TY - JOUR
T1 - Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China
AU - Spatz, Erica S.
AU - Wang, Yongfei
AU - Beckman, Adam L.
AU - Wu, Xuekun
AU - Lu, Yuan
AU - Du, Xue
AU - Li, Jing
AU - Xu, Xiao
AU - Davidson, Patricia M.
AU - Masoudi, Frederick A.
AU - Spertus, John A.
AU - Krumholz, Harlan M.
AU - Jiang, Lixin
N1 - Funding Information:
At the time this study was conducted, Dr Spatz was supported by grant K12HS023000 from the Agency for Healthcare Research and Quality Patient-Centered Outcomes Research (PCOR) Institutional Mentored Career Development Program. This project was supported by the Research Special Fund for Public Welfare Industry of Health (201202025, 201502009) from the National Health and Family Planning Commission of China, the National Key Technology R&D Program (2013BAI09B01, 2015BAI12B01, 2015BAI12B02) from the Ministry of Science and Technology of China and the 111 Project (B16005). The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Publisher Copyright:
© 2018 The Authors. Circulation: Cardiovascular Quality and Outcomes is published on behalf of the American Heart Association, Inc.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - BACKGROUND: Amid national efforts to improve the quality of care for people with cardiovascular disease in China, the use of traditional Chinese medicine (TCM) is increasing, yet little is known about its use in the early management of acute myocardial infarction (AMI). METHODS AND RESULTS: We aimed to examine intravenous use of TCM within the first 24 hours of hospitalization (early IV TCM) for AMI. Data come from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction, restricted to a large, representative sample of Western medicine hospitals throughout China (n=162). We conducted a chart review of randomly sampled patients with AMI in 2001, 2006, and 2011, comparing early intravenous TCM use across years, predictors of any early intravenous TCM use, and association with in-hospital bleeding and mortality. From 2001 to 2011, early intravenous TCM use increased (2001: 38.2% versus 2006: 49.1% versus 2011: 56.1%; P<0.01). Nearly all (99%) hospitals used early intravenous TCM. Salvia miltiorrhiza was most commonly prescribed, used in one third (35.5%) of all patients admitted with AMI. Patients receiving any early intravenous TCM, compared with those who did not, were similar in age and sex and had fewer cardiovascular risk factors. In multivariable hierarchical models, admission to a secondary (versus tertiary) hospital was most strongly associated with early intravenous TCM use (odds ratio: 2.85; 95% confidence interval: 1.98-4.11). Hospital-level factors accounted for 55% of the variance (adjusted median odds ratio: 2.84). In exploratory analyses, there were no significant associations between early intravenous TCM and in-hospital bleeding or mortality. CONCLUSIONS: Early intravenous TCM use for AMI in China is increasing despite the lack of evidence of their benefit or harm. There is an urgent need to define the effects of these medications because they have become a staple of treatment in the world's most populous country.
AB - BACKGROUND: Amid national efforts to improve the quality of care for people with cardiovascular disease in China, the use of traditional Chinese medicine (TCM) is increasing, yet little is known about its use in the early management of acute myocardial infarction (AMI). METHODS AND RESULTS: We aimed to examine intravenous use of TCM within the first 24 hours of hospitalization (early IV TCM) for AMI. Data come from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction, restricted to a large, representative sample of Western medicine hospitals throughout China (n=162). We conducted a chart review of randomly sampled patients with AMI in 2001, 2006, and 2011, comparing early intravenous TCM use across years, predictors of any early intravenous TCM use, and association with in-hospital bleeding and mortality. From 2001 to 2011, early intravenous TCM use increased (2001: 38.2% versus 2006: 49.1% versus 2011: 56.1%; P<0.01). Nearly all (99%) hospitals used early intravenous TCM. Salvia miltiorrhiza was most commonly prescribed, used in one third (35.5%) of all patients admitted with AMI. Patients receiving any early intravenous TCM, compared with those who did not, were similar in age and sex and had fewer cardiovascular risk factors. In multivariable hierarchical models, admission to a secondary (versus tertiary) hospital was most strongly associated with early intravenous TCM use (odds ratio: 2.85; 95% confidence interval: 1.98-4.11). Hospital-level factors accounted for 55% of the variance (adjusted median odds ratio: 2.84). In exploratory analyses, there were no significant associations between early intravenous TCM and in-hospital bleeding or mortality. CONCLUSIONS: Early intravenous TCM use for AMI in China is increasing despite the lack of evidence of their benefit or harm. There is an urgent need to define the effects of these medications because they have become a staple of treatment in the world's most populous country.
KW - Cardiovascular diseases
KW - Chinese traditional
KW - Complementary therapies
KW - Medicine
KW - Quality of health care
KW - Salvia miltiorrhiza
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U2 - 10.1161/CIRCOUTCOMES.117.004190
DO - 10.1161/CIRCOUTCOMES.117.004190
M3 - Article
C2 - 29848478
AN - SCOPUS:85053388935
SN - 1941-7713
VL - 11
JO - Circulation: Cardiovascular Quality and Outcomes
JF - Circulation: Cardiovascular Quality and Outcomes
IS - 3
M1 - e004190
ER -