Heart patients in China may be receiving substandard hospital care

A new study suggests that China needs a national strategy to improve hospital care for heart patients.

The study, a collaboration among researchers in China and the United States, appears Jan. 8 in the journal JAMA Network Open. Harlan Krumholz, M.D., cardiologist and director of the Yale Center for Outcomes Research and Evaluation (CORE), is co-senior author of the study along with Chinese researcher Jing Li, M.D.

The Chinese government has made heart patient care a priority in the past decade, initiating extensive health care reforms. The new study is the first to evaluate heart failure care among hospitals there.

“This is an important evaluation of the state of heart failure care in China – and it identifies ample areas for improvement,” Krumholz said.

This is an important evaluation of the state of heart failure care in China – and it identifies ample areas for improvement.

Harlan Krumholz

The researchers analyzed more than 10,000 heart failure hospitalizations from 2015 at a diverse group of 189 hospitals in China. They focused on how caregivers handled core aspects of heart failure care, including assessment, prescription of standard medications for eligible patients upon discharge, and the scheduling of follow-up appointments.

The study said the median composite percentage of performance of expected tasks, across all hospitals, was 40%. The study also noted a marked variation across hospitals, with the odds of receiving guideline-recommended care varying, on average, by two-to-five-fold among the hospitals.

The researchers said urban hospitals in China tended to perform better than rural hospitals, and hospitals in the eastern region of China performed better than those in the western region – but none of the areas excelled.

The researchers also noted that a similar push in the U.S. to improve heart patient care in hospitals two decades ago may be instructive for China. National initiatives in the U.S. that focused on ways to boost adherence to recommended guidelines, as well as the public reporting of quality measures, led to better overall performance and a narrowing of the performance gap among U.S. hospitals.

The first author of the study was former CORE research fellow Aakriti Gupta of Columbia University. Yale co-authors, in addition to Krumholz, were Shuling Liu and Qi Tan.

Funding for the study came from the National Key Research and Development Program from the Ministry of Science and Technology of China, the CAMS Innovation Fund for Medical Sciences, and the 111 Project from the Ministry of Education of China.

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