Table of Contents
EDITORIAL
Year : 2016  |  Volume : 1  |  Issue : 3  |  Page : 1-3

Acceleration of chest pain center construction and improvements for the treatment of acute myocardial infarction in China


1 Department of Cardiology, Peking University First Hospital, Beijing, China
2 Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China

Date of Web Publication26-Dec-2018

Correspondence Address:
Prof. Yong Huo
Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 108 Fenglin Road, 200032 Shanghai
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2470-7511.248350

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  Abstract 


At present, cardiovascular disease (CVD) prevention and control in China is in crisis. The level of acute coronary syndrome treatment and the establishment of modern treatment guidelines in China lag behind those other developed countries. The Chinese Medical Association, the Chinese Association of Cardiovascular Health, and the Cardiovascular Health Alliance have developed a program to accelerate the construction of China Chest Pain Centers (CCPC) and stringent certification requirements. The program includes (1) establishing demonstration centers in 60 cities throughout China, (2) development of guidelines for the construction and certification of regional and primary chest pain centers, (3) expansion of the number of training instructors and certification experts, (4) expansion of the scale and frequency of training, (5) quality improvements to the overall training system, and (6) quality improvements to key assessment indicators information systems and related initiatives. We propose the establishment of 40 chest pain center demonstration bases through the provision of guidance and training to 2500 hospitals toward the goals of promotion, construction, and certification of 1000 chest pain centers in China between 2016 and 2018.

Keywords: Acute myocardial infarction, chest pain center, emergency cardiac care


How to cite this article:
Huo Y, Ge J. Acceleration of chest pain center construction and improvements for the treatment of acute myocardial infarction in China. Cardiol Plus 2016;1:1-3

How to cite this URL:
Huo Y, Ge J. Acceleration of chest pain center construction and improvements for the treatment of acute myocardial infarction in China. Cardiol Plus [serial online] 2016 [cited 2021 Mar 3];1:1-3. Available from: https://www.cardiologyplus.org/text.asp?2016/1/3/1/248350




  Introduction Top


The 2015 China CVD Report indicates that there are 290 million patients in China with CVD including coronary heart disease, stroke, heart failure, hypertension, and a trend of rapid growth. Mortality from CVD is the leading cause of death in China, which is higher than that of cancer and other diseases. Two out of every five deaths in China are related to CVD.

The 2015 Lancet article, “Assessment of the Medical Treatment Results in Coronary Heart Disease and Clinical Translational Research” (China PEACE),[1] reported no significant improvement in the total hospital mortality of ST-segment elevation myocardial infarction (STEMI) patients between 2001 and 2011. Furthermore, emergency percutaneous coronary intervention (PCI) rates rose from 10.6% to 28.1%; intravenous thrombolysis rates decreased from 42% to 18%; and STEMI hospital mortality rates maintained at 10%–11% in tertiary hospitals in China. World Bank estimates that by 2030, the number of people suffering from myocardial infarction in China will surge to 22.63 million from the current 8.1 million.[2] In Western countries, the CVD mortality rate has declined gradually over the past 20 years as the incidence and mortality in China has increased rapidly. Improving the treatment level of acute myocardial infarction (AMI) and creating access to higher quality medical services in China has become imperative. The China Chest Pain Center (CCPC) model of emergency rescue and treatment of acute CVD offers patients with acute coronary syndrome (ACS) a reduction in treatment time, a decreased rate of mortality, and a decreased incidence of complications.

In 1981, the first US chest pain center was established at St. Agnes Hospital. The Society of Chest Pain Centers (SCPC) and the American SCPC were founded in 1998 followed by the SCPC Certification Committee in 2001. As of this writing, there are nearly 1000 accredited chest pain centers in the US. A total of 1,374,232 patients with STEMI from 2157 hospitals were treated with PCI in the United States between 1990 and 2006. The average time interval of infarct-related blood vessels reopened (door-to-balloon or D-to-B) decreased from 111 min per patient in 1994 to 79 min in 2006 (P < 0.001), while the overall mortality rate decreased from 8.6% to 3.1% (P < 0.001).[3] Since 2009, the CPC model has achieved positive results with an average D-to-B interval of 67 min for patients with STEMI in the United States.[4],[5] Since then, the CPC model has been established in hospitals throughout Britain, France, Canada, Australia, and Germany. Today, Germany's CPCs are the most advanced internationally. Results from a German chest pain unit registration study published in 2012 showed that the average time of STEMI patients presenting disease symptoms to the first medical contact (FMC) was 2.08 h. Nearly 97% of STEMI patients received emergency PCI treatment with an average D-to-B interval of 31 min,[6],[7]

The CCPC Independent Certification System (CCPICS) was established in September 2013. The medical affairs authority of China's National Health and Family Planning Commission authorized the cardiovascular disease (CVD) branch of the Chinese Medical Association to oversee China's chest pain center certification process. As of this writing, CCPICS is the third such certification system in the world. Basing its model on the certification standards developed by the Association of Society of Chest Pain Centers and the German Heart Association, the CCPC Committee (CCPCC) established its own certification system to address the health crisis in China. The first version of the chest pain certification standards for China was developed in 2013 and continues to be updated annually.[8] In February 2014, five chest pain centers achieved certification in China. Since September 2016, eight groups totaling 84 chest pain centers achieved certification. Nearly 300 hospitals are registered for construction and currently await verification and certification. In 2016, CCPCC developed its first primary chest pain center certification standards to guide and assist primary medical institutions applying for chest pain center certification. Data from certified chest pain centers in China suggest that the average D-to-B times for STEMI patients are between 60 and 90 min. FMC to myocardial reperfusion time was also reduced significantly in most of these chest pain centers. These events suggest the chest pain center model dramatically improves the quality of AMI treatment in China.[9],[10],[11] Nevertheless, only 84 chest pain centers obtained certification in the past 3 years – an unsatisfactory rate considering the growing health crisis. Therefore, we strongly recommend escalating the importance of the promotion and certification of chest pain centers in China.

