• Sheng-Chia Chung, Johan Sundström, Chris P Gale, Stefan James, John Deanfield, Lars Wallentin, Adam Timmis, Tomas Jernberg, Harry Hemingway, Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies/Register of Information and Knowledge about Swedish Heart Intensive care Admissions, National Institute for Cardiovascular Outcomes Research/Myocardial Ischaemia National Audit Project, and CAardiovascular Disease Research Using Linked Bespoke Studies and Electronic Health Records.
• Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London NW1 2DA, UK s.chung@ucl.ac.uk.
• BMJ. 2015 Jan 1;351:h3913.

ObjectiveTo assess the between hospital variation in use of guideline recommended treatments and clinical outcomes for acute myocardial infarction in Sweden and the United Kingdom.DesignPopulation based longitudinal cohort study using nationwide clinical registries.Setting And ParticipantsNationwide 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.Main Outcome MeasuresBetween hospital variation in 30 day mortality of patients admitted with acute myocardial infarction.ResultsCase 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.ConclusionBetween 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.© Chung et al 2015.

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