1. A comparison of in-hospital acute myocardial infarction management between Portugal and the United States : 2000–2010
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Luís Filipe Azevedo, Armando Teixeira-Pinto, Altamiro Costa-Pereira, José Pereira-Miguel, Bruno Melica, Alberto Freitas, Francisco Rocha-Gonçalves, Vanessa Azzone, Cláudia Nisa, Sharon-Lise T. Normand, Mariana Lobo, Frederic S. Resnic, Leonor Bacelar-Nicolau, and Repositório da Universidade de Lisboa
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Psychological intervention ,Myocardial Infarction ,Comorbidity ,Acute myocardial infarction ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Acute care ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Hospital Mortality ,Coronary Artery Bypass ,Intensive care medicine ,International comparison ,Aged ,Retrospective Studies ,Aged, 80 and over ,Portugal ,business.industry ,Health Policy ,Hazard ratio ,Public Health, Environmental and Occupational Health ,Percutaneous coronary intervention ,Retrospective cohort study ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,United States ,Hospitalization ,Cross-Sectional Studies ,Treatment Outcome ,Conventional PCI ,Emergency medicine ,Female ,Patient management ,business - Abstract
© The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com, Objective: To compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA. Design: Repeated cross-sectional retrospective cohort study. Setting: Acute care hospitals in Portugal and USA during 2000-2010. Participants: Adults discharged with AMI. Interventions: Coronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery). Main Outcome Measures: In-hospital mortality and length of stay. Results: We identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47%; CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969]; Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03. Conclusions: Although in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal., This paper was funded by the Harvard Medical School—Portugal Program [HMSP-ICT/0013/2011]. Armando Teixeira-Pinto was partially supported by National Health and Medical Research Council through the Screening & Test Evaluation Program [grant number 633003]. Project Macro-to-Nano human sensing: towards integrated multimodal health monitoring and analytics (NanoSTIMA) [NORTE-01-0145-FEDER-000016] is financed by the North Portugal Regional Operational Programme (NORTE 2020), under the PORTUGAL 2020 Partnership Agreement, and through the European Regional Development Fund (ERDF).
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- 2017