Acute Myocardial Infarction: A Comparison of Short-Term Survival in National Outcome Registries in Sweden and the UK

Study Questions:

What are the time trends for acute myocardial infarction (AMI) care and outcomes in Sweden and the United Kingdom (UK)?

Methods:

The investigators used data from national registries on consecutive patients registered between 2004 and 2010 in all hospitals providing care for acute coronary syndrome in Sweden and the UK. The primary outcome was all-cause mortality 30 days after admission. The authors compared effectiveness of treatment by indirect case mix standardization.

Results:

The investigators assessed data for 119,786 patients in Sweden and 391,077 in the UK. Thirty-day mortality was 7.6% (95% confidence interval [CI], 7.4-7.7) in Sweden and 10.5% (95% CI, 10.4-10.6) in the UK. Mortality was higher in the UK in clinically relevant subgroups defined by troponin concentration, ST-segment elevation, age, sex, heart rate, systolic blood pressure, diabetes mellitus status, and smoking status. In Sweden, compared with the UK, there was earlier and more extensive uptake of primary percutaneous coronary intervention (59% vs. 22%) and more frequent use of beta-blockers at discharge (89% vs. 78%). After case mix standardization, the 30-day mortality ratio for UK versus Sweden was 1.37 (95% CI, 1.30-1.45), which corresponds to 11,263 (95% CI, 9,620-12,827) excess deaths, but did decline over time (from 1.47; 95% CI, 1.38-1.58 in 2004 to 1.20; 95% CI, 1.12-1.29 in 2010; p = 0.01).

Conclusions:

The authors concluded that there are clinically important differences between countries in AMI care and outcomes.

Perspective:

This study reports greater mortality among patients with AMI in the UK than similar patients in Sweden. Uptake of effective treatments, especially primary percutaneous coronary intervention to treat ST-segment elevation MI and beta-blockers at discharge, was slower in the UK than in Sweden. The greater cumulative 30-day mortality in the UK was much improved after standardization, with the Swedish case mix suggesting that more than 10,000 deaths at 30 days may have been prevented or delayed had UK patients experienced the care of their Swedish counterparts. International and regional comparisons of care and outcomes might lead to significant insights that may help guide health care policy and practice to improve the quality of care and outcomes in AMI.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Prevention, Smoking

Keywords: Great Britain, Myocardial Infarction, Sweden, Blood Pressure, Heart Rate, Diabetes Mellitus, Smoking, Treatment Outcome, Troponin, Percutaneous Coronary Intervention


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