China PEACE (Patient-centered Evaluative Assessment of Cardiac Events)
Coronary heart disease (CHD) mortality has declined by half in most industrialized countries over the past 30 years.1 However, CHD mortality has increased substantially in China over the same time period.2,3 These trends are expected to continue as the Chinese population becomes more Westernized and more likely to develop traditional CHD risk factors.4,5
While knowledge of the clinical epidemiology of cardiovascular disease within China continues to grow, our understanding of treatment patterns for patients hospitalized with CHD remains limited. We lack basic information about the use of standard revascularization strategies such as fibrinolytic therapy and percutaneous coronary intervention (PCI), preferences for different anti-thrombotic regimens, adherence to quality measures commonly used in the US, and resultant outcomes including in-hospital death, stroke, and bleeding. Little is known about whether patterns of care differ across geographic regions or hospital type and whether documentation practices are of sufficient quality to permit performance assessment.
To deepen our understanding of current treatment for cardiovascular disease and identify areas for quality improvement, CORE is collaborating with the China National Center for Cardiovascular Diseases, the Chinese Ministry of Health, and an international team of researchers to develop three prospective and two retrospective registries for CHD. These registries will be part of the larger China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Initiative. Each will be national in scope and intended to be a prelude to a national quality improvement initiative in China.
More details regarding China PEACE can be found at www.clinicaltrials.gov
Project 1: The China PEACE-Retrospective AMI Study
In this first study from the China PEACE collaboration, we sought to generate knowledge about the characteristics, treatments, and outcomes of patients hospitalized with AMI in China during the past decade. We examined a nationally representative sample of more than 18,000 patient records from 162 randomly selected hospitals for 2001, 2006 and 2011. The specific aims of the study are to:
1) Describe the characteristics of patients hospitalized with AMI in China
2) Characterize patterns of in-hospital treatment
3) Describe mortality rates and other in-hospital outcomes
4) Determine trends over time in patient characteristics, treatments and outcomes
5) Develop and test prognostic scores to stratify risk
6) Compare treatment across regions and hospitals and determine whether differences in treatment patterns by setting may be associated with differences in outcomes
7) Examine the alignment of diagnostic testing and treatment strategies with quality measures
8) Compare differences in patient characteristics, treatment approaches, and outcomes between China and other countries
9) Determine the quality of documentation within the medical record
10) Collaborate with participating hospitals and the Chinese government to disseminate study findings to improve quality of care and outcomes
Project 2: The China PEACE-Retrospective CathPCI Study
In the second project, we sought to assess the characteristics, treatments, and outcomes of patients who receive diagnostic catheterization and PCI in a large nationally representative sample of 55 Chinese hospitals during 2001, 2006 and 2011. This study provides a unique opportunity to compare variation in care patterns and outcomes across hospitals, regions, and time in the context of an era of rapid adoption of new cardiovascular technologies. The specific aims of the study are to:
1) Describe the characteristics of patients undergoing coronary catheterization or PCI in China
2) Characterize patterns of treatment including the use of procedural technologies and adjunctive therapies
3) Describe in-hospital outcomes such as mortality, treatment complications, length of stay, and hospital charges
4) Characterize differences in treatment and outcomes by patient characteristics, hospital, region, and year of study
5) Examine adherence to quality measures for PCI
1. Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 1999;353:1547-57.
2. Critchley J, Liu J, Zhao D, Wei W, Capewell S. Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999.Circulation 2004;110:1236-44.
3. Cheng J, Zhao D, Zeng Z, et al. The impact of demographic and risk factor changes on coronary heart disease deaths in Beijing, 1999-2010.BMC Public Health 2009;9:30.
4. Zhang XH, Lu ZL, Liu L. Coronary heart disease in China.Heart 2008;94:1126-31.
5. Ueshima H, Sekikawa A, Miura K, et al. Cardiovascular disease and risk factors in Asia: a selected review.Circulation 2008;118:2702-9.