Key result
ACC Chest Pain Center accreditation was associated with higher rates of coronary angiography (98.6% vs. 97.9%, P<0.0001) and guideline-based treatments for MI compared to nonaccredited hospitals.
Why the study?
Whether American College of Cardiology Chest Pain Center accreditation alters guideline adherence rates remains unclear.
Does ACC Chest Pain Center accreditation improve adherence to guideline-recommended management in patients with acute myocardial infarction?
Observational (n=192,374)
Yes
Does ACC Chest Pain Center accreditation improve adherence to guideline-recommended management in patients with acute myocardial infarction?
Absolute Event Rate: 98.6% vs 97.9%
p-value: p=< 0.0001
ACC Chest Pain Center accreditation is associated with small but statistically significant improvements in adherence to guideline-based catheter care and discharge medications for MI patients, though some time-to-treatment metrics were better at nonaccredited centers.
Accreditation linked to small gains in NSTEMI revascularization and discharge meds; leaves open whether it improves outcomes or merits routine pursuit.
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 January 1, 2019, to December 31, 2020, 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 nonaccredited hospitals were numerically small, although frequently significant. Patients at accredited hospitals were more likely to undergo coronary angiography (98.6% vs. 97.9%, P < 0.0001), percutaneous coronary intervention 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). Nonaccredited 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, 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.
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A 2021 study conducted an observational in myocardial infarction (MI) (n=192,374). ACC Chest Pain Center accreditation vs. Nonaccredited hospitals was evaluated on coronary angiography (p=< 0.0001). ACC Chest Pain Center accreditation was associated with higher rates of coronary angiography (98.6% vs. 97.9%, P<0.0001) and guideline-based treatments for MI compared to nonaccredited hospitals.
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