Table of Contents
MINI REVIEW
Year : 2017  |  Volume : 2  |  Issue : 2  |  Page : 18-21

Chest pain centers in China: Current status and prospects


Department of Cardiovascular, Guangzhou General Hospital Guangzhou Command, Guangzhou, China

Date of Web Publication26-Dec-2018

Correspondence Address:
Prof. Xiang Dingcheng
Department of Cardiovascular, Guangzhou General Hospital Guangzhou Command, Guangzhou 510010
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2470-7511.248469

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  Abstract 


The goal of the China chest pain center (CPC) is to optimize the diagnosis and treatment processes for patients with acute chest pain by establishing a regional cooperative rescue system. This article introduces the developing history, accreditation criteria, current status, efficiencies of accreditation, and prospects of the China CPC.

Keywords: Accreditation, acute chest pain, acute myocardial infarction, chest pain center


How to cite this article:
Dingcheng X, Shaodong Y. Chest pain centers in China: Current status and prospects. Cardiol Plus 2017;2:18-21

How to cite this URL:
Dingcheng X, Shaodong Y. Chest pain centers in China: Current status and prospects. Cardiol Plus [serial online] 2017 [cited 2021 Jul 30];2:18-21. Available from: https://www.cardiologyplus.org/text.asp?2017/2/2/18/248469




  Introduction Top


A chest pain center (CPC) is an integrated medical rescue model based on a normalized diagnosis and treatment process for patients with acute chest pain, especially acute myocardial infarction (AMI). CPCs were established in China 30 years later than in the United States but were developed more rapidly by comparison. This article will introduce the history, current status, and prospects for China CPCs.


  The Urgency to Develop Chest Pain Centers in China Top


The morbidity and mortality of AMI in China have increased year by year, and the in-hospital mortality rate of ST-elevation myocardial infarcts (STEMI) has shown little improvement over the past 10 years.[1],[2] Due to the prevalence of risk factors and an aging population, China will have at least 75 million new cases of AMI patients in the next 15 years, which will place a serious disease burden on existing health services.[3] In addition, the treatment processes for patients with acute chest pain, especially STEMI patients, face the following challenges:[4],[5] (1) a lack of standardized diagnosis and treatment process along with high rates of missed and misdiagnosis cases, (2) inefficient use of medical resources caused by the coexistence of excessive/insufficient diagnosis and treatment processes, (3) a much longer reperfusion time caused by various delays compared to guideline requirements, (4) a low proportion of early reperfusion (only 5% of the STEMI patients received primary percutaneous coronary intervention [PPCI] before 2012), and (5) a lack of standardized management of AMI patients and inadequate secondary prevention measures.[2],[4] The above problems are the result of the lack of a comprehensive medical rescue system and a standardized process of diagnosis and treatment for patients with acute chest pain. The CPC is specifically designed to optimize the diagnosis and treatment process for patients with acute chest pain during which early reperfusion therapy of STEMI patients is the first step. Therefore, it is of great significance and necessity to develop standardized CPCs in China.


  History of Chest Pain Centers in China Top


The genesis of CPCs can be found in the development of the in-hospital green channel for STEMI patients promoted by Prof. Dayi Hu in the 1990's.[5] The first chest pain unit was established in 2002 in Jinan, Shandong Province. The Chinese Consensus on CPC Construction of 2010 served as a catalyst for the development of China CPCs. The first regional collaborative chest pain rescue network was established by Guangzhou General Hospital of PLA in 2011,[6] which marked the beginning of CPCs in China. In 2012, two CPCs in Guangzhou General Hospital of PLA and Shanghai Chest Hospital were accredited by the America-based Society of Cardiovascular Patient Care (previously the Society of CPCs). Based on these events, especially the new model of a regional collaborative rescue network at Guangzhou General Hospital of PLA, the Chinese Society of Cardiology (CSC) released the Accreditation Criteria of China CPCs for PPCI-capable hospitals.[7] The CSC then established the CPC Accreditation Working Committee and the Accreditation Office in Guangzhou in 2013 to undertake CPC accreditation which resulted in the approval of its first accreditations the same year. In 2015, the CSC released the Accreditation Criteria for Basic CPC for non-PCI-capable hospitals[8] to guide the construction of CPCs in community hospitals. The China CPC headquarters was later established at China Heart House in Suzhou on July 16, 2016 to accelerate the development of CPCs.[5] [Figure 1] illustrates the history of CPCs in China.
Figure 1: History of chest pain centers in China

