胸痛中心认证对急性主动脉夹层住院治疗效果的影响:一项在中国进行的全国性研究。

IF 16.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Military Medical Research Pub Date : 2024-08-26 DOI:10.1186/s40779-024-00565-0
Li-Wei Liu, Yi-Kai Cui, Lin Zhang, Dai-Le Jia, Jing Wang, Jia-Wei Gu, Jin-Yan Zhang, Zhen Dong, Xue-Juan Jin, Xiao-Yi Zou, Guo-Li Sun, Yu-Xiang Dai, Ai-Jun Sun, Jun-Bo Ge
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引用次数: 0

摘要

背景:国家胸痛中心项目(NCPCP)是一项全国性的质量提升项目,旨在提高中国急性胸痛患者的救治水平。胸痛中心(CPC)认证对急性冠脉综合征的益处已得到证实。然而,尚无证据表明胸痛中心认证是否能改善急性主动脉夹层(AAD)患者的预后:方法:我们利用国家卫计委从 2016 年 1 月 1 日至 2022 年 12 月 31 日的数据,对中国 1671 家医院的 AAD 患者进行了回顾性观察研究。患者分为两组:评审前和评审后入院。研究结果包括院内死亡率、误诊率和斯坦福A型AAD手术率。我们采用多变量逻辑回归来探讨 CPC 评审与院内预后之间的关系。此外,我们还根据医院的地理位置(东部/中部/西部地区)或行政地位(省会/非省会地区)对医院进行了分层,以评估 CPC 评审对不同地区 AAD 患者的影响:结果:分析涵盖了40,848名确诊为AAD的患者。通过评审后的一组患者的院内死亡率和误诊率明显降低(12.1% 对 16.3%,P 结论:CPC 评审与 AAD 的治疗效果相关:CPC 评审与改善 AAD 患者的管理和院内预后相关。
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Effectiveness of chest pain center accreditation on the hospital outcome of acute aortic dissection: a nationwide study in China.

Background: The National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. The benefits of chest pain center (CPC) accreditation on acute coronary syndrome have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD).

Methods: We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016 to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis, and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions.

Results: The analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.1% vs. 16.3%, P < 0.001 and 2.9% vs. 5.4%, P < 0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.1% vs. 42.1%, P < 0.001) compared with the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR 0.644, 95% CI 0.599-0.693) and misdiagnosis (adjusted OR 0.554, 95% CI 0.493-0.624), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR 1.973, 95% CI 1.797-2.165). Following CPC accreditation, there were significant reductions in in-hospital mortality across various regions, particularly in Western regions (from 21.5 to 14.1%). Moreover, CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities (adjusted OR 0.607 vs. 0.713).

Conclusion: CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.

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来源期刊
Military Medical Research
Military Medical Research Medicine-General Medicine
CiteScore
38.40
自引率
2.80%
发文量
485
审稿时长
8 weeks
期刊介绍: Military Medical Research is an open-access, peer-reviewed journal that aims to share the most up-to-date evidence and innovative discoveries in a wide range of fields, including basic and clinical sciences, translational research, precision medicine, emerging interdisciplinary subjects, and advanced technologies. Our primary focus is on modern military medicine; however, we also encourage submissions from other related areas. This includes, but is not limited to, basic medical research with the potential for translation into practice, as well as clinical research that could impact medical care both in times of warfare and during peacetime military operations.
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