title: Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries.
abstract: 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.
  
  
  METHODS
  Population based longitudinal cohort study using nationwide clinical registries.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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. Clinical trials registration Clinical trials NCT01359033.
authors.affiliation: Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London NW1 2DA, UK s.chung@ucl.ac.uk.
authors.forename: Sheng-Chia
authors.initials: SC
authors.lastname: Chung
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
authors.affiliation: Cardiovascular Health Sciences, University of Leeds, Leeds, UK.
authors.forename: Chris P
authors.initials: CP
authors.lastname: Gale
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: James
authors.affiliation: National Centre for Cardiovascular Prevention and Outcomes, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Deanfield
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.affiliation: National Institute for Health Research, Cardiovascular Biomedical Research Unit, Bart's Health London, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Timmis
authors.affiliation: Department of Medicine, Huddinge, Section of Cardiology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Jernberg
authors.affiliation: Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London NW1 2DA, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003953:Diagnosis-Related Groups; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012042:Registries; D055502:Secondary Prevention / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002316:Cardiotonic Agents