The construction of chest pain center systems will (1) allow more CVD and other critical-to-severe patients timely and more effective treatment, (2) relieve the current chest pain center “supply and demand” imbalance, and (3) enhance acute CVD treatment and medical service capacity for patients in China. In April 2016, at the 19th National Interventional Cardiology Forum, the Chinese Cardiovascular Health Alliance/Chest Pain Center Committee signed a strategic cooperation agreement to accelerate the development of chest pain centers across China according to following aims:

  1. Build regional demonstration centers in 60 cities across China
  2. Guide and establish regional and grassroots chest pain center construction and certification
  3. Expand the number of training instructors and certification experts
  4. Expand the type, scale, and frequency of training
  5. Continuously improve the quality of the training system and key assessment indicators
  6. Assist in the evaluation and certification system of chest pain centers
  7. Establish an information quality control system and regional collaborative treatment platform
  8. Develop a grassroots chest pain assessment system.


The CCPCC goals for 2016–2018 are to:

  1. Establish 40 demonstration centers
  2. Promote 1000 hospital certifications
  3. Conduct 1500 onsite hospital chest pain centers inspections
  4. Train 2500 hospital chest pain center faculty and staff.


The CCPICS current goals are to:

  1. Certify 150 chest pain centers in 2016
  2. Certify 350 chest pain centers in 2017
  3. Certify 500 chest pain centers in 2018.


China has unique national healthcare conditions. The allocation of medical resources is severely challenged, given the large size of its rural population. In May 2015, there were 922,000 primary healthcare institutions and 26,000 hospitals in China. Among those, primary PCI is conducted for the treatment of AMI in only 1200 medical institutions, most of which are concentrated in large- and medium-sized cities. To improve the quality of the treatment of ACS patients in China, greater importance must be attached to the construction of chest pain centers in primary hospitals. It is essential to establish primary chest pain centers in suitable locations to (1) optimize collaborations with nearby county municipal medical institutions, (2) promote achievement of the standards established for chest pain centers, (3) simplify chest pain center reporting and the certification process, (4) streamline the medical institution application and certification process, (5) strengthen the guidance and supervision of chest pain centers, (6) standardize surgical procedures within chest pain centers, and (7) promote quality improvement among all chest pain centers. Through the efforts of the CCPCC and the construction of chest pain centers throughout China, the treatment of AMI patients in China will improve significantly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Li J, Li X, Wang Q, Hu S, Wang Y, Masoudi FA, et al. ST-segment elevation myocardial infarction in china from 2001 to 2011 (the China PEACE-retrospective acute myocardial infarction study): A retrospective analysis of hospital data. Lancet 2015;385:441-51.  Back to cited text no. 1
    
2.
The World Bank. Toward a Healthy and Harmonious Life in China: Stemming the Rising Tide of Non-Communicable Diseases[R/OL]. Washington, DC, USA: The World Bank, 2011.  Back to cited text no. 2
    
3.
Gibson CM, Pride YB, Frederick PD, Pollack CV Jr., Canto JG, Tiefenbrunn AJ, et al. Trends in reperfusion strategies, door-to-needle and door-to-balloon times, and in-hospital mortality among patients with ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J 2008;156:1035-44.  Back to cited text no. 3
    
4.
Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med 2013;369:901-9.  Back to cited text no. 4
    
5.
Rybicki FJ, Udelson JE, Peacock WF, Goldhaber SZ, Isselbacher EM, Kazerooni E, et al. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS appropriate utilization of cardiovascular imaging in emergency department patients with chest pain: A joint document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol 2016;67:853-79.  Back to cited text no. 5
    
6.
Post F, Giannitsis E, Riemer T, Maier LS, Schmitt C, Schumacher B, et al. Pre- and early in-hospital procedures in patients with acute coronary syndromes:First results of the “German Chest Pain Unit Registry”. Clin Res Cardiol 2012;101:983-91.  Back to cited text no. 6
    
7.
Breuckmann F, Burt DR, Melching K, Erbel R, Heusch G, Senges J, et al. Chest pain centers: A comparison of accreditation programs in Germany and the United States. Crit Pathw Cardiol 2015;14:67-73.  Back to cited text no. 7
    
8.
China Chest Pain Center Certification Work Committee. China chest pain center certification standard (revised November 2015). Chin J Interv Cardiol 2016;3:121-30.  Back to cited text no. 8
    
9.
China Chest Pain Center Certification Work Committee. China chest pain center certification standard (revised November 2015). Chin J Interv Cardiol 2016;3:131-3.  Back to cited text no. 9
    
10.
Wang B, Wang Y, Ye T, Xiao G, Chang H, Wen H, et al. Integrated regional network construction for ST-segment elevation myocardial infarction care. Zhonghua Xin Xue Guan Bing Za Zhi 2014;42:650-4.  Back to cited text no. 10
    
11.
Gong Z, Xiang D, Dong F. Effect of regional cooperative treatment system on time points of patients with acute St-elevation myocardial infarction in non-percutaneous coronary intervention hospitals. Chin J Interv Cardiol 2015;23:125-8.  Back to cited text no. 11
    




 

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