Key result
While both countries observed annual decreases in risk-adjusted AMI mortality (USA HR 0.97; Portugal HR 0.99), the risk of dying in a high vs low mortality hospital was much larger in Portugal (2.65 vs 1.03).
Why the study?
Does in-hospital acute myocardial infarction management and associated mortality differ between Portugal and the United States?
Cohort (n=1,566,601)
Yes
Does in-hospital acute myocardial infarction management and associated mortality differ between Portugal and the United States?
While in-hospital AMI mortality improved in both the US and Portugal from 2000-2010, the US demonstrated more effective management and significantly less between-hospital disparity in quality of care.
Greater between-hospital AMI mortality variation in Portugal than the US may reflect care differences; leaves open whether standardization reduces disparities.
OBJECTIVE: To compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA. DESIGN: Repeated cross-sectional retrospective cohort study. SETTING: Acute care hospitals in Portugal and USA during 2000-2010. PARTICIPANTS: Adults discharged with AMI. INTERVENTIONS: Coronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery). MAIN OUTCOME MEASURES: In-hospital mortality and length of stay. RESULTS: We identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47%; CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969]; Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03. CONCLUSIONS: Although in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal.
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Lobo et al. (2017) conducted a cohort in Acute myocardial infarction (n=1,566,601). Hospitalization in Portugal vs. Hospitalization in the United States was evaluated on In-hospital mortality (annual decrease) (HR 0.99, 95% CI 0.979-0.991). While both countries observed annual decreases in risk-adjusted AMI mortality (USA HR 0.97; Portugal HR 0.99), the risk of dying in a high vs low mortality hospital was much larger in Portugal (2.65 vs 1.03).
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