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

May 20, 2014
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Authors:
Chung SC, Gedeborg R, Nicholas O, et al.
Citation:
Lancet 2014;383:1305-1312.
Summary By:
Hitinder S. Gurm, MBBS, FACC

Study Questions:

What is the difference in care and outcome of acute coronary syndromes (ACS) in Sweden versus the United Kingdom (UK)?

Methods:

The authors used data from national registries on consecutive patients registered between 2004 and 2010 in all hospitals that provided care for ACS in Sweden and the UK. The primary outcome was all-cause mortality 30 days after admission.

Results:

The study population was comprised of 119,786 patients in Sweden and 391,077 in the UK. The 30-day mortality in Sweden was 7.6% (95% confidence interval [CI], 7.4–7.7) compared with the UK, where it was 10.5% (95% CI, 10.4–10.6). Mortality was higher in the UK in all subgroups, as defined by presence of ST-segment elevation, diabetes, degree of troponin elevation, age, sex, heart rate, systolic blood pressure, and smoking status. After case-mix standardization, the 30-day mortality ratio for UK versus Sweden was 1.37 (95% CI, 1.30–1.45) and declined over time (from 1.47, 95% CI, 1.38–1.58 in 2004 to 1.20, 1.12–1.29 in 2010; p = 0.01). In Sweden, 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%), and these two factors accounted for a large fraction of the observed difference in outcome.

Conclusions:

There were substantial differences in care and outcome of patients with ACS in Sweden and the UK.

Perspective:

This interesting study highlights the advantage of comparing outcomes across different health care systems (or as in this case, across different countries) using registry data. This study demonstrates differences in both care and outcome of patients with ACS in two countries that are similar in that both provide universal health coverage. The ability of analysis like this to define gaps in clinical practice and the resultant impact on outcome should serve as an impetus for similar studies across more disparate health systems as well as guide changes in policy and practice.

Keywords: United Kingdom, Myocardial Infarction, Acute Coronary Syndrome, Sweden, Blood Pressure, Heart Rate, Diabetes Mellitus, Smoking, Troponin, Percutaneous Coronary Intervention


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