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National quality assessment evaluating spironolactone use during hospitalization for acute myocardial infarction (AMI) in China: China Patient-centered Evaluation Assessment of Cardiac Events (PEACE)-Retrospective AMI Study, 2001, 2006, and 2011.

ABSTRACT: Spironolactone, the only aldosterone antagonist available in China, improves outcomes in acute myocardial infarction (AMI) among patients with systolic dysfunction and either diabetes or heart failure (HF). However, national practice patterns in the use of spironolactone in China are unknown.From a nationally representative sample of AMI patients from in 2001, 2006, and 2011, we identified 6906 patients with either diabetes or HF and classified them into 1 of 4 groups according to their eligibility for spironolactone-"ideal"(left ventricular ejection fraction [LVEF] ?40% and without contraindications), "contraindicated," "not indicated" (neither ideal nor contraindicated), and "unknown indications" (LVEF unmeasured)-to determine how frequently patient eligibility for this drug is assessed in the hospital, how it is used in several groups, and to identify factors associated with the use in these groups. From 2001 to 2011, the proportion of patients whose eligibility for spironolactone was not assessed decreased (66.9% in 2001 to 32.8% in 2011). Spironolactone use significantly increased among ideal patients over this period (28.6% to 72.4%; P<0.001 for trend), but also in contraindicated patients (11.4% to 27.5%; P=0.002 for trend) and in other patients groups (not indicated: 27.5% to 38.3%; unknown indications: 21.3% to 35.1%; both P<0.01 for trend). In all 4 groups, patients presenting with HF on admission were more likely to receive spironolactone.Although the appropriate use of spironolactone and assessment of eligibility increased in China over the past decade, there remains marked opportunities for improvement.URL: http://www.clinicaltrials.gov Unique identifier: NCT01624883.

SUBMITTER: Guan W

PROVIDER: S-EPMC4599529 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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National quality assessment evaluating spironolactone use during hospitalization for acute myocardial infarction (AMI) in China: China Patient-centered Evaluation Assessment of Cardiac Events (PEACE)-Retrospective AMI Study, 2001, 2006, and 2011.

Guan Wenchi W Murugiah Karthik K Downing Nicholas N Li Jing J Wang Qing Q Ross Joseph S JS Desai Nihar R NR Masoudi Frederick A FA Spertus John A JA Li Xi X Krumholz Harlan M HM Jiang Lixin L

Journal of the American Heart Association 20150612 6

<h4>Background</h4>Spironolactone, the only aldosterone antagonist available in China, improves outcomes in acute myocardial infarction (AMI) among patients with systolic dysfunction and either diabetes or heart failure (HF). However, national practice patterns in the use of spironolactone in China are unknown.<h4>Methods and results</h4>From a nationally representative sample of AMI patients from in 2001, 2006, and 2011, we identified 6906 patients with either diabetes or HF and classified them ...[more]

PMID: 26071031

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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

National quality assessment evaluating spironolactone use during hospitalization for acute myocardial infarction (AMI) in China: China Patient-centered Evaluation Assessment of Cardiac Events (PEACE)-Retrospective AMI Study, 2001, 2006, and 2011.

Publications

National quality assessment evaluating spironolactone use during hospitalization for acute myocardial infarction (AMI) in China: China Patient-centered Evaluation Assessment of Cardiac Events (PEACE)-Retrospective AMI Study, 2001, 2006, and 2011.

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