Title |
Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995–2014
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Published in |
European Heart Journal, August 2017
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DOI | 10.1093/eurheartj/ehx515 |
Pubmed ID | |
Authors |
Karolina Szummer, Lars Wallentin, Lars Lindhagen, Joakim Alfredsson, David Erlinge, Claes Held, Stefan James, Thomas Kellerth, Bertil Lindahl, Annica Ravn-Fischer, Erik Rydberg, Troels Yndigegn, Tomas Jernberg |
Abstract |
Impact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented. All STEMI cases (n = 105.674) registered in the nation-wide SWEDEHEART registry between 1995 and 2014 were included and followed for fatal and non-fatal outcomes for up to 20 years. Most changes in treatment and outcomes occurred from 1994 to 2008. Evidence-based treatments increased: reperfusion from 66.2 to 81.7%; primary percutaneous coronary intervention: 4.5 to 78.0%; dual antiplatelet therapy from 0 to 89.6%; statin: 14.1 to 93.6%; beta-blocker: 78.2 to 91.0%, and angiotensin-converting-enzyme/angiotensin-2-receptor inhibitors: 40.8 to 85.2% (P-value for-trend <0.001 for all). One-year mortality decreased from 22.1 to 14.1%. Standardized incidence ratio compared with the general population decreased from 5.54 to 3.74 (P < 0.001). Cardiovascular (CV) death decreased from 20.1 to 11.1%, myocardial infarction (MI) from 11.5 to 5.8%; stroke from 2.9 to 2.1%; heart failure from 7.1 to 6.2%. After standardization for differences in demography and baseline characteristics, the change of 1-year CV-death or MI corresponded to a linear trend of 0.915 (95% confidence interval: 0.906-0.923) per 2-year period which no longer was significant, 0.997 (0.984-1.009), after adjustment for changes in treatment. The changes in treatment and outcomes were most pronounced from 1994 to 2008. Gradual implementation of new and established evidence-based treatments in STEMI patients during the last 20 years has been associated with prolonged survival and lower risk of recurrent ischaemic events, although a plateauing is seen since around 2008. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 6 | 13% |
United Kingdom | 4 | 9% |
Venezuela, Bolivarian Republic of | 3 | 7% |
Colombia | 3 | 7% |
France | 3 | 7% |
Spain | 2 | 4% |
Argentina | 2 | 4% |
Philippines | 2 | 4% |
Chile | 1 | 2% |
Other | 7 | 15% |
Unknown | 13 | 28% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 30 | 65% |
Practitioners (doctors, other healthcare professionals) | 7 | 15% |
Scientists | 6 | 13% |
Science communicators (journalists, bloggers, editors) | 3 | 7% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 171 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Ph. D. Student | 18 | 11% |
Researcher | 16 | 9% |
Student > Bachelor | 16 | 9% |
Other | 14 | 8% |
Student > Doctoral Student | 13 | 8% |
Other | 37 | 22% |
Unknown | 57 | 33% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 68 | 40% |
Nursing and Health Professions | 7 | 4% |
Biochemistry, Genetics and Molecular Biology | 5 | 3% |
Pharmacology, Toxicology and Pharmaceutical Science | 5 | 3% |
Agricultural and Biological Sciences | 4 | 2% |
Other | 12 | 7% |
Unknown | 70 | 41% |