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Liu LW, Cui YK, Zhang L, Jia DL, Wang J, Gu JW, Zhang JY, Dong Z, Jin XJ, Zou XY, Sun GL, Dai YX, Sun AJ, Ge JB. Effectiveness of chest pain center accreditation on the hospital outcome of acute aortic dissection: a nationwide study in China. Mil Med Res 2024; 11:62. [PMID: 39183322 DOI: 10.1186/s40779-024-00565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/09/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. The benefits of chest pain center (CPC) accreditation on acute coronary syndrome have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD). METHODS We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016 to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis, and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions. RESULTS The analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.1% vs. 16.3%, P < 0.001 and 2.9% vs. 5.4%, P < 0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.1% vs. 42.1%, P < 0.001) compared with the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR 0.644, 95% CI 0.599-0.693) and misdiagnosis (adjusted OR 0.554, 95% CI 0.493-0.624), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR 1.973, 95% CI 1.797-2.165). Following CPC accreditation, there were significant reductions in in-hospital mortality across various regions, particularly in Western regions (from 21.5 to 14.1%). Moreover, CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities (adjusted OR 0.607 vs. 0.713). CONCLUSION CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.
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Affiliation(s)
- Li-Wei Liu
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Yi-Kai Cui
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Lin Zhang
- Department of Emergency and Critical Care Medicine, Jinshan Hospital of Fudan University, Shanghai, 201508, China
| | - Dai-Le Jia
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Jing Wang
- Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jia-Wei Gu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jin-Yan Zhang
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Zhen Dong
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Xue-Juan Jin
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
| | - Xiao-Yi Zou
- Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Guo-Li Sun
- Department of Cardiology, Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Yu-Xiang Dai
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China
| | - Ai-Jun Sun
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China.
| | - Jun-Bo Ge
- Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
- State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
- Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai, 200032, China.
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