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 overweight and more likely to develop traditional CHD risk factors.4,5 Cigarette smoking has already reached epidemic proportions, as over 50% of working age men actively smoke.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 fibrinolysis 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. We are also unaware of how treatment differs by hospital or whether documentation practices are of sufficient quality to permit performance improvement.
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 will incorporate experience from the US National Cardiovascular Data Registry (NCDR) to facilitate cross-country comparison. Core topic areas will include treatment for acute myocardial infarction, in-depth examination of PCI processes and outcomes, and longitudinal study of patients with multi-vessel coronary artery disease.
More details regarding China PEACE can be found at www.clinicaltrials.gov
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.