Abstract
BackgroundThe aim of the study was to explore trends in short- and long-term mortality after hospitalization for acute myocardial infarction (AMI) over the period 2001─2011 in Estonian secondary and tertiary care hospitals while adjusting for changes in baseline characteristics.MethodsIn this nationwide cross-sectional study random samples of patients hospitalized due to AMI in years 2001, 2007 and 2011 were identified and followed for 1 year. Trends in 30-day and 1-year all-cause mortality were analysed using Cox proportional hazards regression model.ResultsThe final analysis included 423, 687 and 665 patients in years 2001, 2007 and 2011 respectively. During the study period, the prevalence of most comorbidities remained unchanged while the in-hospital and outpatient treatment improved significantly. For example, the proportion of tertiary care hospital AMI patients who underwent revascularization was almost three times higher in 2011 compared to 2001. The proportion of secondary care patients who were referred to a tertiary care centre for more advanced care increased from 5.8 to 40.1 % (p for trend <0.001). Meanwhile, the 1-year mortality rates decreased from 29.5 to 20.2 % (adjusted p = 0.004) in the tertiary and from 32.4 to 23.1 % (adjusted p = 0.006) in the secondary care. The decrease in the 30-day mortality rates was statistically significant only in the secondary care hospitals.ConclusionsThe use of evidence-based treatments in Estonian AMI patients improved between 2001 and 2011. At the same time, we observed a significant reduction in the long-term mortality rates, both for patients primarily hospitalized into secondary as well as into tertiary care hospitals.
Highlights
The aim of the study was to explore trends in short- and long-term mortality after hospitalization for acute myocardial infarction (AMI) over the period 2001─2011 in Estonian secondary and tertiary care hospitals while adjusting for changes in baseline characteristics
As we intended to evaluate treatment of AMI in the hospital where the patient was primarily hospitalized, the following exclusion criteria were applied: (1) patients who were not primarily hospitalized into one of the study hospitals; (2) patients who were re-admitted with AMI diagnosis within 28 days after the first admission; (3) patients whose length of hospital stay was less than 3 days if they were discharged alive and were not transferred, which made the diagnosis of AMI very unlikely considering the local clinical practice
The results show increased proportion of patients with non-ST-segment-elevation acute myocardial infarction (NSTEMI) compared to that of patients with segment elevation myocardial infarction (STEMI) in both hospital types over time
Summary
The aim of the study was to explore trends in short- and long-term mortality after hospitalization for acute myocardial infarction (AMI) over the period 2001─2011 in Estonian secondary and tertiary care hospitals while adjusting for changes in baseline characteristics. Even though the fatality rates for acute myocardial infarction (AMI) have markedly decreased during the last few decades, Estonian death rates from CAD are still among the highest in Europe [2]. Important components of AMI treatment are early diagnosis, timely reperfusion and use of evidence-based medications [5, 6]. Earlier studies [7,8,9] from Estonia show improvement in AMI treatment, emphasizing better access to invasive diagnostics and treatment and wider use of evidence-based medications over time. A recent overview about quality of care and mortality following AMI from Central and Eastern European countries describes lack of comparable data and wide variation in acute cardiac care, in both between and within European countries [10]
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