P4490Quality matters: classification of centres by quality of care in acute myocardial infarction using the ESC-Acute Cardiac Care Association quality indicators

Background: ESC-Acute Cardiac Care Association Quality Indicators (ESC-ACCA QI) enable assessment of quality of care (QoC) as well as benchmarking and classification of centres. How centres can be classified, and whether classification grade is related to outcomes is poorly documented. Methods: ESC-ACCA QIs were applied in patients included in the FAST-MI 2005, 2010 and 2015 registries. Centres with >15 patients included were categorized as low, medium and high quality according to the Composite QI (by comparison with the national mean of the composite QI). One-year survival adjusted for period, type of AMI, quintiles of GRACE risk score, LVEF, age, diabetes and atrial fibrillation was compared across center quality categories. Results: The quality analysis included 10 565 patients included in 95 centers (n=2676 pts) in 2005, 100 centers (n=3371) in 2010 and 125 centers (n=4518) in 2015. There was a significant increase in the composite QI over time (0.67±0.19, 0.73±0.19, 0.77±0.20 in 2005, 2010 and 2015 respectively, p<0.001 for trend). As a result, centers were classified as follows: low quality 21%, medium quality 48% and high quality 31% (figure), with respective crude one year survival of 0.89±0.05, 0.90±0.06 and 0.92±0.10. Multivariate analysis showed that 1-year survival was 35% higher in high quality, and 24% higher in medium quality centers compared to low quality centers (p<0.001).