Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study
Abstract
:1. Introduction
2. Methods
2.1. Data Source and Study Population
2.2. Quality Indicators
2.3. Statistical Analysis
3. Results
3.1. Clinical Characteristics
3.2. Compliance Measurements
3.3. Association between Process Indicators and Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Patient Characteristics | Frequency (%) | In-Hospital Mortality | LOS (day) | ||
---|---|---|---|---|---|
N (%) | p Value | mean ± SD | p Value | ||
Age | |||||
~50 | 316 (11.87) | 26 (8.23) | 0.8170 | 6.07 ± 3.05 | <0.0001 |
50–60 | 414 (15.55) | 32 (7.73) | 7.27 ± 2.50 | ||
60–70 | 736 (27.64) | 61 (8.29) | 7.64 ± 2.29 | ||
70~ | 1197 (44.95) | 109 (9.11) | 7.41 ± 2.50 | ||
Sex | |||||
Male | 1859 (69.81) | 159 (8.55) | 0.9803 | 7.33 ± 2.55 | 0.6370 |
Female | 804 (30.19) | 69 (8.58) | 7.29 ± 2.59 | ||
Obese | |||||
No | 2314 (86.89) | 201 (8.69) | 0.5544 | 7.37 ± 2.53 | 0.0045 |
Yes | 349 (13.11) | 27 (7.74) | 6.96 ± 2.69 | ||
Insurance | |||||
Government | 673 (25.27) | 60 (8.92) | 0.9177 | 7.16 ± 2.77 | 0.0040 |
Private | 341 (12.81) | 28 (8.21) | 7.49 ± 2.78 | ||
Uninsured | 1649 (61.92) | 140 (8.49) | 7.70 ± 2.46 | ||
Smoking | |||||
No | 1162 (43.63) | 95 (8.18) | 0.5308 | 7.32 ± 2.57 | 0.2555 |
Yes | 1501 (56.37) | 133 (8.86) | 7.31 ± 2.55 | ||
Family history of IHD * | |||||
No | 1536 (57.68) | 132 (8.59) | 0.9451 | 7.24 ± 2.58 | 0.1109 |
Yes | 1127 (42.32) | 96 (8.52) | 7.42 ± 2.53 | ||
Prior MI/CAD | |||||
No | 1693 (63.57) | 153 (9.04) | 0.2467 | 7.23 ± 2.58 | 0.0214 |
Yes | 970 (36.43) | 75 (7.73) | 7.46 ± 2.58 | ||
History Of DM | |||||
No | 1754 (65.87) | 151 (8.61) | 0.9039 | 7.26 ± 2.62 | 0.2349 |
Yes | 909 (34.13) | 77 (8.47) | 7.41 ± 2.42 | ||
History of Hypertension | |||||
No | 1611 (60.50) | 130 (8.07) | 0.2612 | 7.20 ± 2.40 | 0.0151 |
Yes | 1052 (39.50) | 98 (9.32) | 7.48 ± 2.48 | ||
MI | |||||
NSTEMI | 1209 (45.40) | 124 (10.26) | 0.0044 | 6.09 ± 2.65 | <0.0001 |
STEMI | 1454 (54.60) | 104 (7.15) | 8.33 ± 1.96 | ||
Hospital type | |||||
Specialized | 1034 (38.83) | 103 (9.96) | 0.0397 | 7.08 ± 2.64 | <0.0001 |
Generalized | 1629 (61.17) | 125 (7.67) | 7.46 ± 2.49 |
Comorbidities | Frequency (%) | In-Hospital Mortality | LOS (day) | ||
---|---|---|---|---|---|
N (%) | p Value | Mean ± SD | p Value | ||
Rheumatic heart disease | |||||
no | 2655 (99.70) | 226 (8.51) | 0.0002 | 7.32 ± 2.56 | 0.8367 |
yes | 8 (0.30) | 2 (25.00) | 6.88 ± 3.18 | ||
Heart Failure | |||||
no | 2615 (98.20) | 222 (8.49) | 0.3251 | 7.31 ± 2.56 | 0.9827 |
yes | 48 (1.80) | 6 (12.50) | 7.35 ± 2.37 | ||
Cardiogenic Shock | |||||
no | 2392 (89.82) | 204 (8.53) | 0.8550 | 7.27 ± 2.57 | 0.0137 |
yes | 271 (10.18) | 24 (8.86) | 7.68 ± 2.43 | ||
Hypertension | |||||
