Mortality due to coronary heart disease has declined substantially since the 1970s (see indicator “Mortality from circulatory diseases” in Chapter 3). Important advances in both prevention policies, such as for smoking (see indicator “Smoking among adults” in Chapter 4), and treatment of cardiovascular diseases have contributed to these declines (OECD, 2015[1]). A good indicator of acute care quality is the 30-day AMI case-fatality rate. The measure reflects the processes of care, including timely transport of patients and effective medical interventions.
Figure 6.18 shows the case-fatality rates within 30 days of admission for AMI where the death occurs in the same hospital as the initial AMI admission. This method of calculating the indicator is influenced by not only the quality of care provided in hospitals but also differences in hospital transfers and average length of stay. The lowest rates are found in Iceland, Denmark, Norway, the Netherlands, Australia and Sweden (all 4% or less). The highest rates are in Latvia and Mexico, suggesting that AMI patients do not always receive recommended care in these countries. In Mexico, the absence of a co-ordinated system of care between primary care and hospitals may contribute to delays in reperfusion and low rates of angioplasty (Martínez-Sánchez et al., 2017[2]).
Figure 6.19 shows 30-day case-fatality rates where fatalities are recorded regardless of where they occur (including after transfer to another hospital or after discharge). This is a more robust indicator because it records deaths more widely than the same-hospital indicator, but it requires a unique patient identifier and linked data, which are not available in all countries. The AMI case-fatality rate in 2017 ranged from 4.0% in the Netherlands to 16.5% in Latvia.
Case-fatality rates for AMI decreased substantially between 2007 and 2017 (Figure 6.18 and Figure 6.19). Across OECD countries, case fatalities fell from 9.5% to 6.9% when considering same-hospital deaths and from 12.5% to 9.1% when considering deaths in and out of hospital.
Variations in AMI 30-day case-fatality rates at the national level are influenced by the dispersion of rates across hospitals within countries, as represented in Figure 6.20. The interquartile range of rates within countries varies markedly. The differences between the upper and lower rates are 1.9 deaths per 100 admissions for Sweden and 4.1 deaths per 100 admissions for Korea (based on linked data).
Multiple factors contribute to variations in outcomes of care, including hospital structure, processes of care and organisational culture. Recent research points to higher total numbers of hospital patients as being significantly related to higher performance; this may support national movements towards concentration of care services (Lalloué et al., 2019[3]).
