Research published in The Lancet has found that between 2001 and 2011, hospitalizations in China for the most severe type of heart attack quadrupled, from 3.7 to 15.8 admissions per 100,000 people.
The type of heart attack in question is an ST-elevation myocardial infarction (STEMI), defined by the American Heart Association (AHA) as "a severe heart attack caused by a prolonged period of blocked blood supply that affects a large area of the heart. These attacks carry a substantial risk of death and disability and call for a quick response by many individuals and systems."
Heart attacks are a danger to health worldwide. According to the Centers for Disease Control and Prevention (CDC), every year around 715,000 Americans have a heart attack. Of these people, 15% will die as a result.
The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Retrospective Acute Myocardial Infarction Study collaborative group report that STEMI accounts for more than 80% of heart attacks in China.
Funded by the Chinese government, the study set out to assess any trends in treatment and outcomes for STEMI, as no previous research had examined how these cardiac episodes were managed over the previous decade across the country.
'No major decrease' in STEMI deaths
The researchers examined the medical records, care processes and outcomes for 13,815 admissions for STEMI in 162 hospitals across China.
As well as the rise in hospital admissions, the study also found that there was no major decrease in the amount of deaths attributable to STEMI during this period, despite increases in treatment intensity, procedure use and testing.
Unfortunately, the study is unable to establish whether the cause for this rise in hospitalizations was due to a corresponding rise in heart attacks, or whether the results are due to improved access to hospitals.
STEMI incidence has risen in China seemingly without significant improvement to treatment outcomes.
The study's first author, Dr. Jing Li from the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, China, says that the research period was marked by an increasing prevalence of cardiovascular risk factors.
Alongside this rise, China had launched health care reform that had doubled annual expenditures in order to improve access to health care.
In addition to this, the researchers found that gaps in cardiac care have persisted despite improvements being made in the quality of care elsewhere during this time. While use of aspirin, clopidogrel and statins has increased, they report that medication such as beta blockers that reduce mortality in patients with STEMI are underused.
Reperfusion therapy, a treatment that restores the flow of blood through blocked arteries, was also underutilized, with only half of ideal candidates for it receiving the treatment. This figure did not improve over the duration of the study.
Precedent for improvements
The researchers note that after a similar study was carried out in the US, investment was made in quality improvement for the treatment of cardiovascular disease. This led to improvements in admission rates and the process of care and outcomes for heart attacks. They hope that this new study will lead to similar improvements in China.
The investigators claim that the study provides important information about opportunities for improvement. Prof. Lixin Jiang, of the National Center for Cardiovascular Diseases in Beijing, China, and corresponding author of the study, says:
"The growing needs for inpatient STEMI care will create pressure for Chinese hospitals to increase capacity, adequately train health care professionals, develop infrastructure, and improve care. The striking increases in hospital admissions for STEMI noted in our study show that important improvements in capacity have been made; however, national STEMI mortality suggests that further growth will be necessary to ensure adequate access for patients with the disorder in China."
"Furthermore," Prof. Jiang adds, "our study underlines that access to care does not ensure the delivery of the highest-quality care; suggesting that in addition to improvements in capacity, hospitals in China must simultaneously strive to improve care."
The team states that there is a need for national initiatives to understand the reason for the persistent gaps in care and to improve the use of evidence-based care for STEMI in China.
In a commentary article attached to the study in The Lancet, Prof. Gregg Stone, of Columbia University Medical Center, New York, believes that publication of this information is an important step toward improving health care in China that should be cherished as an opportunity that could translate into saving thousands of lives.
He also notes that the study's findings could be useful on a wider scale:
"And no doubt exists that the conditions described herein apply to other large countries and populations, each with their own unique considerations. To truly enhance global health, close collaboration between physician-scientists, industry, and governments on a multinational scale is necessary and should be prioritized, representing the ultimate expression of the heart team approach."