title: International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries.
abstract: OBJECTIVE
  To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries.
  
  
  BACKGROUND
  Results from clinical trials suggest significant variation in care across the world. However, international comparisons in "real world" registries are limited.
  
  
  METHODS
  We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n=137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n=45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n=147,438] clinical registries.
  
  
  RESULTS
  Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%).
  
  
  CONCLUSIONS
  The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.
authors.affiliation: Yale University School of Medicine, Cardiovascular Medicine, New Haven, CT, USA. Electronic address: robert.mcnamara@yale.edu.
authors.forename: R L
authors.initials: RL
authors.lastname: McNamara
authors.affiliation: Farr Institute of Health Informatics Research @ UCL Partners, University College London, London, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Chung
authors.affiliation: Dept of Medicine (Huddinge), Cardiology, Karolinska Institutet, and Dept of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Jernberg
authors.affiliation: Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA.
authors.forename: D
authors.initials: D
authors.lastname: Holmes
authors.affiliation: Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Roe
authors.affiliation: National Institute for Health Research, Biomedical Research Unit, Barts Health London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Timmis
authors.affiliation: Dept. of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: James
authors.affiliation: University College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: G C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Duke Clinical Research Institution, Duke University Medical Center, Durham, NC, USA.
authors.forename: E D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Jeppsson
authors.affiliation: Farr Institute of Health Informatics Research @ UCL Partners, University College London, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants
keywords: Acute myocardial infarction; Clinical registries; International comparisons; Treatment