Objective: To describe the investigation and management of patients admitted to hospitals in China with suspected acute coronary syndromes (ACS) and to identify potential areas for improvement in practice.
Design: A multicentre prospective survey of sociodemographic characteristics, medical history, clinical features, in-hospital investigations, treatment practices and major events among patients with suspected ACS.
Setting: Large urban public hospitals.
Patients: Consecutive patients admitted to in-patient facilities with a diagnosis of suspected acute myocardial infarction (MI) or unstable angina pectoris.
Main outcome measures: Myocardial infarction/re-infarction, heart failure, death.
Results: Between September 2004 and May 2005, data were collected prospectively from 2973 patients admitted to 51 hospitals in 18 provinces of China. An initial diagnosis of ST elevation MI, non-ST elevation MI and unstable angina was made in 43%, 11% and 46% of patients, respectively. Diagnosis was inconsistent with objective measures in up to 20% of cases. At both tertiary and non-tertiary centres, there was little evidence that clinical risk stratification was used to determine the intensity of investigation and management. The mortality rate during hospitalisation was 5% overall and similar in tertiary and non-tertiary centres, but reported in-hospital re-infarction rates (8%) and heart failure rates (16%) were substantially higher at non-tertiary centres.
Conclusion: This study has identified a number of areas in the management of ACS patients, including diagnosis and risk stratification, which deviate from current guidelines. These findings will help inform the introduction of widely used quality improvement initiatives such as clinical pathways.
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Funding:This study was funded by unrestricted educational grants from Guidant and Sanofi-Aventis, and grants from the Royal Australasian College of Physicians. AP is supported by an Australian National Heart Foundation Career Development Award.
Competing interests: Some authors have received honoraria and/or research grants from study sponsors.
Management committee: R Gao (co-principal investigator), A Patel (co-principal investigators), W Gao, D Hu, D Huang, L Kong, W Qi, Y Wu,Y Yang, P Harris.
Coordinating centre: Beijing: Dorothy Han, Jean Zhang, Xioman Zou, Xin Lu, Jie Qian. Sydney: Lucy Chen, Fiona Turnbull, Charles Algert, Patrick Groenestein, Gemma Starzec.
Study investigators: Shiping Cao (Nanfang Hospital, Nanfang Medical University of Guangdong); Yundai Chen (Beijing Anzhen Hospital, Beijing); Jiayu Cui (The People’s Hospital of Binzhou City, Shandong); Luyue Gai (The Chinese PLA General Hospital (301 Hospital, Beijing); Wei Gao (The Third Affiliated Hospital, Beijing University, Beijing); Yi Gao (The People’s Hospital of Yanjiao of Sanhe City, Hebei); Dongshuang Guo (The People’s Hospital of Yu County, Shanxi); Lixian Han (Central Hospital of Cangzhou City, Hebei); Yong He (West China Hospital, Sichuan University, Sichuan); Lan Huang (Xinqiao Hospital, Third Military Medical University, Chongqing); Zhenwen Huang (The First Affiliated Hospital, Henan Medical Universiity, Henan); Zhimei Jia (The First Affiliated Hospital, China Medical University, Liaoning); Zhaohui Jin (261 Hospital, Beijing); Hong Jiang (Sino-Japan Friendship Hospital, Beijing); Shisen Jiang (Nanjing General Hospital of Nanjing Military Command, Jiangsu); Menghuan Jing (Huludao Central Hospital, Hebei); Tianchang Li (Beijing Tongren Hospital, Beijing); Yinjun Li (Shenyang 4th People’s Hospital, Liaoning); Yuhua Liao (Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Hubei); Jinghua Liu (General Hospital of Coal Industry Ministry, Beijing); Dunxiang Lu (The People’s Hospital of Daxing District, Beijing); Fanghong Lu (Central Hospital of Zibo City, Shandong); Kailiang Luo (The Second Affiliated Hospital, Chongqing Medical University, Chongqing); Qingzhi Meng (Central Hospital of Zhabei District, Shanghai); Jie Qian (Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing); Jiulin Ren (Tongliao Hospital, Inner Mongolia); Weichen Shi (The Seventh People’s Hospital of Chengdu, Sichuan); Xiling Shou (The People’s Hospital of Shaanxi Province, Shaanxi); Xinyong Sun (The First Affiliated Hospital, Ha’erbin Medical University, Heilongjiang); Yanqin Sun (Beijing Coal Industry Company , Beijing); Gang Tian (The First Affiliated Hospital, Xi’an Jiaotong University, Shaanxi); Dongyuan Wang (Shenyang 242 Hospital, Liaoning); Feng Wang (The People’s Hospital, Guangxi Zhuang Autonomous Region); Jingping Wang (Shanxi Cardiology Hospital, Shanxi); Lei Wang (Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing); Lemin Wang (Tongji Hospital, Tongji University, Shanghai); Suxian Wang (Central Hospital, Shenyang Medical College, Liaoning); Xu Wang (The People’s Hospital of Langfang, Hebei); Qizhi Wu (Huli Hospital of Xiamen City, Fujian); Yinsheng Wu (The First Affiliated Hospital, Jiangxi Medical University, Jiangxi); Rui Xiao (Lishan Hospital, Anshan Steel Group, Anhui); Qiang Xie (The First Affiliated Hospital of Xiamen, Fujian Medical University, Fujian); Wenyuan Xu (The Second Hospital of Bazhou, Hebei); Ming Yang (Beijing Fuxing Hospital, Beijing); Qingxiang Yang (The First People’s Hospital of Lianyungang City, Jiangsu); Xinchun Yang (Chaoyang Hospital, Capital University of Medical Sciences, Beijing); Mingzhong Zhao (The People’s Hospital, Beijing University, Beijing); Ruiping Zhao (Baotou Central Hospital, Inner Mongolia); Sanming Zhao (The People’s Hospital of Taiyuan, Shanxi); Ming Zhong (Qilu Hospital, Shandong University, Shandong); Guoying Zhu (Wuhan Asia Heart Hospital, Hubei).
Role of the funding source: None of the study sponsors had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Contributors: All authors contributed substantially to one or more of the following activities—study design, study conduct, data analysis, interpretation of data and writing of the manuscript.