TY - JOUR
T1 - International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States
T2 - The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries
AU - McNamara, R. L.
AU - Chung, S. C.
AU - Jernberg, T.
AU - Holmes, D.
AU - Roe, M.
AU - Timmis, A.
AU - James, S.
AU - Deanfield, J.
AU - Fonarow, G. C.
AU - Peterson, E. D.
AU - Jeppsson, A.
AU - Hemingway, H.
N1 - Funding Information:
Funding acknowledgements : This study has been supported by the European Implementation Score (EIS) project, funded by the EU 7th Framework Programme (Grant agreement: 223153 ), National Institute for Health Research (Programme Grant, RP-PG-0407-10314 ), Wellcome Trust ( WT 086091/Z/08/Z ) and the Farr Institute of Health Informatics Research @ UCL Partners ( MR/K006584/1 ) [HH, AT]. Barts and the London Cardiovascular Biomedical Research Unit, funded by National Institute for Health Research [AT], and the Swedish Heart Lung Foundation [TJ, SJ], and the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR) [DH, MR, EP]. ACTION Registry®-GWTG™ is an initiative of the American College of Cardiology Foundation and the American Heart Association, with partnering support from the Society of Cardiovascular Patient Care, the American College of Emergency Physicians, and the Society of Hospital Medicine. The views expressed in this manuscript represent those of the authors' and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com .
PY - 2014/8/1
Y1 - 2014/8/1
N2 - Objectives To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. Background Results from clinical trials suggest significant variation in care across the world. However, international comparisons in "real world" registries are limited. Methods We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries. Results Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%). Conclusions The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.
AB - Objectives To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. Background Results from clinical trials suggest significant variation in care across the world. However, international comparisons in "real world" registries are limited. Methods We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries. Results Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%). Conclusions The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.
KW - Acute myocardial infarction
KW - Clinical registries
KW - International comparisons
KW - Treatment
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U2 - 10.1016/j.ijcard.2014.04.270
DO - 10.1016/j.ijcard.2014.04.270
M3 - Article
C2 - 24882696
AN - SCOPUS:84904270417
SN - 0167-5273
VL - 175
SP - 240
EP - 247
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 2
ER -