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oai:repisalud.isciii.es:20.500.12105/51572024-09-27T09:36:47Zcom_20.500.12105_19604com_20.500.12105_2051col_20.500.12105_19605

00925njm 22002777a 4500 dc Bebb, Owen author Hall, Marlous author Fox, Keith A. A. author Dondo, Tatendashe B. author Timmis, Adam author Bueno, Hector author Schiele, Francois author Gale, Chris P. author 2017 Aims 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. Methods and results 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 0fondaparinux received among NSTEMI0 (interquartile range 84.7\%) and least variation 0centre organisation0 (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\%). Conclusions 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 30day 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. Eur Heart J. 2017; 38(13):974-982 10.1093/eurheartj/ehx008 1522-9645 0195-668X European Heart Journal 28329279 http://hdl.handle.net/20.500.12105/5157 Quality indicators Acute myocardial infarction Mortality Hospital performance ACUTE MYOCARDIAL-INFARCTION PERCUTANEOUS CORONARY INTERVENTION ST-SEGMENT ELEVATION EUROPEAN COUNTRIES TERM MORTALITY CARE DETERMINANTS MANAGEMENT ADHERENCE KINGDOM Performance of hospitals according to the ESC ACCA quality indicators and 30-day mortality for acutemyocardial infarction: national cohort study using the United KingdomMyocardial Ischaemia National Audit Project (MINAP) register