The George Institute For Global Health
United Kingdom

Clinical Pathways for Acute Coronary Syndromes in China

Project status: 

Reducing the burden of chronic diseases has become one of the most important health issues facing the world today. In China and around the globe, chronic diseases such as heart disease and stroke are killing more people every year. As more of the world’s population age, solutions on how to manage these conditions will change how we all live and receive healthcare in the decades to come.

The CPACS study, completed in 2006, examined existing practices in Chinese hospitals for managing acute coronary syndrome (ACS). ACS is a condition where chest pain results from blockages in the arteries that carry blood and oxygen to the heart, sometimes resulting in a heart attack. ACS is a general term that covers several conditions that concern the amount of blood reaching the heart which usually causes severe chest pain and can lead to coronary heart disease, heart attacks, and stroke. The damage done to the heart and the pathways that transport blood to and from the heart usually results from poor diet, high cholesterol, smoking, lack of exercise, high blood pressure and diabetes.

Effective treatment following hospitalization for ACS can have a major impact on reducing a patient’s risk for a future heart attack, stroke or death. Using the most up-to-date clinical evidence can help doctors not only improve their patients’ health but also help them get back to living their lives sooner and for the better.

The focus of CPACS is to find ways to improve how patients admitted to hospitals for ACS receive treatment in China. Over several phases, CPACS will progress from identifying where improvement is needed in health services to improving how doctors and hospitals manage and treat patients for ACS.  

In the first phase of the study, CPACS-1 looked at how patients are currently treated for ACS in hospitals and identified areas where improvement is needed.


The overall objective of this project is to develop, implement and evaluate clinical pathways for the management of acute coronary syndromes (ACS) in tertiary and non-tertiary hospitals in China.


Phase 1

A prospective survey of patients with suspected ACS admitted to 51 tertiary and non-tertiary institutions throughout China. This study was completed in July 2006, and identified a number of areas in which the introduction of in-hospitalquality improvement initiativecould potentially increase evidence-based patient care.

Phase 2

Development, implementation and evaluation (using a cluster-randomised trial design) of clinical pathways for ACS management based upon data collected in Phase 1, to increase the use of recommended treatments and reduce the use of expensive and unnecessary investigations and treatment. The study was launched in October 2007, and involves the implementation of clinical pathways in 75 urban tertiary and non-tertiary hospitals. It is expected to finish in the middle of 2011.


Once the first phase of the study was completed in 2006, CPACS-2 began to implement strategies for improving how patients hospitalized for ACS events get treatment afterwards. Involving 75 urban hospitals in China, CPACS-2 is using the most current clinical evidence to help patients get back to good health.

The vision of CPACS will also include a third phase, CPACS-3. Building on the evidence generated from the earlier phases of CPACS, this third phase will take those strategies and expand to 100 county hospitals. With the evidence from CPACS-3, The George Institute will be able to help craft how patients with ACS receive healthcare in the future, from clinical guidelines for ACS to the patient’s quality of life. Not only will more patients avoid experiencing a heart attack or stroke in the future, but they will be able to get back to living life to the fullest.