Abstract 11002: Care and Outcomes of Acute Myocardial Infarction in Taiwan, 2004-2008: Get With the Guidelines in Taiwan

Abstract

Background: Despite recent advances, acute myocardial infarction (AMI) still carries significant morbidity and mortality. The American Heart Association Get With the Guidelines program (GWTG) has improved the quality of AMI care with important implications for other countries in the world. This study evaluated the care and outcomes of AMI in Taiwan and assessed the applicability of GWTG in Taiwan.

Methods and Results: The National Health Insurance Research database (NHIRD) is derived from the claims data of the National Health Insurance program that covers over 99% of Taiwan’s population. By using the 1999-2008 NHIRD, we analyzed the temporal patterns of AMI care during hospitalization based on GWTG measures in Taiwan. Overall, the AMI incidence is still increasing in Taiwan. The age-adjusted incidence of AMI (/100,000 persons/year) gradually increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). Aspirin was used in 92.3% in 2004 and 92.2% in 2008 (P=NS). Dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). ACE inhibitor or ARB were used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and beta blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). All these indicators significantly fall behind the recently reported GWTG standards in Asian-Americans in 2008 (aspirin 96.5%, ACE inhibitor or ARB 91.9%, beta blocker 96% and statin 93.1%). The in-hospital mortality of AMI in Taiwan decreased from 14% in 2004 to 12% in 2008 (P<0.05), but is higher than that in Asian-Americans (10%). Multivariate analysis showed that DAPT (OR 0.75, 95% CI 0.70-0.80), ACE inhibitor/ARB (OR 0.44, 95% CI 0.41-0.49), beta blocker (OR 0.69, 95% CI 0.66-0.74) and statin (OR 0.62, 95% CI 0.58-0.66) were all independently associated with reduced in-hospital mortality of AMI patients in Taiwan.

Conclusions: The prescription rate of evidence-based medicine for AMI needs to be increased in Taiwan. The GWTG performance measures can become international standards across national and ethnic boundaries for assessing and improving quality of AMI care and outcomes.