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Sweden’s success with heart disease

A major new study in the Lancet in the UK has found that the chance of surviving a heart attack is far lower in the UK & Ireland than in Sweden. The study results suggest the quality of care experienced by patients was a major factor that saved proportionally more victims of heart disease as result of the early adoption of new technologies and innovative treatments by the Swedish healthcare sector.

“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,” commented Prof Harry Hemingway, from the Farr Institute of Health Informatics Research, and the National Institute for Cardiovascular Outcomes Research, University College London.

Using whole-country data from national clinical registries, the researchers analysed time trends for quality of care and outcomes for all hospitals and patients who were diagnosed between 2004 and 2010 – some 11,9786 patients from 86 hospitals in Sweden and 39,1077 patients from 242 hospitals in the United Kingdom.

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 per cent  vs 7.6 per cent). Importantly, although the difference in death rates did decrease over time, the rate of death remained higher in the UK.

After adjusting for differences in casemix using a model that took into account 17 variables including demography, severity of acute myocardial infarction and risk factors (eg 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.

Co-study leader Dr Tomas Jernberg from Karolinska University Hospital in Sweden said “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 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 per cent vs 22 per cent) and prescribing of recommended treatments at discharge (eg, ß blockers; 89 per cent vs 78 per cent) 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 concluded: “International comparisons of care and outcome registries might inform new research and policy initiatives to improve the quality of health systems.”


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