Measuring outcomes: one month survival after acute myocardial infarction in Scotland.

Capewell, Simon; Kendrick, S; Boyd, James H.; Cohen, Geoff; Juszczak, Ed; Clarke, Jan

doi:10.1136/hrt.76.1.70

Cited by 30 publications

(27 citation statements)

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“…This linkage permits analysis of each individual patient's outcome. 8 Although some minor losses to follow-up might be expected, emigration of people of "pensionable age" from Scotland was Ͻ2% per decade. All deaths occurring within the United Kingdom are captured by the linked database.…”

Section: Data Sourcesmentioning

confidence: 99%

“…Category 1 represents the least deprived section of the population; category 5, the most deprived. 8 This identified those patients who had been admitted to hospital for any other reason within 5 years before their first admission for heart failure. To consistently obtain a 5-year history of prior hospital admission for each patient, the principal analyses in the present study were confined to patients admitted between January 1986 and December 1995.…”

Section: Information Availablementioning

confidence: 99%

“…5,8 This database is linked, with the use of probability matching, to information held by the General Registrar's Office for Scotland on in-hospital and out-of-hospital deaths. This linkage permits analysis of each individual patient's outcome.…”

Section: Data Sourcesmentioning

confidence: 99%

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Evidence of Improving Prognosis in Heart Failure

et al. 2000

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Background-Contemporary survival in unselected patients with heart failure and the population impact of newer therapies have not been widely studied. Therefore, we have documented case-fatality rates (CFRs) over a recent 10-year period. Methods and Results-In Scotland, all hospitalizations and deaths are captured on a single database. We have studied case fatality in all patients admitted with a principal diagnosis of heart failure from 1986 to 1995. A total of 66 547 patients (47% male) were studied. Although survival has increased significantly over the last decade, there is still much room for improvement.

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Section: Data Sourcesmentioning

confidence: 99%

Section: Information Availablementioning

confidence: 99%

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Evidence of Improving Prognosis in Heart Failure

et al. 2000

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“…1 Since that study, at least one cardiologist has been appointed in each Scottish hospital and acute medical care has been reorganised in most to ensure more rapid and appropriate care of patients suspected to have this diagnosis. 2 We have re-examined variation in survival after admission with AMI 10 years after the initial study.…”

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Reduced between-hospital variation in short term survival after acute myocardial infarction: the result of improved cardiac care?

Murphy

MacIntyre

Stewart³

et al. 2005

Heart

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Objectives: To re-examine interhospital variation in 30 day survival after acute myocardial infarction (AMI) 10 years on to see whether the appointment of new cardiologists and their involvement in emergency care has improved outcome after AMI. Design: Retrospective cohort study. Setting: Acute hospitals in Scotland. Participants: 61 484 patients with a first AMI over two time periods: 1988-1991; and 1998-2001. Main outcome measures: 30 day survival. Results: Between 1988 and 1991, median 30 day survival was 79.2% (interhospital range 72.1-85.1%). The difference between highest and lowest was 13.0 percentage points (age and sex adjusted, 12.1 percentage points). Between 1998 and 2001, median survival rose to 81.6% (and range decreased to 78.0-85.6%) with a difference of 7.6 (adjusted 8.8) percentage points. Admission hospital was an independent predictor of outcome at 30 days during the two time periods (p , 0.001). Over the period 1988-1991, the odds ratio for death ranged, between hospitals, from 0.71 (95% confidence interval (CI) 0.58 to 0.88) to 1.50 (95% CI 1.19 to 1.89) and for the period 1998-2001 from 0.82 (95% CI 0.60 to 1.13) to 1.46 (95% CI 1.07 to 1.99). The adjusted risk of death was significantly higher than average in nine of 26 hospitals between 1988 and 1991 but in only two hospitals between 1998 and 2001. Conclusions: The average 30 day case fatality rate after admission with an AMI has fallen substantially over the past 10 years in Scotland. Between-hospital variation is also considerably less notable because of better survival in the previously poorly performing hospitals. This suggests that the greater involvement of cardiologists in the management of AMI has paid dividends.

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“…Various reports of increases in non-fatal acute myocardial infarction rates have a complex explanation which includes a reduction in hospital admission thresholds, an increase in the sensitivity of enzyme diagnostic tests, and financial pressures to recode non-specific coronary disease as frank acute myocardial infarction. 7 Trends in case fatality are easier to describe than to explain. The majority of reports from the USA, UK, Europe, and Australasia show substantial reductions in case fatality.…”

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confidence: 99%

Descending thoracic aortic aneurysm in rheumatoid arthritis

Modi¹

2000

Heart

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In this issue the MONICA (monitoring trends and determinants in cardiovascular disease) team from Toulouse reports on myocardial infarction trends in south west France between 1985 and 1993. 1 There were 3263 events in men and there appeared to be an annual decrease of around 2% in both event rate and mortality rates. Twenty eight day case fatality fell by about 3% per year for first events and by 6% for recurrent events. The confidence intervals, however, are very wide around these estimates. The authors have concluded that the decrease in myocardial infarction mortality was predominantly attributable to reduction in case fatality and, by inference, improvements in acute management. It should be noted that there were few events in women.

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Measuring outcomes: one month survival after acute myocardial infarction in Scotland.

Abstract: research and local clinical audit before one month survival after acute myocardial infarction can be reliably used for detecting differences in quality of care. In addition, it would be essential to take account of infarct severity. (Heart 1996;76:70-75)

Cited by 30 publications

References 23 publications

Evidence of Improving Prognosis in Heart Failure

Evidence of Improving Prognosis in Heart Failure

Reduced between-hospital variation in short term survival after acute myocardial infarction: the result of improved cardiac care?

Descending thoracic aortic aneurysm in rheumatoid arthritis

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