intervention included clinical pathway implementation and performance measurement using standardized indicators with 6 monthly audit-feedback cycles. Eight key performance indicators reflecting in hospital management of ACS were measured. After adjustment for differences in patient characteristics and comorbidities at presentation, women were significantly less likely to undergo coronary angiography when indicated (RR 0.88 [0.85 to 0.92], P<0.001), less likely to receive guideline recommended medical therapies at discharge (RR 0.94 [0.91 to 0.98], P=0.003) and more likely to be hospitalized for shorter (mean difference -0.42 [-0.73 to -0.12] days, P=0.007). However, in-hospital clinical outcomes did not differ by sex. There was no evidence of heterogeneity in the relative effects of the quality improvement initiative by sex.
  
  
  CONCLUSIONS
  Sex disparities were apparent in some key quality of care indicators for patients with suspected with ACS presenting to hospitals in China. The beneficial effect of the quality improvement program was consistent in women and men.
  
  
  BACKGROUND
  http://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.
authors.affiliation: Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The George Institute for Global Health at Peking University Health Science Center, Beijing, China. Electronic address: dxin@georgeinstitute.org.cn.
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Xian
authors.initials: X
authors.lastname: Li
authors.affiliation: Peking University Clinical Research Institute, Beijing, China; Peking University School of Public Health, Beijing, China; Peking University People's Hospital, Beijing, China.
authors.forename: Yangfeng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Turnbull
authors.affiliation: The Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
authors.forename: Runlin
authors.initials: R
authors.lastname: Gao
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D000368:Aged; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D019091:Critical Pathways / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement / Q000639:trends*; D012727:Sex Characteristics; D016896:Treatment Outcome
keywords: Acute coronary syndromes; Quality improvement; Quality of care; Women