Abstract 11345: Comparative Effectiveness of Acute Myocardial Infarction Care Delivered In Sweden and the United Kingdom Using National Outcome Registries
Introduction: International comparative effectiveness research for acute myocardial infarction (AMI) has been lacking. We compared casemix, hospital treatment, discharge medication and short term mortality in Sweden and the UK. Hypotheses: We assessed the hypotheses that (i) patient characteristics, care and outcomes of AMI differed between Sweden and the UK, and (ii) the mortality outcome differed if patients from one country had experienced the AMI care environment of the other.
Methods: We used registry data from the SWEDEHEART/RIKS-HIA and NICOR/MINAP which include data from all hospitals in Sweden and UK. The study included AMI patients (n=119,786 in Sweden and n=391,077 in the UK) registered between 2004 and 2010. The primary outcome was death from any cause at 30 days after admission. We assessed comparative effectiveness by applying mixed effect casemix models from one country to patients in the other country to obtain the standardized mortality.
Results: The 30 day mortality was 7.6% in Sweden and 10.5% in the UK. MI patients in Sweden had a lower prevalence of ST-elevation MI than those in the UK (33% and 40%). Primary PCI for ST-elevation MI patients was more common in Sweden (59%) than the UK (33%), with a greater mortality risk reduction. In contrast, associations with mortality of casemix, MI type and severity, inhospital treatment and discharge medication were largely similar between the two countries. When UK patients were standardised to the Swedish casemix, the estimated 30-day mortality decreased (relative risk reduction 0.73 (95% CI: 0.69, 0.78)), an estimated 8,604 deaths which could be prevented or postponed.
Conclusion: Clinically important differences in the care and outcomes of acute myocardial infarction are observed in Sweden compared to the UK. UK patients may have experienced better outcomes if they had been managed in Sweden. Figure: Kaplan-Meier curves and 95% confidence interval (dashed lines) for cumulative mortality in Sweden and the UK.
- Comparative effectiveness
- Myocardial infarction
- Evidence-based medicine
- Quality of medical care
- © 2012 by American Heart Association, Inc.