Disparities in the management of cardiogenic shock complicating acute myocardial infarction: a questionnaire survey in Beijing.
To investigate disparities in the management of cardiogenic shock complicating acute myocardial infarction (AMI-CS) across different hospital levels in Beijing.
A standardized questionnaire was electronically distributed to 61 hospitals through the Beijing Cardiovascular Internal Medicine Quality Control and Improvement Center and the Beijing Extracorporeal Life Support Quality Control and Improvement Center. A multistage sampling method was also used to survey hospitals in eight Beijing districts that were not included in these quality control networks. Hospitals were categorized as Level 1 hospitals, Level 2 hospitals, or Level 3 hospitals according to international standards and the domestic context.
A total of 142 hospitals were analyzed. All participating hospitals were capable of managing cardiovascular diseases. 33.1% of hospitals did not have percutaneous coronary intervention (PCI) capability; 40.8% provided only intra-aortic balloon pump and PCI, whereas 26.0% offered temporary or durable mechanical circulatory support. Level 3 hospitals often lacked established protocols for AMI-CS management. Level 1 hospitals (59.4%) and Level 2 hospitals (56.5%) were more likely to maintain a minimum mean arterial pressure target of 65 mmHg, whereas Level 3 hospitals more commonly accepted a lower target (45.5%). Pulmonary artery catheter monitoring was infrequently used across all hospital levels. Continuous lactate monitoring also differed significantly (Level 3, 39.1% vs. Level 2, 74.6% vs. Level 1, 84.4%; overall p < 0.001). Among the 61 hospitals participating in the quality control network, only 3.6% adopted the Society for Cardiovascular Angiography and Interventions shock stage classification. Shock teams were available in 71.9% of Level 1 hospitals and 44.4% of Level 2 hospitals. Furthermore, only 31.9% of Level 3 hospitals had established referral networks.
Significant disparities exist in the diagnosis and management of AMI-CS across different hospital levels in Beijing. There is an urgent need to enhance the understanding and management of AMI-CS, especially in Level 2 and Level 3 hospitals.
A standardized questionnaire was electronically distributed to 61 hospitals through the Beijing Cardiovascular Internal Medicine Quality Control and Improvement Center and the Beijing Extracorporeal Life Support Quality Control and Improvement Center. A multistage sampling method was also used to survey hospitals in eight Beijing districts that were not included in these quality control networks. Hospitals were categorized as Level 1 hospitals, Level 2 hospitals, or Level 3 hospitals according to international standards and the domestic context.
A total of 142 hospitals were analyzed. All participating hospitals were capable of managing cardiovascular diseases. 33.1% of hospitals did not have percutaneous coronary intervention (PCI) capability; 40.8% provided only intra-aortic balloon pump and PCI, whereas 26.0% offered temporary or durable mechanical circulatory support. Level 3 hospitals often lacked established protocols for AMI-CS management. Level 1 hospitals (59.4%) and Level 2 hospitals (56.5%) were more likely to maintain a minimum mean arterial pressure target of 65 mmHg, whereas Level 3 hospitals more commonly accepted a lower target (45.5%). Pulmonary artery catheter monitoring was infrequently used across all hospital levels. Continuous lactate monitoring also differed significantly (Level 3, 39.1% vs. Level 2, 74.6% vs. Level 1, 84.4%; overall p < 0.001). Among the 61 hospitals participating in the quality control network, only 3.6% adopted the Society for Cardiovascular Angiography and Interventions shock stage classification. Shock teams were available in 71.9% of Level 1 hospitals and 44.4% of Level 2 hospitals. Furthermore, only 31.9% of Level 3 hospitals had established referral networks.
Significant disparities exist in the diagnosis and management of AMI-CS across different hospital levels in Beijing. There is an urgent need to enhance the understanding and management of AMI-CS, especially in Level 2 and Level 3 hospitals.
Authors
Ren Ren, Liu Liu, Xie Xie, Zhao Zhao, Tian Tian, Wang Wang, Du Du, Hao Hao, Li Li, Hou Hou, Wang Wang
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