TY - JOUR
T1 - Adherence to ACC/AHA Performance Measures for Myocardial Infarction in Six Middle-Eastern Countries
T2 - Association with In-Hospital Mortality and Clinical Characteristics
AU - Longenecker, Joseph C.
AU - Alfaddagh, Abdulhamied
AU - Zubaid, Mohammad
AU - Rashed, Wafa
AU - Ridha, Mustafa
AU - Alenezi, Fahad
AU - Alhamdan, Rashed
AU - Akbar, Mousa
AU - Bulbanat, Bassam Y.
AU - Al-Suwaidi, Jassim
N1 - Funding Information:
Gulf RACE is a Gulf Heart Association (Doha, Qatar) project and was financially supported by Sanofi Aventis Gulf (Dubai, United Arab Emirates) and Qatar Telecommunications Company (Doha, Qatar). The sponsors had no role in study design, data collection, data analysis and interpretation, the writing of the report, or submission of the manuscript.
Funding Information:
Gulf RACE is a Gulf Heart Association project and was financially supported by Sanofi Aventis and Qatar Telecommunications Company. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.
PY - 2013/8/20
Y1 - 2013/8/20
N2 - 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.
AB - 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.
KW - Adherence
KW - Guidelines
KW - Middle East
KW - Mortality
KW - Myocardial Infarction
KW - Performance Measures
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U2 - 10.1016/j.ijcard.2012.04.066
DO - 10.1016/j.ijcard.2012.04.066
M3 - Article
C2 - 22578736
AN - SCOPUS:84881478866
SN - 0167-5273
VL - 167
SP - 1406
EP - 1411
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 4
ER -