World health matters – UK: Heart attack survival far lower in UK than Sweden

by Gary Finnegan: New research reveals that patients in Sweden have a better chance of surviving a heart attack than their UK counterparts.

Based on 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. This amounted to a total of 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, severity of acute myocardial infarction [heart attack], and risk factors such as 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.

“Our findings are a cause for concern,” says Professor Harry Hemingway, from the Farr Institute of Health Informatics Research, and the National Institute for Cardiovascular Outcomes Research, University College London in the UK.

“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,”

Dr Tomas Jernberg from the Karolinska University Hospital in Sweden, says the 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, ß 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,” he says.