Adherence to ACC/AHA Performance Measures for Myocardial Infarction in Six Middle-Eastern Countries: Association with In-Hospital Mortality and Clinical Characteristics

作者：Longenecker Joseph C^*; Alfaddagh Abdulhamied; Zubaid Mohammad; Rashed Wafa; Ridha Mustafa; Alenezi Fahad; Alhamdan Rashed; Akbar Mousa; Bulbanat Bassam Y; Al Suwaidi Jassim

来源：International Journal of Cardiology, 2013, 167(4): 1406-1411.

DOI：10.1016/j.ijcard.2012.04.066

• Adherence
• Performance Measures
• Guidelines
• Myocardial Infarction
• Mortality
• Middle East

Background/Objectives: This study assesses adherence to performance measures for acute myocardial infarction (AMI) in six Middle-Eastern countries, and its association with in-hospital mortality. Few studies have previously assessed these performance measures in the Middle East.
Methods: This cohort study followed 5813 patients with suspected AMI upon admission to discharge. Proportions of eligible participants receiving the following performance measures were calculated: medications within 24 hours of admission (aspirin and beta-blocker) and on discharge (aspirin, beta-blockers, angiotensin converting enzyme inhibitors [ACEI], and lipid-lowering therapy), reperfusion therapy, and low-density lipoprotein (LDL) cholesterol measurement. A composite adherence score was calculated. Associations between performance measures and clinical characteristics were assessed using multivariate logistic regression.
Results: Adherence was above 90% for aspirin, reperfusion, and lipid-lowering therapies; between 60% and 82% for beta-blockers, ACEI, statin therapy, time-to-balloon within 90 minutes, and LDL-cholesterol measurement; and 33% for time-to-needle within 30 minutes. After adjustment, factors associated with high composite performance score (>85%) included Asian ethnicity (Odds Ratio, OR=1.3; p=0.01) and history of hyperlipidemia (OR=1.4; p=0.001). Factors associated with a lower score included atypical symptoms (OR=0.6; p=0.003) and high GRACE score (OR=0.6; p<0.001). Lower in-hospital mortality was associated with provision of reperfusion therapy (OR=0.54, p=0.047) and beta-blockers within 24 hours (OR=0.33, p=0.005).
Conclusions: Overall adherence was lowest among the highest-risk patients. Lower in-hospital mortality was independently associated with adherence to early performance measures, comprising observational evidence for their effectiveness in a Middle East cohort. These data provide a focus for regional quality improvement initiatives and research.

• 出版日期2013-8-20