O A Alabas1, T Jernberg2, M Pujades-Rodriguez3, M J Rutherford4, R M West3, M Hall5, A Timmis6, B Lindahl7, K A A Fox8, H Hemingway9,10,11, C P Gale5. 1. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. 2. Department of clinical sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden. 3. Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, University of Leeds, Leeds, UK. 4. Department of Health Sciences, University of Leicester, Leicester, United Kingdom. 5. Clinical and Population Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds, Worsley Building, Level 11, Clarendon Way, Leeds, UK. 6. Barts Heart Centre, London, UK. 7. Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden. 8. Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom. 9. Health Data Research UK London, University College London, 222 Euston Road, London, UK. 10. Institute of Health Informatics, University College London, 222 Euston Road, London. 11. The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, 222 Euston Road, London, UK.
Abstract
AIMS: To compare ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) mortality between Sweden and the UK, adjusting for background population rates of expected death, case mix and treatments. METHODS AND RESULTS: National data were collected from hospitals in Sweden (n = 73 hospitals, 180,368 patients, Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies [SWEDEHEART]) and the UK (n = 247, 662,529 patients, Myocardial Ischaemia National Audit Project [MINAP]) between 2003 and 2013. There were lower rates of revascularisation [STEMI (43.8% vs. 74.9%); NSTEMI (27.5% vs 43.6%)] and pharmacotherapies at time of hospital discharge including [aspirin (82.9% vs. 90.2%) and (79.9% vs. 88.0%), β-blockers (73.4% vs. 86.4%) and (65.3% vs. 85.1%)] in the UK compared with Sweden, respectively. Standardised net probability of death (NPD) between admission and 1 month was higher in the UK for STEMI (8.0 [95% confidence interval 7.4-8.5] vs. 6.7 [6.5-6.9]) and NSTEMI (6.8 [6.4-7.2] vs. 4.9 [4.7-5.0]). Between 6 months and 1 year and more than 1 year, NPD remained higher in the UK for NSTEMI (2.9 [2.5-3.3] vs. 2.3 [2.2-2.5]) and (21.4 [20.0-22.8] vs. 18.3 [17.6-19.0]), but was similar for STEMI (0.7 [0.4-1.0] vs. 0.9 [0.7-1.0]) and (8.4 [6.7-10.1] vs. 8.3 [7.5-9.1]). CONCLUSION: Short-term mortality following STEMI and NSTEMI was higher in the UK compared with Sweden. Mid- and longer-term mortality remained higher in the UK for NSTEMI, but was similar for STEMI.Differences in mortality may be due to differential use of guideline-indicated treatments. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To compare ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) mortality between Sweden and the UK, adjusting for background population rates of expected death, case mix and treatments. METHODS AND RESULTS: National data were collected from hospitals in Sweden (n = 73 hospitals, 180,368 patients, Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies [SWEDEHEART]) and the UK (n = 247, 662,529 patients, Myocardial Ischaemia National Audit Project [MINAP]) between 2003 and 2013. There were lower rates of revascularisation [STEMI (43.8% vs. 74.9%); NSTEMI (27.5% vs 43.6%)] and pharmacotherapies at time of hospital discharge including [aspirin (82.9% vs. 90.2%) and (79.9% vs. 88.0%), β-blockers (73.4% vs. 86.4%) and (65.3% vs. 85.1%)] in the UK compared with Sweden, respectively. Standardised net probability of death (NPD) between admission and 1 month was higher in the UK for STEMI (8.0 [95% confidence interval 7.4-8.5] vs. 6.7 [6.5-6.9]) and NSTEMI (6.8 [6.4-7.2] vs. 4.9 [4.7-5.0]). Between 6 months and 1 year and more than 1 year, NPD remained higher in the UK for NSTEMI (2.9 [2.5-3.3] vs. 2.3 [2.2-2.5]) and (21.4 [20.0-22.8] vs. 18.3 [17.6-19.0]), but was similar for STEMI (0.7 [0.4-1.0] vs. 0.9 [0.7-1.0]) and (8.4 [6.7-10.1] vs. 8.3 [7.5-9.1]). CONCLUSION: Short-term mortality following STEMI and NSTEMI was higher in the UK compared with Sweden. Mid- and longer-term mortality remained higher in the UK for NSTEMI, but was similar for STEMI.Differences in mortality may be due to differential use of guideline-indicated treatments. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: J Walker Blackston; Monika M Safford; Matthew T Mefford; Elizabeth Freeze; George Howard; Virginia J Howard; David C Naftel; Todd M Brown; Emily B Levitan Journal: Circ Cardiovasc Qual Outcomes Date: 2020-12-11
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Authors: Marco Trevisan; Edouard L Fu; Karolina Szummer; Anna Norhammar; Pia Lundman; Christoph Wanner; Arvid Sjölander; Tomas Jernberg; Juan Jesus Carrero Journal: Eur Heart J Cardiovasc Pharmacother Date: 2021-03-15