Mortality due to coronary heart diseases has declined substantially over the past few decades (see indicator “Mortality from circulatory diseases” in Chapter 3). Reductions in smoking (see indicator “Smoking among adults” in Chapter 4) and improvements in treatment for heart diseases have contributed to these declines. Despite this progress, acute myocardial infarction (AMI or heart attack) remains the leading cause of cardiovascular deaths in Europe, highlighting the need for further reductions in risk factors and care quality improvements (OECD/The King’s Fund, 2020).
A good indicator of acute care quality is the 30‑day mortality rate following AMI after hospital admission. The measure reflects the processes of care, such as timely transport of patients and effective medical interventions. However, the indicator is influenced not only by the quality of care provided in hospitals, but also by differences in hospital transfers, average length of stay and AMI severity.
Figure 6.12 shows mortality rates within 30 days of admission to hospital for AMI using unlinked data – that is, only counting deaths that occurred in the hospital where the patient was initially admitted. Across EU countries, the lowest rates in 2017 were in Denmark, the Netherlands, and Sweden (less than 4% of patients aged 45 and over), while the highest rate was in Latvia (over 13%).
Figure 6.13 shows the same 30‑day mortality rate but calculated based on linked data whereby the deaths are recorded regardless of where they occurred (i.e. either in the hospital where the patient was initially admitted, after transfer to another hospital or after being discharged). Based on these linked data, the AMI mortality rates in 2017 ranged from 4% in the Netherlands to over 14% in Latvia.
Thirty-day mortality rates for AMI have decreased substantially between 2007 and 2017. Across EU countries for which data are available, they fell by around 30% on average from 9.2% to 6.5% based on unlinked data and from 12.4% to 9.3% based on linked data. Better and more timely access to acute care following an AMI, including timely transportation of patients and admissions in specialised health facilities, such as percutaneous catheter intervention-capable centres, have contributed to the reduction in mortality rates (OECD, 2015).
Mortality rates for patients admitted with AMI vary significantly not only across countries, but also across different hospitals in each country. As shown in Figure 6.14, differences in 30‑day mortality rates following AMI across hospitals in each country are often much larger than across countries. In general, a greater volume and concentration of acute care for AMI patients in specialised hospital services is associated with lower mortality rates (Lalloué et al., 2019).