no | 1998 (75.03) | 167 (8.36) | 0.5155 | 7.30 ± 2.57 | 0.8212 |
yes | 665 (24.97) | 61 (9.17) | 7.35 ± 2.53 | ||
Cerebrovascular disease | |||||
no | 2253 (84.60) | 205 (9.10) | 0.0022 | 7.29 ± 2.60 | 0.5060 |
yes | 410 (15.40) | 23 (5.61) | 7.43 ± 2.32 | ||
Gastrointestinal disease | |||||
no | 2620 (98.39) | 226 (8.63) | 0.3555 | 7.32 ± 2.56 | 0.5060 |
yes | 43 (1.61) | 2 (4.65) | 7.05 ± 2.54 | ||
Type-I DM | |||||
no | 2307 (86.63) | 200 (8.67) | 0.6138 | 7.29 ± 2.60 | 0.5357 |
yes | 356 (13.37) | 28 (7.87) | 7.48 ± 2.26 | ||
Type-II DM | |||||
no | 2322 (87.19) | 197 (8.48) | 0.7084 | 7.33 ± 2.56 | 0.4519 |
yes | 341 (12.81) | 31 (9.09) | 7.23 ± 2.52 | ||
Renal failure | |||||
no | 2451 (92.04) | 206 (8.40) | 0.3247 | 7.34 ± 2.54 | 0.3972 |
yes | 212 (7.96) | 22 (10.38) | 7.00 ± 2.71 | ||
Dysrhythmia | |||||
no | 2485 (93.32) | 216 (8.69) | 0.3689 | 7.29 ± 2.57 | 0.1766 |
yes | 178 (6.68) | 12 (6.74) | 7.66 ± 2.69 | ||
Peripheral Vascular Disease | |||||
no | 2389 (89.71) | 201 (8.41) | 0.4196 | 7.30 ± 2.58 | 0.9493 |
yes | 274 (10.29) | 27 (9.85) | 7.41 ± 2.32 | ||
COPD | |||||
no | 2525 (94.82) | 215 (8.51) | 0.7113 | 7.30 ± 2.56 | 0.1561 |
yes | 138 (5.18) | 13 (9.42) | 7.61 ± 2.43 | ||
Liver disease | |||||
no | 2615 (98.20) | 224 (8.57) | 0.9545 | 7.31 ± 2.56 | 0.4408 |
yes | 48 (1.80) | 4 (8.33) | 7.60 ± 2.44 | ||
Hypercholesterolemia | |||||
no | 1614 (60.61) | 140 (8.67) | 0.7972 | 7.22 ± 2.59 | 0.0499 |
yes | 1049 | 88 (8.39) | 7.46 ± 2.50 | ||
Thyroid Disorder | |||||
no | 1950 | 175 (8.97) | 0.2082 | 7.19 ± 2.62 | <0.0001 |
yes | 713 | 53 (7.43) | 7.65 ± 2.34 |
Quality Indicators (QI) | Eligible Patients, No. (%) a | Overall Adherence, % | Hospital Variation, Range (%) |
---|---|---|---|
QI1: Aspirin prescribed within 3h of hospital arrival | 1549 (58.17) | 73.08 | 62.11–85.81 |
QI2: Beta-blockers within 12h of arrival | 785 (23.69) | 38.98 | 32.89–45.45 |
QI3: Clopidogrel within 12h of arrival | 2408 (90.42) | 67.86 | 62.68–73.27 |
QI4: Thrombolytics received within 30 min of hospital arrival | 971 (36.46) | 7.52 | 3.57–11.43 |
QI5: ECG within 10 min of hospital arrival | 2663 (100.00) | 62.49 | 57.74–71.84 |
QI6: Left ventricular function assessment | 2663 (100.00) | 62.79 | 56.33–67.53 |
QI7: Coronary angiography performed during hospital stay | 2663 (100.00) | 66.35 | 60.85–71.78 |
QI8: Primary PCI | 2366 (88.85) | 37.36 | 29.52–43.59 |
Prescription filled post-discharge | |||
QI9: Aspirin | 1549 (58.17) | 47.97 | 38.51–61.29 |
QI10: Beta-blocker | 785 (29.48) | 22.29 | 10.94–34.21 |
QI11: Clopidogrel | 2408 (90.42) | 45.35 | 35.36–53.59 |
QI12: Statin | 2020 (75.85) | 36.39 | 30.11–41.76 |
QI13: ACE inhibitor | 2567 (96.40) | 38.02 | 29.70–45.54 |
Outcome indicators | |||
In-hospital mortality | 2663 (100.00) | 8.56 | 5.56–12.50 |
