Standards of care in relation to age and sex in patients with ST-elevation myocardial infarction in 2023. European unified registries on heart care evaluation and randomized trials (Euroheart)

Abstract Background The European Unified Registries On Heart care Evaluation And Randomized Trials (EuroHeart) is a collaboration between national registries of quality of care in Europe. The mission of the collaboration is to monitor and improve the quality and support an equitable care of cardiovascular care in Europe. Purpose The purpose of this subproject was to describe of care in relation to sex, age and country in patients admitted to hospital with ST-elevation myocardial infarction (STEMI) in countries participating in the registration in 2023. Methods Continuous registration of all admitted patients with STEMI was performed in participating hospitals in Estonia, France, Hungary, Iceland, Portugal, Romania, Singapore, and Sweden. The recorded data were predefined, standardized and harmonized between the countries in accordance with the EuroHeart data standards for ACS. The variables included baseline characteristics and processes of care including treatments in hospital and at discharge. The collected individual patient-level data were aggregated in subgroups stratified in 9 different age groups, sex and diabetes. The aggregated subsets were presented as proportions and visually compared as seen in the figures. Results Between 1st January and 31st December 2023, 26,021 STEMI admissions were recorded of which a third were female (30%) and the median age was 66. When stratifying for age and sex; older and female patients were more likely to have hypertension and heart failure while younger and male patients were more likely to be current smokers (figure 1). A high proportion of patients with STEMI received primary PCI (80-95%) but there were large country differences in time to reperfusion (figure 2). A high proportion were prescribed dual antiplatelet treatment in both women and men but high-intensity P2Y12 inhibitors were variably prescribed in some countries (figure 2). A high proportion were prescribed statins but ezetimibe was only prescribed in around 5 – 25% with large variations between the countries. ACE/A2 inhibitors were prescribed in around 70 – 80% and in a lower proportion in the elderly in several countries (figure 1). Conclusion The EuroHeart ACS/PCI registry provides a contemporary mapping of the standards of care for patients admitted with ACS and particularly STEMI in Europe. There are opportunities to identify areas of improvement of care e.g., modifiable risk factors, time to reperfusion, intensity of initial antiplatelet treatment and lipid-lowering and heart failure medications.