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UK heart attack death rates much higher than Sweden

11,000 deaths could have been prevented over 7 years

Adrian O'Dowd

Thursday, 23 January 2014

People who have a heart attack in the UK are far more likely to die than their equivalents in Sweden where treatments and technologies are better, concludes a study published today in The Lancet.

Around 11,000 people who died following a heart attack over a seven-year period in the UK could have survived if they had been treated in Sweden, found a team of international researchers.

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.

They studied data on 119,786 patients from 86 hospitals in Sweden and 391,077 patients from 242 hospitals in the UK. Sweden and the UK have similar health systems.

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% compared with 7.6%).

Although the difference in death rates decreased over time, mortality was always higher in the UK.

After adjusting for differences in the type of cases using a model that took into account 17 variables including demographics, severity of heart attack, and risk factors, 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.

One of the study leaders Professor Harry Hemingway, from the Farr Institute of Health Informatics Research, and University College London, said: “Our findings are a cause for concern. 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.”

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) and prescribing of recommended treatments at discharge such as beta blockers, were lower in the UK than Sweden.”

The authors concluded that international comparisons of care and outcome registries could inform new research and policy initiatives to improve the quality of health systems.

Writing in a linked comment, Chris Gale from the University of Leeds and Keith Fox from the University of Edinburgh, said: “Through highlighting the prospect of a substantial excess of deaths in the UK compared with Sweden, they [the researchers] 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 NHS.”

Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “The reasons behind the differing survival rates are complex, but one explanation could be the speed with which the two countries adopted primary angioplasty as an emergency treatment.

“Sweden’s early adoption meant they saw the benefits quicker and this is reflected in the figures. However, the UK has caught up and last year the majority of patients received this treatment.”

DOI:10.1016/S0140-6736(13)62070-X
DOI:10.1016/S0140-6736(13)62367-3

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