Dataset Information

Trends in cardiac biomarker testing in China for patients with acute myocardial infarction, 2001 to 2011: China PEACE-retrospective AMI study.

ABSTRACT:

Objectives

To describe trends in the availability of biomarker testing in Chinese hospitals and how practice complies with established standards for the diagnosis of acute myocardial infarction (AMI).

Background

Cardiac biomarker testing is standard in high-income countries, but little is known about the availability and use of cardiac biomarker testing in low- and middle-income countries (LMICs) such as China.

Methods

Based on a nationally representative sample of Chinese hospitals in 2001, 2006 and 2011, we describe the temporal trends and regional differences in the hospital capability and rates of use of cardiac biomarker testing, as well as the variation in use across hospitals with testing capability, for patients labeled with the diagnosis of AMI.

Results

We sampled 175 hospitals (162 participated in the study) and 18,631 AMI admissions. 14,370 patients were included in analysis of biomarker use. The proportion of hospitals with biomarker testing capability was 57.4% in 2001 (25.0% troponin and 32.4% creatine kinase MB fraction (CK-MB) only) and 96.3% (81.4% troponin and 14.9% CK-MB only) in 2011. The proportion of hospitals with troponin testing capability in 2011 was significantly higher in urban compared with rural hospitals (96.8% vs. 71.4%, p< 0.001). In 2011, only 55.9% of hospitals with troponin testing capability (71 out of 127 hospitals) used the assay for more than 80% of their patients with AMI. Among hospitals with either biomarker testing capability, there was marked variation in use in both rural (from 7.1% to 100.0% of patients) and urban hospitals (from 57.9% to 100.0% of patients). In 2011, 36.1% of the patients with AMI did not have troponin tested and 4.9% did not have either biomarker measured.

Conclusions

The recommended biomarker tests for AMI diagnosis are not universally available and the testing is not consistently applied when it is available in China.

Trial registration

ClinicalTrials.gov NCT01624883.

SUBMITTER: Zhan L

PROVIDER: S-EPMC4404305 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Trends in cardiac biomarker testing in China for patients with acute myocardial infarction, 2001 to 2011: China PEACE-retrospective AMI study.

Zhan Lijuan L Masoudi Frederick A FA Li Xi X Hu Shuang S Venkatesh Arjun K AK Spertus John A JA Lin Zhenqiu Z Desai Nihar R NR Li Jing J Krumholz Harlan M HM Jiang Lixin L

PloS one 20150420 3

<h4>Objectives</h4>To describe trends in the availability of biomarker testing in Chinese hospitals and how practice complies with established standards for the diagnosis of acute myocardial infarction (AMI).<h4>Background</h4>Cardiac biomarker testing is standard in high-income countries, but little is known about the availability and use of cardiac biomarker testing in low- and middle-income countries (LMICs) such as China.<h4>Methods</h4>Based on a nationally representative sample of Chinese ...[more]

