Continuous Monitoring of Coronary Care Mortality Using the Global Registry for Acute Coronary Events (GRACE) Score.
Journal
Critical pathways in cardiology
ISSN: 1535-2811
Titre abrégé: Crit Pathw Cardiol
Pays: United States
ID NLM: 101165286
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
pubmed:
4
4
2020
medline:
19
8
2021
entrez:
4
4
2020
Statut:
ppublish
Résumé
The aim was to assess the utility of cumulative sum techniques for continuous monitoring of coronary care outcomes, applied to patients with acute coronary syndrome stratified by the Global Registry for Acute Coronary Events (GRACE) risk score. A prospective longitudinal study to assess GRACE score for real-time monitoring of coronary care mortality in a community hospital was conducted between January 2012 and December 2017. An expected-to-observed probability of death chart for individual risk and a variable life-adjusted display were used to monitor the results. A total of 1,255 patients undergoing acute coronary syndrome were included in the analysis. GRACE-based variable life-adjusted plots monitoring in-hospital mortality showed that observed death rates remained in general within the expected 95% confidence limit over time, and these behaviors were similar for ST-segment elevation and non-ST-segment elevation myocardial infarction. In-hospital all-cause mortality was 2.6% for the overall population, and 56% of these cases corresponded to unexpected deaths; conversely, unexpected survival occurred in 5.2% of survivors. Continuous monitoring of coronary care mortality based on cumulative sum charts and the GRACE score demonstrated the occurrence of series of favorable and unfavorable outcomes on a real-time basis. Additionally, plotting the expected-to-observed probability of death for individual cases was useful to individualize unexpected deaths in low-risk patients. Although overall coronary care performance was adequate according to the GRACE score, we found that there is still some room for improvement, since over half of the deaths occurring in low-risk patients were potentially preventable.
Sections du résumé
BACKGROUND
The aim was to assess the utility of cumulative sum techniques for continuous monitoring of coronary care outcomes, applied to patients with acute coronary syndrome stratified by the Global Registry for Acute Coronary Events (GRACE) risk score.
METHODS
A prospective longitudinal study to assess GRACE score for real-time monitoring of coronary care mortality in a community hospital was conducted between January 2012 and December 2017. An expected-to-observed probability of death chart for individual risk and a variable life-adjusted display were used to monitor the results.
RESULTS
A total of 1,255 patients undergoing acute coronary syndrome were included in the analysis. GRACE-based variable life-adjusted plots monitoring in-hospital mortality showed that observed death rates remained in general within the expected 95% confidence limit over time, and these behaviors were similar for ST-segment elevation and non-ST-segment elevation myocardial infarction. In-hospital all-cause mortality was 2.6% for the overall population, and 56% of these cases corresponded to unexpected deaths; conversely, unexpected survival occurred in 5.2% of survivors.
CONCLUSIONS
Continuous monitoring of coronary care mortality based on cumulative sum charts and the GRACE score demonstrated the occurrence of series of favorable and unfavorable outcomes on a real-time basis. Additionally, plotting the expected-to-observed probability of death for individual cases was useful to individualize unexpected deaths in low-risk patients. Although overall coronary care performance was adequate according to the GRACE score, we found that there is still some room for improvement, since over half of the deaths occurring in low-risk patients were potentially preventable.
Identifiants
pubmed: 32243277
doi: 10.1097/HPC.0000000000000208
pii: 00132577-202009000-00005
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
126-130Références
Poldervaart JM, Langedijk M, Backus BE, et al. Comparison of the GRACE, HEART and TIMI score to predict major adverse cardiac events in chest pain patients at the emergency department. Int J Cardiol. 2017;227:656–661.
Jakimov T, Mrdović I, Filipović B, et al. Comparison of RISK-PCI, GRACE, TIMI risk scores for prediction of major adverse cardiac events in patients with acute coronary syndrome. Croat Med J. 2017;58:406–415.
Zhu H, Xue H, Wang H, et al. Risk stratification and prognostic value of GRACE and TIMI risk scores for female patients with non-ST segment elevation acute coronary syndrome. Minerva Cardioangiol. 2015;63:171–178.
D’Ascenzo F, Biondi-Zoccai G, Moretti C, et al. TIMI, GRACE and alternative risk scores in acute coronary syndromes: a meta-analysis of 40 derivation studies on 216,552 patients and of 42 validation studies on 31,625 patients. Contemp Clin Trials. 2012;33:507–514.
Granger CB, Goldberg RJ, Dabbous O, et al.; Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med. 2003;163:2345–2353.
Noyez L. Control charts, Cusum techniques and funnel plots. A review of methods for monitoring performance in healthcare. Interact Cardiovasc Thorac Surg. 2009;9:494–499.
Grunkemeier GL, Wu YX, Furnary AP. Cumulative sum techniques for assessing surgical results. Ann Thorac Surg. 2003;76:663–667.
Cohen Arazi H, Blanco P, Higa C, et al. Influence of medical coverage on the treatment and prognosis of ST-segment elevation myocardial infarction. SCAR registry subanalysis. Rev Argent Cardiol. 2015;83:402–407.
Lawrance RA, Dorsch MF, Sapsford RJ, et al. Use of cumulative mortality data in patients with acute myocardial infarction for early detection of variation in clinical practice: observational study. BMJ. 2001;323:324–327.
Sherlaw-Johnson C, Morton A, Robinson MB, et al. Real-time monitoring of coronary care mortality: a comparison and combination of two monitoring tools. Int J Cardiol. 2005;100:301–307.
Shuvy M, Beeri G, Klein E, et al. Accuracy of the Global Registry of Acute Coronary Events (GRACE) risk score in contemporary treatment of patients with acute coronary syndrome. Can J Cardiol. 2018;34:1613–1617.
Firdous S, Mehmood MA, Malik U. Validity of GRACE risk score as a prognostic marker of In-hospital mortality after acute coronary syndrome. J Coll Physicians Surg Pak. 2017;27:597–601.
Smith IR, Rivers JT, Mengersen KL, et al. Performance monitoring in interventional cardiology: application of statistical process control to a single-site database. EuroIntervention. 2011;6:955–962.
Kunadian B, Dunning J, Roberts AP, et al. Funnel plots for comparing performance of PCI performing hospitals and cardiologists: demonstration of utility using the New York hospital mortality data. Catheter Cardiovasc Interv. 2009;73:589–594.
Neuburger J, Walker K, Sherlaw-Johnson C, et al. Comparison of control charts for monitoring clinical performance using binary data. BMJ Qual Saf. 2017;26:919–928.
Jones MA, Steiner SH. Assessing the effect of estimation error on risk-adjusted CUSUM chart performance. Int J Qual Health Care. 2012;24:176–181.
Chen TT, Chung KP, Hu FC, et al. The use of statistical process control (risk-adjusted CUSUM, risk-adjusted RSPRT and CRAM with prediction limits) for monitoring the outcomes of out-of-hospital cardiac arrest patients rescued by the EMS system. J Eval Clin Pract. 2011;17:71–77.