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  Current Status of Chest Pain Centers in China Top


Since 2011, the construction of CPCs in China has resulted in the following achievements:

A: Established the Chinese model of CPCs based on the successful development of a regional collaborative rescue network.[4],[5],[6] This model addresses the above-mentioned problems in STEMI treatment in China, including the lack of effective green channels in PPCI-capable hospitals, inadequate diagnostic capacities of community hospitals, and a lack of effective and timely communication mechanisms between the prehospital/in-hospital stages and between the different levels of hospitals. Moreover, the Emergency Medical Service System (EMS) ambulances usually take chest pain patients to the nearest hospital regardless of the hospital's treatment capacity, which frequently results in the second referral for many STEMI patients. As the first standardized pilot CPC in China, Guangzhou General Hospital of PLA proposed the concept of integrated regional medical resources then created the first regional collaborative rescue network.[6] Regional information sharing and prehospital diagnosis were achieved through remote transmission of real-time electrocardiograms (ECGs) and the use of WeChat mobile application software. STEMI patients can now bypass the emergency room and coronary care unit and be sent directly to the catheterization laboratory. As of this writing, the regional collaborative rescue system has become the gold standard for CPCs in China.[7],[8]

B: Established accreditation organizations for China CPCs.[5] Under the authorization of the National Health and Family Planning Commission, the CSC founded several accreditation organizations in September 2013, including the Accreditation Steering Committee, Accreditation Working Committee, and Accreditation Office. The Accreditation Office is a permanent office located at the General Hospital of Guangzhou Military Command of PLA, Guangzhou. The rapid development of CPCs gradually increased the workload of managing CPC accreditations. Subsequently, three regional accreditation offices were established in 2016 in Wuhan, Xiamen, and Harbin, respectively, to share the accreditation work. In February 2016, the China CPC Accreditation Supervision Committee was founded to oversee the accreditation process and to address various complaints and reports to ensure that the accreditation process upholds the highest ethical standards. In 2016, the CPC established a quality control office at Shanghai Chest Hospital to supervise accredited CPCs and facilitate continuous quality improvement through the publication of operation status reports and the key performance indexes of accredited CPCs. In July 2016, a China CPC headquarters was established under the auspices of the China Cardiovascular Health Alliance in Suzhou. The headquarters is responsible for the coordination of resources, national CPC training, and education while the accreditation offices maintain full responsibility for CPC-associated accreditation.

C: Developed accreditation criteria for CPCs. The China CPC Accreditation Committee released the China CPC Accreditation Criteria[6] in Guangzhou on September 14, 2013, later updated on November 13, 2015 to the current V5.0 version. The Accreditation criteria of China basic chest pain center[8] was issued at the same time with the goal of providing guidance to community hospitals without full PPCI capacity. Each of the two standards contains the identical five key criteria, including: (1) the basic conditions and qualifications of facilities, (2) the assessment and treatment of acute chest pain, (3) the seamless cooperation between prehospital emergency and in-hospital green channel, (4) training and education, and (5) continuous quality improvement. China CPC Accreditation Criteria V5.0 places more emphasis on fast and standardized treatment of acute chest pain at PPCI-capable hospitals and emphasizes the importance of PPCI as the primary choice of reperfusion therapy for STEMI patients. Accreditation Criteria for Basic CPC V1.0 targets PPCI hospitals not a full capacity and recommends more reperfusion choices, such as transport PPCI, thrombolysis, and PPCI if future conditions apply.

D: Promoted the rapid and standardized development of CPCs across China. [Figure 2] and [Figure 3] illustrate the rapid increase in the number of registered and accredited CPCs after formal accreditation was initiated in 2013. During the past 3½ years, more than 2000 CPCs were registered nationally of which 181 were accredited in 11 batches. More hospitals are building their own CPCs and are expected to apply for accreditation over the next 1–2 years.
Figure 2: Trend of registered chest pain centers in China

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Figure 3: The number of approved chest pain centers in each batch of accreditation

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E: Established CPC quality control system.[5] The CPC quality control system uses a cloud data platform for accreditation and includes 15 key performance indexes that cover the entire process from symptom onset to the end of key therapies. The quality control office of China CPC releases quality control reports every month and ranks all of the accredited CPCs by each a standard performance index to encourage improvements.

