Journal
BMJ-BRITISH MEDICAL JOURNAL
Volume 351, Issue -, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bmj.h3913
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Funding
- European Implementation Score project - EU [223153]
- National Institute for Health Research [RP-PG-0407-10314]
- Wellcome Trust [086091/Z/08/Z]
- Medical Research Council Population Health Scientist Fellowship [MR/M015084/1]
- Medical Research Council Prognosis Research Strategy (PROGRESS) Partnership [G0902393/99558]
- Medical Research Council
- Arthritis Research UK
- British Heart Foundation
- Cancer Research UK
- Chief Scientist Office
- Economic and Social Research Council
- Engineering and Physical Sciences Research Council
- National Institute for Health Research
- National Institute for Social Care and Health Research
- Wellcome Trust
- Barts and the London Cardiovascular Biomedical Research Unit - National Institute for Health Research
- Swedish Heart Lung Foundation
- Swedish Research Council [2007-5942, 2010-1078]
- Medical Research Council [MR/M015084/1, MR/L01629X/1, MR/K006584/1] Funding Source: researchfish
- National Institute for Health Research [RP-PG-0407-10314] Funding Source: researchfish
- MRC [MR/L01629X/1, MR/M015084/1] Funding Source: UKRI
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OBJECTIVE To assess the between hospital variation in use of guideline recommended treatments and clinical outcomes for acute myocardial infarction in Sweden and the United Kingdom. DESIGN Population based longitudinal cohort study using nationwide clinical registries. SETTING AND PARTICIPANTS Nationwide registry data comprising all hospitals providing acute myocardial infarction care in Sweden (SWEDEHEART/RIKS-HIA, n=87; 119 786 patients) and the UK (NICOR/MINAP, n=242; 391 077 patients), 2004-10. MAIN OUTCOME MEASURES Between hospital variation in 30 day mortality of patients admitted with acute myocardial infarction. RESULTS Case mix standardised 30 day mortality from acute myocardial infarction was lower in Swedish hospitals (8.4%) than in UK hospitals (9.7%), with less variation between hospitals (interquartile range 2.6% v 3.5%). In both countries, hospital level variation and 30 day mortality were inversely associated with provision of guideline recommended care. Compared with the highest quarter, hospitals in the lowest quarter for use of primary percutaneous coronary intervention had higher volume weighted 30 day mortality for ST elevation myocardial infarction (10.7% v 6.6% in Sweden; 12.7% v 5.8% in the UK). The adjusted odds ratio comparing the highest with the lowest quarters for hospitals' use of primary percutaneous coronary intervention was 0.70 (95% confidence interval 0.62 to 0.79) in Sweden and 0.68 (0.60 to 0.76) in the UK. Differences in risk between hospital quarters of treatment for non-ST elevation myocardial infarction and secondary prevention drugs for all discharged acute myocardial infarction patients were smaller than for reperfusion treatment in both countries. CONCLUSION Between hospital variation in 30 day mortality for acute myocardial infarction was greater in the UK than in Sweden. This was associated with, and may be partly accounted for by, the higher practice variation in acute myocardial infarction guideline recommended treatment in the UK hospitals. High quality healthcare across all hospitals, especially in the UK, with better use of guideline recommended treatment, may not only reduce unacceptable practice variation but also deliver improved clinical outcomes for patients with acute myocardial infarction.
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