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Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries.

https://arctichealth.org/en/permalink/ahliterature267362
Source
BMJ. 2015;351:h3913
Publication Type
Article
Date
2015
Author
Sheng-Chia Chung
Johan Sundström
Chris P Gale
Stefan James
John Deanfield
Lars Wallentin
Adam Timmis
Tomas Jernberg
Harry Hemingway
Source
BMJ. 2015;351:h3913
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cardiotonic Agents - therapeutic use
Cohort Studies
Diagnosis-Related Groups
Female
Great Britain - epidemiology
Guideline Adherence
Hospital Mortality
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Myocardial Infarction - mortality - therapy
Percutaneous Coronary Intervention - utilization
Practice Guidelines as Topic
Professional Practice - standards - statistics & numerical data
Quality of Health Care
Registries
Secondary Prevention - statistics & numerical data
Sweden - epidemiology
Treatment Outcome
Abstract
To assess the between hospital variation in use of guideline recommended treatments and clinical outcomes for acute myocardial infarction in Sweden and the United Kingdom.
Population based longitudinal cohort study using nationwide clinical registries.
Nationwide registry data comprising all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART/RIKS-HIA, n=87; 119,786 patients) and the UK (NICOR/MINAP, n=242; 391,077 patients), 2004-10.
Between hospital variation in 30 day mortality of patients admitted with acute myocardial infarction.
Case mix standardised 30 day mortality from acute myocardial infarction was lower in Swedish hospitals (8.4%) than in UK hospitals (9.7%), with less variation between hospitals (interquartile range 2.6% v 3.5%). In both countries, hospital level variation and 30 day mortality were inversely associated with provision of guideline recommended care. Compared with the highest quarter, hospitals in the lowest quarter for use of primary percutaneous coronary intervention had higher volume weighted 30 day mortality for ST elevation myocardial infarction (10.7% v 6.6% in Sweden; 12.7% v 5.8% in the UK). The adjusted odds ratio comparing the highest with the lowest quarters for hospitals' use of primary percutaneous coronary intervention was 0.70 (95% confidence interval 0.62 to 0.79) in Sweden and 0.68 (0.60 to 0.76) in the UK. Differences in risk between hospital quarters of treatment for non-ST elevation myocardial infarction and secondary prevention drugs for all discharged acute myocardial infarction patients were smaller than for reperfusion treatment in both countries.
Between hospital variation in 30 day mortality for acute myocardial infarction was greater in the UK than in Sweden. This was associated with, and may be partly accounted for by, the higher practice variation in acute myocardial infarction guideline recommended treatment in the UK hospitals. High quality healthcare across all hospitals, especially in the UK, with better use of guideline recommended treatment, may not only reduce unacceptable practice variation but also deliver improved clinical outcomes for patients with acute myocardial infarction. Clinical trials registration Clinical trials NCT01359033.
Notes
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Comment In: BMJ. 2015;351:h413326254446
PubMed ID
26254445 View in PubMed
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Differences in undergoing cardiac procedures within three months after first myocardial infarction by country of birth in women and men: a Swedish national cohort study.

https://arctichealth.org/en/permalink/ahliterature268267
Source
Acute Card Care. 2015 Mar;17(1):5-13
Publication Type
Article
Date
Mar-2015
Author
Dong Yang
Stefan James
Ulf De Faire
Lars Alfredsson
Tomas Jernberg
Tahereh Moradi
Source
Acute Card Care. 2015 Mar;17(1):5-13
Date
Mar-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary - utilization
Coronary Angiography
Coronary Artery Bypass - utilization
Female
Humans
Male
Middle Aged
Myocardial Infarction - ethnology - radiography - surgery
Percutaneous Coronary Intervention - utilization
Sex Factors
Sweden - epidemiology
Abstract
To examine the relationship between country of birth and the utilization of coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) after a first-time myocardial infarction (MI).
117,494 MI patients of all ages who were admitted to coronary care units between 2001 and 2009 in Sweden were followed-up for three months after admission.
Undergoing coronary angiography, PCI or CABG after first-time MI.
proportion of patients undergoing angiography and PCI increased whereas proportion of patients undergoing CABG also delay time for all three procedures decreased over the study period. The proportion of women undergoing any of the three procedures was markedly lower and delay time longer than those of men regardless of study period and migration background. Overall foreign-born first MI patients had higher rate of angiography (HR = 1.30, 95% CI: 1.27-1.33), PCI (HR = 1.27, 95% CI: 1.24-1.30) and CABG (HR = 1.21, 95% CI: 1.15-1.28) compared with Sweden born first MI patients. After controlling for potential confounding factors in multivariable models, the overall differences vanished for angiography and reduced markedly for PCI and CABG. However, multivariable stratified analysis by specific country of birth yielded higher rate of angiography among men born in Uganda (HR = 2.11, 95% CI: 1.00-4.43) and Peru (HR = 1.98, 95% CI: 1.07-3.68) and lower rate among men born in Croatia (HR = 0.71, 95% CI: 0.52-0.99) and women born in Thailand (HR = 0.49, 95% CI: 0.35-0.94). PCI adjusted rates were higher among women born in Palestine state (HR = 2.44, 95% CI: 1.15-5.16), Iraq (HR = 1.34, 95% CI: 1.04-1.74) and Poland (HR = 1.21, 95% CI: 1.02-1.44) and rate of CABG was higher among immigrants from some parts of Asia, including men born in Sri Lanka (HR = 3.19, 95% CI: 1.43-7.12), India (HR = 1.95, 95% CI: 1.21-3.14), Vietnam (HR = 2.65, 95% CI: 1.32-5.33), Palestine State (HR = 2.11, 95% CI: 1.06-4.24), and women born in Syria (HR = 2.36, 95% CI: 1.25-4.45), Iraq (HR = 1.74, 95% CI: 1.02-2.94), and Turkey (HR = 1.70, 95% CI: 1.03-2.79).
The observed high rate of CABG for immigrants and particularly those born in some Asian countries was not explained by the potential confounding factors. A more severe coronary disease in this population might explain this high rate but needs further research. Awareness and subsequent intervention at earlier stage of coronary disease among immigrants could prolong their life and reduce the healthcare costs.
PubMed ID
25806974 View in PubMed
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International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries.

https://arctichealth.org/en/permalink/ahliterature262178
Source
Int J Cardiol. 2014 Aug 1;175(2):240-7
Publication Type
Article
Date
Aug-1-2014
Author
R L McNamara
S C Chung
T. Jernberg
D. Holmes
M. Roe
A. Timmis
S. James
J. Deanfield
G C Fonarow
E D Peterson
A. Jeppsson
H. Hemingway
Source
Int J Cardiol. 2014 Aug 1;175(2):240-7
Date
Aug-1-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Disease Management
Female
Great Britain - epidemiology
Humans
Internationality
Male
Middle Aged
Myocardial Infarction - diagnosis - epidemiology - therapy
Percutaneous Coronary Intervention - utilization
Registries - statistics & numerical data
Sweden - epidemiology
United States - epidemiology
Abstract
To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries.
Results from clinical trials suggest significant variation in care across the world. However, international comparisons in "real world" registries are limited.
We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n=137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n=45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n=147,438] clinical registries.
Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%).
The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.
Notes
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PubMed ID
24882696 View in PubMed
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