F: Significantly improved the treatment efficiency and prognosis of STEMI patients. Published data of single CPCs[9],[10],[11],[12] along with data from the CPC accreditation cloud platform suggest that accredited CPCs significantly reduce the delay in diagnosis and treatment for STEMI patients. The average time from first medical contact to first ECG was decreased to ±7.9 min; the average door-to-balloon time for STEMI patients was decreased to ±78 min. The ratio rate of transmitting prehospital EKGs increased significantly to 47% for STEMI patients, which enabled 34.6% of PPCI patients to bypass the emergency room and coronary care unit to enter catheter room immediately. The in-hospital mortality of STEMI patients was reduced from 6.5% to 3.4% while the incidence of in-hospital heart failure was reduced by 10%.

G: Established the highest national academic platform for CPCs, the China CPC Summit Forum[13] has been held for 6 consecutive years. In its first few years, the Forum was focused on promoting the concept of CPCs which stimulated the rapid development of CPC construction. Accordingly, the primary task of the Forum evolved to explore prevailing theory and practice norms, updating the standards, quality control, training and education, and announcing CPC achievements. The Forum changed its name to the China CPC Congress in 2017 to more fully embrace its current trajectory and significance.

H: Obtained strong government support and established a successful model for the positive influence of experts and academic organizations on relevant national policy. Based on the successful experience of CPCs, the General Office of the State Health Insurance Commission issued the Notice on Enhancing the Rescue Ability of Acute Cardiovascular and Cerebrovascular Diseases on March 17, 2015, requiring that CPCs were developed more rapidly in locations where conditions permit. As of this writing, more than ten provincial health administrative departments have announced the requirements for local medical facilities to promote the construction of CPCs. In some provinces, the CPC is a prerequisite for the qualification of key disciplines and hospital grade review. The Provincial CPC Alliance has become an important forum to promote escalated development of CPCs.


  Prospects for China Chest Pain Centers Top


The construction of CPCs in China has entered into an era of rapid development and important challenges. Therefore, the following strategies are recommended for strong consideration: (1) the rapid growth and beneficial impact of CPCs require ongoing encouragement. The strict enforcement of and adherence to accreditation standards must continue in order to control and improve the quality of CPCs. However, the treatment of AMI in China will not improve if the rapid growth of CPCs is encouraged at the expense of their quality; (2) A regional collaborative rescue system centered on EMS should be established when the number of CPCs reaches a predetermined goal. A distribution map of CPCs within each city can be issued along with an information sharing platform created for EMS and accredited CPCs. Once dispatched, EMS can transport patients with acute chest pain to the nearest CPCs at accredited hospitals to receive the most appropriate treatment within the shortest possible time; (3) Continuous quality control and quality improvement measures of accredited CPCs must be emphasized, and key performance indexes should be integrated into the reaccreditation process. A phase-out mechanism should be developed to reinforce the commitment to continuous improvement; and (4) The success of CPCs can be shared to guide and expand the construction and accreditation of CPCs in other Asian regions and countries in alignment with China's “One Belt, One Road” vision.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Xiang DC, Duan TB, Qin WY, Luo WS, Zhang JX, Yi SD, et al. Impacts of a normalized chest pain center on the door-to-balloon time and the short-term outcomes after primary percutaneously coronary intervention in the patients with ST segment elevated myocardial infarction. Zhonghua Xin Xue Guan Bing Za Zhi 2013;41:1-4.  Back to cited text no. 9
    
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Duan T, Xiang D, Qin W, Peng Y, Li R, Peng H, et al. Impact of establishing regional collaborative network on reperfusion time and prognosis of patients with ST-segment elevated myocardial infarction admitting to community hospitals without percutaneous coronary intervention capacity. Zhonghua Xin Xue Guan Bing Za Zhi 2014;42:641-5.  Back to cited text no. 10
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3]


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Introduction
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