Disparities in Myocardial Infarction Outcomes: U.K. vs. Sweden

Beat J. Meyer, MD

A comparison of national registries found significantly lower 30-day mortality in Sweden.

Between-country comparisons of quality of care are difficult because of the voluntary nature of most national registries. However, the U.K. and Sweden both have registries that include all hospitals providing care for acute coronary syndromes, making a direct comparison more feasible. Investigators assessed data on consecutive myocardial infarction (MI) patients in the two countries (about 120,000 in Sweden and 390,000 in the U.K.) registered between 2004 and 2010. They compared all-cause mortality 30 days after admission and adjusted results for differences in case mix to measure effectiveness of treatment.

Thirty-day mortality was higher in the U.K. than Sweden overall (10.5% vs. 7.6%) and in clinically relevant subgroups defined by troponin levels, ST-segment elevation, age, sex, heart rate, systolic blood pressure, diabetes, and smoking. Swedish patients received earlier and more frequent percutaneous coronary intervention than U.K. patients (59% vs. 22%) and were more likely to be using β-blockers at discharge (89% vs. 78%). After adjustment for differences in case mix, 30-day mortality was 37% higher in the U.K. than Sweden. However, the mortality ratio significantly declined over time from 1.47 in 2004 to 1.20 in 2010.

Citation(s):

Chung S-C et al. Acute myocardial infarction: A comparison of short-term survival in national outcome registries in Sweden and the UK. Lancet 2014 Jan 23; [e-pub ahead of print].

Gale CP and Fox KAA.International comparisons of acute myocardial infarction. Lancet 2014 Jan 23; [e-pub ahead of print].