Quality Indicators* | In−Hospital Mortality | Length of Stay | ||
---|---|---|---|---|
Adjusted β (p Value) | Unadjusted β (p Value) | Adjusted β (p Value) | Unadjusted β (p Value) | |
QI1 | −0.0258 (0.9014) | −0.0382 (0.8540) | 0.1668 (0.1880) | 0.2930 (0.0340) |
QI2 | 0.1174 (0.6616) | 0.1079 (0.6856) | 0.1873 (0.2207) | 0.2337 (0.1456) |
QI3 | 0.0238 (0.8831) | 0.0156 (0.9229) | 0.5278 (<0.0001) | 0.7994 (<0.0001) |
QI4 | 0.5451 (0.1898) | 0.6093 (0.1457) | −0.4913 (0.0351) | −0.4994 (0.0328) |
QI5 | 0.0342 (0.8177) | 0.0525 (0.7229) | −0.2179 (0.0159) | −0.2913 (0.0043) |
QI6 | 0.0048 (0.9742) | −0.0636 (0.6647) | 0.4251 (<0.0001) | 0.8413 (<0.0001) |
QI7 | −0.0786 (0.6057) | −0.1535 (0.3110) | 0.9974 (<0.0001) | 1.5171 (<0.0001) |
QI8 | −0.1276 (0.4603) | −0.2174 (0.2102) | 1.2699 (<0.0001) | 1.7515 (<0.0001) |
Factors | Regression Coefficient, 95%CI | p Value |
---|---|---|
STEMI vs. NSTEMI | 1.451 (1.026, 2.053) | 0.0379 |
Generalized vs. Specialized Hospital | 0.877 (0.613, 1.254) | 0.4270 |
Cerebra disease | 0.620 (0.355, 1.082) | 0.0849 |
Rheumatic Heart Disease (RHD) | 2.346 (0.070, 78.121) | 0.4952 |
Composite score (per 10%) | 1.003 (0.937, 1.073) | 0.9284 |
Factors | Regression Coefficient, 95%CI | p Value |
---|---|---|
Age | ||
50–60 vs. ~50 | 0.481 (0.132, 0.829) | 0.0069 |
60–70 vs. ~50 | 0.751 (0.432, 1.071) | <0.0001 |
70~ vs. ~50 | 0.587 (0.282, 0.891) | 0.0002 |
Insurance | ||
Government vs. Uninsured | 0.147 (−0.059, 0.354) | 0.1623 |
Private vs. Uninsured | 0.202 (−0.069, 0.474) | 0.1443 |
Prior MI/CAD | 0.021 (−0.210, 0.251) | 0.8595 |
History of Hypertension | 0.137 (−0.091, 0.365) | 0.2401 |
STEMI vs. NSTEMI | 2.049 (1.871, 2.227) | <0.0001 |
Generalized vs. Specialized hospital | 0.168 (−0.164, 0.499) | 0.3213 |
thyroid | 0.257 (0.058, 0.455) | 0.011 |
lipids | 0.179 (−0.001, 0.359) | 0.051 |
Composite score (per 10%) | 0.258 (0.217, 0.299) | <0.0001 |
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Rehman, S.; Li, X.; Wang, C.; Ikram, M.; Rehman, E.; Liu, M. Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study. Int. J. Environ. Res. Public Health 2019, 16, 3890. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16203890
Rehman S, Li X, Wang C, Ikram M, Rehman E, Liu M. Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study. International Journal of Environmental Research and Public Health. 2019; 16(20):3890. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16203890
Chicago/Turabian StyleRehman, Shazia, Xi Li, Chao Wang, Muhammad Ikram, Erum Rehman, and Meina Liu. 2019. "Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study" International Journal of Environmental Research and Public Health 16, no. 20: 3890. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph16203890