Peacock WF, Levy PD, Diercks DB, Li S, McCord J, Newby LK, Osborne A, Ross M, Winchester DE, Kontos MC, Deitelzweig S, and Bhatt DL. The Impact of American College of Cardiology Chest Pain Center Accreditation on Guideline Recommended Acute Myocardial Infarction Management. Crit Pathw Cardiol 2021.
Crit Pathw Cardiol
BACKGROUND: Whether American College of Cardiology (ACC) Chest Pain Center (CPC) accreditation alters guidelines adherence rates is unclear.
METHODS: We analyzed patient-level, hospital-reported, quality metrics for myocardial infarction (MI) patients from 644 hospitals collected in the ACC's Chest Pain-MI Registry from 1/1/19 to 12/31/20, stratified by CPC accreditation for >1 year.
RESULTS: Of 192,374 MI patients, 67,462 (35.1%) received care at an accredited hospital. In general, differences in guideline adherence rates between accredited and non-accredited hospitals were numerically small, though frequently significant. Patients at accredited hospitals were more likely to undergo coronary angiography (98.6% vs 97.9%, p<0.0001), percutaneous coronary intervention (PCI) for NSTEMI (55.4% vs 52.3%, p<0.0001), have overall revascularization for NSTEMI (63.5% vs 61.0%, p<0.0001), and receive P2Y12 inhibitor on arrival (63.5% vs. 60.2%, p<0.0001). Non-accredited hospitals more ECG within 10 minutes (62.3% vs. 60.4%, p<0.0001) and first medical contact to device activation ≤ 90 minutes (66.8% vs. 64.8%, p<0.0001). Accredited hospitals had uniformly higher discharge medication guideline adherence, with patients more likely receiving aspirin (97.8% vs. 97.4%, p<0.0001), angiotensin converting enzyme inhibitor (46.7% vs. 45.3%, p<0.0001), beta blocker (96.6% vs. 96.2%, p<0.0001), P2Y12 inhibitor (90.3% vs. 89.2%, p<0.0001), and statin (97.8% vs. 97.5%, p<0.0001). Interaction by accredited status was significant only for length of stay (LOS), which was slightly shorter at accredited facilities for specific subgroups.
CONCLUSIONS: ACC CPC accreditation was associated with small consistent improvement in adherence to guideline-based treatment recommendations of catheter-based care (catheterization and PCI) for NSTEMI and discharge medications, and shorter hospital stays.
ePub ahead of print