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Rationale and design of the improving Care for Cardiovascular Disease in China (CCC) project: a national registry to improve management of atrial fibrillation
  1. Yongchen Hao1,
  2. Jing Liu1,
  3. Sidney C Smith2,
  4. Yong Huo3,
  5. Gregg C Fonarow4,
  6. Junbo Ge5,
  7. Jun Liu1,
  8. Kathryn A Taubert6,
  9. Louise Morgan7,
  10. Yang Guo1,
  11. Mengge Zhou1,
  12. Dong Zhao1,
  13. Changsheng Ma8
  14. on behalf of the CCC-AF Investigators
  1. 1 Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
  2. 2 Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina, USA
  3. 3 Department of Cardiology, Peking University First Hospital, Beijing, China
  4. 4 Divisions of Cardiology, Geffen School of Medicine at University of California, Los Angeles, California, USA
  5. 5 Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
  6. 6 Department of Global Strategies, American Heart Association, Basel, Switzerland
  7. 7 International Quality Improvement Department, American Heart Association, Dallas, Texas, USA
  8. 8 Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Changsheng Ma; chshma{at}


Introduction Inadequate management of patients with atrial fibrillation (AF) has been reported in China for anticoagulation therapy and treatment for concomitant diseases. An effective quality improvement programme has been lacking to promote the use of evidence-based treatments and improve outcome in patients with AF.

Methods and analysis The Improving Care for Cardiovascular Disease in China-AF programme is a collaboration of the American Heart Association and the Chinese Society of Cardiology. This programme is designed to promote adherence to AF guideline recommendations and outcomes for inpatients with AF. Launched in February 2015, 150 hospitals are recruited by geographic-economic regions across 30 provinces in China. Each month, 10–20 inpatients with AF are enrolled in each hospital. A web-based data collection platform is used to collect clinical information for patients with AF, including patients’ demographics, admission information, medical history, in-hospital care and outcomes, and discharge medications for managing AF. The quality improvement initiative includes monthly benchmarked reports on hospital quality, training sessions, regular webinars and recognitions of hospital quality achievement. Primary analyses will include adherence to performance measures and guidelines. To address intrahospital correlation, generalised estimating equation models will be applied. As of March 2017, 28 801 AF inpatients have been enrolled.

Ethics and dissemination This study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. Results will be published in peer-reviewed medical journals.

Trial registration number NCT02309398.

  • atrial fibrillation
  • quality improvement
  • healthcare
  • registry study

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  • Contributors The manuscript was prepared on behalf of the CCC-AF Investigators. SCS, YH, GCF, JG, KAT, CM and DZ conceived the study idea. JL, JL, LM, YG and MZ made substantial contributions to the development of the study protocol. YH drafted the manuscript, and all authors contributed to critical revisions of the paper. This final manuscript was read and approved by all authors.

  • Funding The CCC project is a collaborative programme of the AHA and the CSC. The AHA was funded by Pfizer for the quality improvement initiative through an independent grant for learning and change.

  • Disclaimer Pfizer provided no oversight on the goals, execution or publication of the programme. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The Ethics Committee of Beijing Anzhen Hospital, Capital Medical University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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