International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries

• Published in: International journal of cardiology Vol. 175; no. 2; pp. 240 - 247
• Main Authors: McNamara, R.L, Chung, S.C, Jernberg, T, Holmes, D, Roe, M, Timmis, A, James, S, Deanfield, J, Fonarow, G.C, Peterson, E.D, Jeppsson, A, Hemingway, H
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-08-2014; Elsevier
• Subjects: ACUTE CORONARY SYNDROMES; Acute myocardial infarction; Aged; Aged, 80 and over; AMERICAN-COLLEGE; Anticoagulants - therapeutic use; ASSOCIATION TASK-FORCE; Biological and medical sciences; Cardiac & Cardiovascular Systems; Cardiac and Cardiovascular Systems; Cardiology. Vascular system; Cardiovascular; CARE; Clinical registries; Coronary heart disease; DISEASE; Disease Management; Female; Heart; Humans; International comparisons; Internationality; Kardiologi; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - epidemiology; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; OUTCOMES; Percutaneous Coronary Intervention - statistics & numerical data; QUALITY IMPROVEMENT; Registries - statistics & numerical data; Sweden - epidemiology; Treatment; TRENDS; TRIAL; United Kingdom - epidemiology; United States - epidemiology; UNSTABLE ANGINA; Sweden; United States; Europe; America; United Kingdom; World; North America; NSTEMI; ACTION Registry-GWTG; The Acute Coronary Treatment and Intervention Outcomes Network Registry — Get With The Guidelines; United States; Global Registry of Acute Coronary Events; myocardial infarction; National Cardiovascular Data Registry; electrocardiogram; percutaneous coronary intervention; acute coronary syndrome; Myocardial Ischemia National Audit Project; GRACE; UK; Clinical registries; ACEI; RIKS-HIA; MI; US; coronary artery bypass grafting; angiotensin receptor blockers; non-ST segment elevation myocardial infarction; angiotensin converting enzyme inhibitors; Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies; England/Wales; NICOR; NCDR; ECG; National Institute for Cardiovascular Outcomes Research; International comparisons; ACS; ARB; Treatment; PCI; Register of Information and Knowledge About Swedish Heart Intensive Care Admissions; SWEDEHEART; CABG; Acute myocardial infarction; MINAP; Human; Myocardial infarction; Action; Acute; Patient; Cardiovascular disease; Coronary heart disease; Myocardial disease; ST elevation; Clinical management; Register; Cardiology; Comparative study; International
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2014.04.270

Abstract Objectives To compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. Background Results from clinical trials suggest significant variation in care across the world. However, international comparisons in “real world” registries are limited. Methods We compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n = 137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n = 45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n = 147,438] clinical registries. Results Patients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%). Conclusions The care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.