Quality Indicators in Acute Myocardial Infarction Care: An International Comparison - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Oren Zusman Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Owen Bebb Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK Marlous Hall Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK Tatandashe Dondo Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK Ran Kornowski Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel Chris Gale Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK Zaza Iakobishvili Department of Cardiology, Rabin Medical Center, Petach Tiqva, Israel Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Background:
Cardiovascular quality indicators (QIs( have been developed by several bodies including ESC, and come into use in order to improve patient care. Comparison of those between countries and with respect to temporal trends, in addition to patient characteristics, can provide insight.

Methods:
We used data from the United Kingdom (UK) national heart attack register (Myocardial Ischaemia National Audit Project [MINAP]) and from the Acute Coronary Syndrome in Israel Survey (ACSIS) in 2 month period in 2006, 2010 and 2013 and compared patient characteristics and performance across quality indicators defined by the ESC

Results:
Within the identified comparison periods there were 17,068 patients from MINAP (75.1%) and 5,647 from ACSIS (24.9%). Patients in the MINAP registry were older, more likely to be female, and had less diabetes, dyslipidemia and heart failure. Performance of an angiogram and percutaneous coronary intervention (PCI) were higher in ACSIS compared to MINAP (87.6 vs 64.8% and 68.2 vs 41%, respectively). GRACE score was lower in ACSIS compared to MINAP (121.0 vs 110.5). In MINAP, Rates of angiograms have risen significantly (37.3 to 85.5%) as well as performance of PCI (13.8 to 63.3%), with time to achieve arterial access for primary PCI halved between 2006 and 2013 (80.4 vs 40.2 minutes). Performance by composite measures (CQI( increased significantly in MINAP (1.0% to 86.0% ,all-or-none), and ACSIS (70.2 to 78.0%). Both registries saw similar decline in 30-day mortality, but ACSIS had lower rates (4.2% vs 7.6%). Adjusted for GRACE score, the CQI adherence was associated with reduced 30-day mortality (OR 0.95, 95% CI 0.95-0.97, p <0.001).

Conclusions:

Structured, continuous or periodic collection of patient data and quality indicators provides insight and can help improve patient care. Adhering to quality indicators might be associated with improved outcome for patients