PMID: 25893247

Similar Datasets

Project description:BackgroundDespite the importance of ST-segment elevation myocardial infarction (STEMI) in China, no nationally representative studies have characterised the clinical profiles, management, and outcomes of this cardiac event during the past decade. We aimed to assess trends in characteristics, treatment, and outcomes for patients with STEMI in China between 2001 and 2011.MethodsIn a retrospective analysis of hospital records, we used a two-stage random sampling design to create a nationally representative sample of patients in China admitted to hospital for STEMI in 3 years (2001, 2006, and 2011). In the first stage, we used a simple random-sampling procedure stratified by economic-geographical region to generate a list of participating hospitals. In the second stage we obtained case data for rates of STEMI, treatments, and baseline characteristics from patients attending each sampled hospital with a systematic sampling approach. We weighted our findings to estimate nationally representative rates and assess changes from 2001 to 2011. This study is registered with ClinicalTrials.gov, number NCT01624883.FindingsWe sampled 175 hospitals (162 participated in the study) and 18,631 acute myocardial infarction admissions, of which 13,815 were STEMI admissions. 12,264 patients were included in analysis of treatments, procedures, and tests, and 11,986 were included in analysis of in-hospital outcomes. Between 2001 and 2011, estimated national rates of hospital admission for STEMI per 100,000 people increased (from 3·5 in 2001, to 7·9 in 2006, to 15·4 in 2011; ptrend<0·0001) and the prevalence of risk factors-including smoking, hypertension, diabetes, and dyslipidaemia-increased. We noted significant increases in use of aspirin within 24 h (79·7% [95% CI 77·9-81·5] in 2001 vs 91·2% [90·5-91·8] in 2011, ptrend<0·0001) and clopidogrel (1·5% [95% CI 1·0-2·1] in 2001 vs 82·1% [81·1-83·0] in 2011, ptrend<0·0001) in patients without documented contraindications. Despite an increase in the use of primary percutaneous coronary intervention (10·6% [95% CI 8·6-12·6] in 2001 vs 28·1% [26·6-29·7] in 2011, ptrend<0·0001), the proportion of patients who did not receive reperfusion did not significantly change (45·3% [95% CI 42·1-48·5] in 2001 vs 44·8% [43·1-46·5] in 2011, ptrend=0·69). The median length of hospital stay decreased from 12 days (IQR 7-18) in 2001 to 10 days (6-14) in 2011 (ptrend<0·0001). Adjusted in-hospital mortality did not significantly change between 2001 and 2011 (odds ratio 0·82, 95% CI 0·62-1·10, ptrend=0·07).InterpretationDuring the past decade in China, hospital admissions for STEMI have risen; in these patients, comorbidities and the intensity of testing and treatment have increased. Quality of care has improved for some treatments, but important gaps persist and in-hospital mortality has not decreased. National efforts are needed to improve the care and outcomes for patients with STEMI in China.FundingNational Health and Family Planning Commission of China.

Project description:BackgroundChina is experiencing a marked increase in ST-segment elevation myocardial infarction hospitalizations, with 30% occurring among women and higher risk of in-hospital death in relatively younger age groups (<70). Yet, little is known about sex differences in ST-segment elevation myocardial infarction presentation and management.Methods and resultsIn a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to 162 Chinese hospitals in 2001, 2006, and 2011, we examined sex differences in hospitalization rates, clinical profiles, and quality of care. Among 11 986 patients, the proportion of women was unchanged between 2001 and 2011. The estimated national rates of hospital admission per 100 000 people increased from 4.6 in 2001 to 18.0 in 2011 among men (3.9-fold increase) and from 1.9 to 8.0 among women (4.2-fold increase) (Ptrend<0.0001). The median age of women increased from 68 years in 2001 to 72 years in 2011 (Ptrend<0.001); however, there was no age change in men (63 years in 2011) (Ptrend=0.48). After accounting for age, women had a higher frequency of comorbidities. Although there were significant sex differences in the time interval of >12 hours between symptom onset and admission time in 2001, since 2006 delays in presentation were comparable between women and men. Fewer women without contraindications received evidence-based therapies than men, including reperfusion (57.5% versus 44.2%), early aspirin (88.8% versus 85.9%), and clopidogrel (56.9% versus 52.5%, P<0.001 for all) and the differences were largely unchanged over time.ConclusionsWomen experienced a higher increase in hospitalization rates for ST-segment elevation myocardial infarction in China between 2001 and 2011 and were less likely to receive evidence-based therapies, especially reperfusion. In addition to efforts to improve quality of care generally, understanding the reasons for this sex disparity and addressing these differences in care should be a priority.Clinical trial registrationURL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

Dataset Information

Trends in cardiac biomarker testing in China for patients with acute myocardial infarction, 2001 to 2011: China PEACE-retrospective AMI study.

Objectives

Background

Methods

Results

Conclusions

Trial registration

Publications

Trends in cardiac biomarker testing in China for patients with acute myocardial infarction, 2001 to 2011: China PEACE-retrospective AMI study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets