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Principal Investigator: Harry Hemingway
UCL Investigators: Sheng-Chia Chung, Johan Sundström, Chris P Gale, Stefan James, John Deanfield, Lars Wallentin, Adam Timmis, Tomas Jernberg
Swedish Investigators: Johan Sundström, Lars Wallentin, Tomas Jernberg
The Challenge
Comparing healthcare systems between countries can help to identify differences and lead to improvements in quality of care, lower costs and achieve better outcomes for patients. However, no refined cross-country comparisons have been made for heart attack care, despite heart attack being a leading cause of death in developed countries. In 2014, we reported a worrying difference in the rate of deaths following a heart attack in Sweden compared with the UK. By analysing data collected routinely for all patients admitted to hospital in both countries, we found that the rate of death within 30 days after having a heart attack in Sweden was significantly lower (7.6%) than in the UK (10.5%). This was unexpected as the two countries have similar health systems and provide similar care for heart attack patients. The current study was carried out to investigate possible reasons for this difference while taking into account the mix of patients who suffered a heart attack.
The Research
The research was led by researchers from the Farr Institute, London in partnership with colleagues in Sweden. Researchers from both Sweden and the UK analysed data on how hospitals in both countries treated patients who had suffered from a heart attack, and how many of these patients survived for 30 days after their heart attack. We studied hospital use of recommended treatment and compared this within hospitals in each country, and between the two countries.
The Results
The researchers found that overall, in Sweden, fewer heart attack patients died within 30 days after adjusting for the mix of patients, and there was less variation in the number of deaths between hospitals in Sweden. A key factor was that most hospitals in Sweden complied better to recommended treatment guidelines compared with hospitals in the UK. Such recommended treatments included carrying out percutaneous coronary intervention (PCI) (a procedure where a small structure called a stent is inserted to open up blood vessels in the heart that have been narrowed by build-up of plaque) and prescribing beta-blocker medication. In contrast, UK hospitals tended to vary in how they treated similar patients compared to Sweden.
The Impact
This study is the first to compare outcomes after a heart attack across hospitals in Sweden and the UK after taking into account the mix of patients treated by a hospital. This work identified important areas to improve patient outcomes following heart attacks. These improvements could be made in both countries to good effect. Greater attention to application of guideline-recommended treatments, and reducing the variations in practice that exist would likely improve survival for heart attack patients. Patients admitted to hospitals known to adhere to guideline-recommended treatments do better. For example, in the UK, patients admitted to hospitals with the highest stent use have a 32% lower risk of dying compared to hospitals which carry out this procedure less often. The evidence from the study could be used by policy-makers to better incentivise guideline adherence and thus improve standards of care.
For more information: Chung et. al (2015) BMJ 351:h3913, Chung et. al. (2014) Lancet: 383:1305-12.