Abstract Body (Do not enter title and authors here): Background: The National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. Benefits of chest pain center (CPC) accreditation on acute coronary syndrome (ACS) have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD).
Methods: We conducted a retrospective analysis of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016, to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions.
Results: The analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.13% vs. 16.33%, P < 0.001 and 2.90% vs. 5.35%, P < 0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.11% vs. 42.06%, P < 0.001) compared to the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR = 0.64, 95% CI 0.60 − 0.69) and misdiagnosis (adjusted OR = 0.55, 95% CI 0.49 − 0.62), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR = 1.97, 95% CI 1.80 − 2.17). Following CPC accreditation, the management and hospital outcomes for AAD patients in the Western region and non-provincial capital areas showed greater improvement than those in Eastern/Central regions or provincial capital areas.
Conclusion: CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.