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Quality of care at discharge is affected by hospital case volume in acute myocardial infarction patients. A French nationwide assessment


Francois Schiele, FESC Francois Schiele (France)

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List of Authors:
François Schiele, Frédéric Capuano, Philippe Loirat, Armelle Desplanques-Leperre, Geneviève Derumeaux, Jean-François Thebaut, Christine Gardel


Aims: In Acute Myocardial Infarction (AMI), the relationship between volume and Quality Indicators (QI) is poorly documented. Through a nationwide assessment of QI at discharge repeated for three years, we aimed to quantify the relationship between volume and QIs in survivors after AMI.

Methods: Almost all healthcare organisations in France participated. Medical records were randomly selected. Data collection was performed by a independent group. QIs for AMI were defined by an expert consensus group as appropriate prescription at discharge of aspirin, clopidogrel, beta-blocker, statin and an ACE inhibitor in patients with left ventricular ejection fraction <0.40. A composite QI was calculated using the “all or none” method. Volume was classed in 7 categories based on the number of admissions for AMI in 2008 (centres with <10 AMI were excluded). Odds Ratios (ORs) adjusted for age and gender with 95% CI for volume categories were calculated using logistic regression for each QI. Temporal changes were tested in centres who participated in all three campaigns.

Results: A total of 48,503 records were examined: 18,159 in 2008, 14,027 in 2009 and 16,317 in 2010. Median centre volume was 90. 291 centres were eligible for the temporal analysis. AP of antiplatelet agents, beta-blockers, ACEI and statins at discharge increased significantly between 2008 and 2009, and between 2009 and 2010 for AP of ACEI, beta-blockers, statins and the composite QI. Compared to a volume of >300, a significantly lower rate of all QIs was observed in centres with the lowest volume. ORs progressively decreased with increasing volume, but reached a plateau above a threshold of 120 AMI hospitalisations per year. Despite a significant increase in the composite QI over the 3 years, a significant relation persisted between volume (±90) and quality of care.

Conclusion: Analysis of QIs at discharge demonstrates the existence of a relation between volume and quality of care. Centres with the highest volume perform better on quality measures than centres with lower volumes. Temporal analysis over 3 consecutive years confirms this relation and shows that it persists despite improvement in quality indicators between 2008 and 2010.




Clinical Registry Highlight I - Risk and treatment reality

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.