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Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK.

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Title: Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK.
Authors: Sheng-Chia Chung, Gedeborg, Rolf, Nicholas, Owen, James, Stefan, Jeppsson, Anders, Wolfe, Charles, Heuschmann, Peter, Wallentin, Lars, Deanfield, John, Timmis, Adam, Jernberg, Tomas, Hemingway, Harry
Source: Lancet. 4/12/2014, Vol. 383 Issue 9925, p1305-1312. 8p. 1 Diagram, 2 Charts, 3 Graphs.
Subjects: Myocardial infarction, Health outcome assessment, Medical care
Geographic Terms: Sweden, United Kingdom
Abstract: Background: International research for acute myocardial infarction lacks comparisons of whole health systems. We assessed time trends for care and outcomes in Sweden and the UK. Methods: We 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. We compared effectiveness of treatment by indirect casemix standardisation. This study is registered with ClinicalTrials.gov, number NCT01359033. Findings: We assessed data for 119 786 patients in Sweden and 391 077 in the UK. 30-day mortality was 7·6% (95% CI 7·4—7·7) in Sweden and 10·5% (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 β blockers at discharge (89% vs 78%). After casemix standardisation 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 9620—12 827) excess deaths, but did decline 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). Interpretation: We found clinically important differences between countries in acute myocardial infarction care and outcomes. International comparisons research might help to improve health systems and prevent deaths. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK.
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  Data: <searchLink fieldCode="AR" term="%22Sheng-Chia+Chung%22">Sheng-Chia Chung</searchLink><br /><searchLink fieldCode="AR" term="%22Gedeborg%2C+Rolf%22">Gedeborg, Rolf</searchLink><br /><searchLink fieldCode="AR" term="%22Nicholas%2C+Owen%22">Nicholas, Owen</searchLink><br /><searchLink fieldCode="AR" term="%22James%2C+Stefan%22">James, Stefan</searchLink><br /><searchLink fieldCode="AR" term="%22Jeppsson%2C+Anders%22">Jeppsson, Anders</searchLink><br /><searchLink fieldCode="AR" term="%22Wolfe%2C+Charles%22">Wolfe, Charles</searchLink><br /><searchLink fieldCode="AR" term="%22Heuschmann%2C+Peter%22">Heuschmann, Peter</searchLink><br /><searchLink fieldCode="AR" term="%22Wallentin%2C+Lars%22">Wallentin, Lars</searchLink><br /><searchLink fieldCode="AR" term="%22Deanfield%2C+John%22">Deanfield, John</searchLink><br /><searchLink fieldCode="AR" term="%22Timmis%2C+Adam%22">Timmis, Adam</searchLink><br /><searchLink fieldCode="AR" term="%22Jernberg%2C+Tomas%22">Jernberg, Tomas</searchLink><br /><searchLink fieldCode="AR" term="%22Hemingway%2C+Harry%22">Hemingway, Harry</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 4/12/2014, Vol. 383 Issue 9925, p1305-1312. 8p. 1 Diagram, 2 Charts, 3 Graphs.
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  Data: <searchLink fieldCode="DE" term="%22Myocardial+infarction%22">Myocardial infarction</searchLink><br /><searchLink fieldCode="DE" term="%22Health+outcome+assessment%22">Health outcome assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+care%22">Medical care</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Sweden%22">Sweden</searchLink><br /><searchLink fieldCode="DE" term="%22United+Kingdom%22">United Kingdom</searchLink>
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  Label: Abstract
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  Data: Background: International research for acute myocardial infarction lacks comparisons of whole health systems. We assessed time trends for care and outcomes in Sweden and the UK. Methods: We 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. We compared effectiveness of treatment by indirect casemix standardisation. This study is registered with ClinicalTrials.gov, number NCT01359033. Findings: We assessed data for 119 786 patients in Sweden and 391 077 in the UK. 30-day mortality was 7·6% (95% CI 7·4—7·7) in Sweden and 10·5% (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 β blockers at discharge (89% vs 78%). After casemix standardisation 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 9620—12 827) excess deaths, but did decline 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). Interpretation: We found clinically important differences between countries in acute myocardial infarction care and outcomes. International comparisons research might help to improve health systems and prevent deaths. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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              Text: 4/12/2014
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