title: Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries.
abstract: Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary.
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
authors.forename: Terje P
authors.initials: TP
authors.lastname: Hagen
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.|Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
authors.affiliation: Health Services Management Training Center, Semmelweis University, Budapest, Hungary.
authors.forename: Eva
authors.initials: E
authors.lastname: Belicza
authors.affiliation: Centre for Research on Health and Social Care Management, Bocconi University, Milano, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fatore
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Fanny
authors.initials: F
authors.lastname: Goude
mesh_terms: D000368:Aged; D057186:Comparative Effectiveness Research; D005060:Europe / Q000453:epidemiology; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000401:mortality* / Q000706:statistics & numerical data; D020379:Risk Adjustment; D016896:Treatment Outcome
keywords: H42; I12; I14; I18; acute myocardial infarction; comparative effectiveness study; mortality; percutaneous coronary intervention