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

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• 作者：Sheng-Chia Chung ; PhD^a ; Rolf Gedeborg ; MD^d ; Owen Nicholas ; PhD^b ; Stefan James ; MD^d ; ^e ; Prof Anders Jeppsson ; MD^f ; ^g ; Prof Charles Wolfe ; MD^h ; ⁱ ; Peter Heuschmann ; MD^j ; Prof Lars Wallentin ; MD^d ; ^e ; Prof John Deanfield ; FRCP^c ; Prof Adam Timmis ; FRCP^k ; Dr Tomas Jernberg ; MD^l ; ^{tomas.jernberg@karolinska.se" class="auth_mail} ; Prof Harry Hemingway ; FRCP^a ; ^{h.hemingway@ucl.ac.uk" class="auth_mail}
• 刊名：The Lancet
• 出版年：12-18 April, 2014
• 年：2014
• 卷：383
• 期：9925
• 页码：1305-1312
• 全文大小：519 K

文摘

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Summary

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 , number .

Findings

We assessed data for 119鈥?86 patients in Sweden and 391鈥?77 in the UK. 30-day mortality was 7路6% (95% CI 7路4-7路7) in Sweden and 10路5% (10路4-10路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 尾 blockers at discharge (89% vs 78%). After casemix standardisation the 30-day mortality ratio for UK versus Sweden was 1路37 (95% CI 1路30-1路45), which corresponds to 11鈥?63 (95% CI 9620-12鈥?27) excess deaths, but did decline over time (from 1路47, 95% CI 1路38-1路58 in 2004 to 1路20, 1路12-1路29 in 2010; p=0路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.

Funding

Seventh Framework Programme for Research, National Institute for Health Research, Wellcome Trust (UK), Swedish Association of Local Authorities and Regions, Swedish Heart-Lung Foundation.