Trends in the incidence and management of acute myocardial infarction from 1999 to 2008: Get with the guidelines performance measures in Taiwan

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Abstract

Background: The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan. Methods and Results: We used the Taiwan National Health Insurance Research Database (1999-2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age-adjusted incidence of AMI (100 000 person-years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline-based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β-blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in-hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, b-blocker, and statin use during hospitalization were all associated with reduced in-hospital mortality in our AMI patients. Conclusions: AMI incidence was increasing, but the guideline-based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.

Original languageEnglish
Article numbere001066
JournalJournal of the American Heart Association
Volume3
Issue number4
DOIs
Publication statusPublished - 2014 Jan 1

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Taiwan
Myocardial Infarction
Guidelines
Incidence
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Quality of Health Care
Angiotensin Receptor Antagonists
Hospital Mortality
Angiotensin-Converting Enzyme Inhibitors
National Health Programs
Quality Improvement
Compliance
Hospitalization
Cohort Studies
Databases
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{c9498473d12545ddb23319c45dc5bab0,
title = "Trends in the incidence and management of acute myocardial infarction from 1999 to 2008: Get with the guidelines performance measures in Taiwan",
abstract = "Background: The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan. Methods and Results: We used the Taiwan National Health Insurance Research Database (1999-2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age-adjusted incidence of AMI (100 000 person-years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline-based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65{\%} in 2004 to 83.9{\%} in 2008 (P<0.001). Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6{\%} in 2004 and 71.7{\%} in 2008 (P=NS) and β-blocker was used in 60{\%} in 2004 and 59.7{\%} in 2008 (P=NS). Statin use increased from 32.1{\%} to 50.1{\%} from 2004 to 2008 (P<0.001). The in-hospital mortality decreased from 15.9{\%} in 1999 to 12.3{\%} in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, b-blocker, and statin use during hospitalization were all associated with reduced in-hospital mortality in our AMI patients. Conclusions: AMI incidence was increasing, but the guideline-based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.",
author = "Cheng-Han Lee and Ching-Lan Cheng and Yea-Huei Kao and Ting-Hsing Chao and Zi-Yi Chen and Ping-Yen Liu and Chih-Chan Lin and Shih-Hung Chan and Liang-Miin Tsai and Chen, {Jyh Hong} and Lin, {Li Jen} and Yi-Heng Li",
year = "2014",
month = "1",
day = "1",
doi = "10.1161/JAHA.114.001066",
language = "English",
volume = "3",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
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TY - JOUR

T1 - Trends in the incidence and management of acute myocardial infarction from 1999 to 2008

T2 - Get with the guidelines performance measures in Taiwan

AU - Lee, Cheng-Han

AU - Cheng, Ching-Lan

AU - Kao, Yea-Huei

AU - Chao, Ting-Hsing

AU - Chen, Zi-Yi

AU - Liu, Ping-Yen

AU - Lin, Chih-Chan

AU - Chan, Shih-Hung

AU - Tsai, Liang-Miin

AU - Chen, Jyh Hong

AU - Lin, Li Jen

AU - Li, Yi-Heng

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan. Methods and Results: We used the Taiwan National Health Insurance Research Database (1999-2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age-adjusted incidence of AMI (100 000 person-years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline-based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β-blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in-hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, b-blocker, and statin use during hospitalization were all associated with reduced in-hospital mortality in our AMI patients. Conclusions: AMI incidence was increasing, but the guideline-based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.

AB - Background: The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan. Methods and Results: We used the Taiwan National Health Insurance Research Database (1999-2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age-adjusted incidence of AMI (100 000 person-years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline-based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β-blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in-hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, b-blocker, and statin use during hospitalization were all associated with reduced in-hospital mortality in our AMI patients. Conclusions: AMI incidence was increasing, but the guideline-based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.

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