Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries

Abstract

Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary.

Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care?

“…Despite these variations, survival rates in Norway have been documented among the best in Europe and a positive trend has been observed in most hospital catchment areas during the last decade [9,31,32]. In this study, 30-day survival was measured employing the “treatment chain model”.…”

A EuroHOPE kutatási program módszertana

“…Azokat a módszertani kérdéseket emeltük ki, amelyek a jelen lapszámban megjelenő AMI, STR, HIP és VLBW diagnóziscsoportokkal kapcsolatos közle ményeink értelmezéséhez szükségesek. A EuroHOPE kutatás egyéb területeit a nemzetközi publikációkból [3][4][5][6][7][8][9][10][11][12] és a kutatás honlapjáról lehet megismerni (http://www.eurohope.info). Az egyes diagnóziscso portok specifikus módszertani jellemzőit a témát ismer tető dolgozatokban közöljük.…”

Fremtidens PCI-behandling etter hjerteinfarkt

“…Det er vist at pasienter som får utført perkutan koronar intervensjon etter hjerteinfarkt har 60 % lavere 30-dagersmortalitet enn dem som ikke får slik behandling (6). I en svensk studie fant man en halvering av 30-dagersdødeligheten i befolkningen etter et det ble etablert et PCI-tilbud ved lokalsykehuset (8).…”

“…En lignende effekt er påvist i syv europeiske land for perkutan koronar intervensjon ved hjerteinfarkt (6). I områder og land med et stort antall PCI-sentre i forhold til innbyggertall er det et høyere forbruk av tilbudet enn i land og områder med få sentre.…”

“…Det finnes også dokumentasjon for at geografisk naerhet til et medisinsk tilbud øker tilgjengeligheten. Den europeiske studien viser at dette også gjelder for perkutan koronar intervensjon i alle de undersøkte landene, bortsett fra i Norge, der antallet prosedyrer er høyt på tross av at tilbudet er sentralisert (6). Likevel ser vi altså at pasienter i enkelte områder i Norge i mindre grad får invasiv behandling etter hjerteinfarkt, og at det enkelte steder også er lavere overlevelse.…”