PLoS ONE:Higher in-hospital mortality of STEMI patients admitted during off-hour

Clinical Pathways for Acute Coronary Syndromes in China (CPACS-3) research from The George Institute China has revealed factors attributed to the higher in-hospital mortality of ST elevation myocardial infarction (STEMI) patients admitted during off-hour in comparison with those during regular hours.

Ever since it was initiated in 2004, CPACS has been committed to finding ways to close the gaps in cardiology care. As the largest study to focus on the implementation of evidence-based care for patients experiencing acute coronary syndromes (ACS) in China, it has been adopted by the Chinese Ministry of Health as its official project. Outcomes of phases 1 and 2 have been crucial to informing the Chinese Government’s ongoing process of mandating the use of clinical pathways for a range of conditions treated in hospitals. And the Chinese Cardiac Society has used the CPACS result to promote adherence to national guideline recommendations and improve ACS management in hospitals.

The registry-based study recruited 7456 STEMI patients prospectively from 99 level two hospitals across China. Generalized linear mixed models were applied to quantify the risk of in-hospital death attributed to admission time and the explainers of its change, accounting for the clustering of patients within hospitals. There were 45.2% patients admitted during regular hours and 54.8% during off-hours. In-hospital mortality was 7.0% for patients admitted during regular hours and 8.3% for those during off-hours. Generalized linear mixed models adjusting for age, gender and education showed that patients' disease severity at admission and medical treatments received after admission could explain the risk difference attributed to admission time by 55% and 20%, respectively.

Professor Yangfeng Wu, Senior Director of The George Institute China calls for public attention to the higher severity of STEMI patients admitted during off-hour in addition to improving medical resources for STEMI at off-hour.

He said, “Insufficient capacities in dealing with public health emergencies, weak public consciousness of health are major factors driving the increase of cardiovascular disease (CVD) in China.”

"The control and prevention of CVD is a long-term approach. With the aim of reducing CVD burden, we hope to find out sustainable intervening measures by conducting research projects.”