Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries

作者：Sheng‐Chia Chung, Johan Sundström, Chris P Gale, Stefan Karl James, John Eric Deanfield, Lars C. Wallentin, Adam Timmis, Tomas Jernberg, Harry Hemingway · 发表于：BMJ · 年份：2015 · DOI：10.1136/bmj.h3913 · 被引用次数：109 · 研究领域：Acute Myocardial Infarction Research、Coronary Interventions and Diagnostics、Cardiac Health and Mental Health

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...