The chance of surviving a heart attack is far lower in the UK
than Sweden, according to a major new study. The startling findings
suggest that more than 11,000 lives could have been saved over the
past seven years had UK patients experienced the same care as their
Swedish counterparts.
"Our findings are a cause for concern," says study leader
Professor Harry Hemingway, from the Farr Institute of Health
Informatics Research, and the National Institute for Cardiovascular
Outcomes Research at UCL. "The uptake and use of new technologies
and effective treatments recommended in guidelines has been far
quicker in Sweden. This has contributed to large differences in the
management and outcomes of patients."
Using whole-country data from national clinical registries, the
researchers analysed time trends for quality of care and outcomes
for all hospitals and patients diagnosed between 2004 and 2010 -
119,786 patients from 86 hospitals in Sweden and 391,077 patients
from 242 hospitals in the UK.
Results showed that 30 days after a heart attack, death rates
for UK patients were more than a third higher than for Swedish
patients (10.5% vs 7.6%). Importantly, although the difference in
death rates did decrease over time, mortality was always higher in
the UK.
After adjusting for differences in case mix using a model that
took into account 17 variables including demography (e.g. age and
sex), severity of acute myocardial infarction [heart attack], and
various risk factors (e.g. smoking and diabetes), the researchers
estimated that 11,263 deaths over the seven years of study could
have been delayed or prevented in the UK if patients had received
the same care as their Swedish counterparts.
According to co-study leader Dr Tomas Jernberg from Karolinska
University Hospital in Sweden: "Our findings suggest that failure
to get the best treatment is one likely reason why short-term
survival for heart attack patients is lower in the UK.
"In particular, we noted that the uptake of primary percutaneous
coronary intervention (procedures such as balloon angioplasty or
stent placement used to open narrowed coronary arteries; 59% vs
22%) and prescribing of recommended treatments at discharge (eg,
beta blockers; 89% vs 78%) were lower in the UK than Sweden. In
Sweden, the quality improvement work associated with quality
registries has increased our ability to adhere to guidelines."
The authors conclude: "International comparisons of care and
outcome registries might inform new research and policy initiatives
to improve the quality of health systems."
Writing in a linked Lancet Comment, Dr Chris Gale from the
University of Leeds and Keith Fox from the University of Edinburgh
in the UK, say: "Through highlighting the prospect of a substantial
excess of deaths in the UK compared with Sweden, Chung and
colleagues have drawn our attention to the need for further
comparative effectiveness research for acute myocardial infarction.
Efforts to improve cardiovascular outcomes in the UK should,
therefore, concentrate on data enhancement through the linkage of
electronic health-care records and the early and systematic
implementation of evidence-based therapies across the National
Health Service."
The paper, Acute myocardial infarction: a comparison of short-term survival in
national outcome registries in Sweden and the UK, is published
in The Lancet.