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Sweden 'sets heart care standards'

Thousands of lives could be saved if heart attack survival in the UK matched that of Sweden, research has shown.

Between 2004 and 2010, over a third more Britons than Swedes died within a month of having a heart attack, according to a major study of half a million patients.

More than 11,000 deaths could have been avoided if UK care standards were as good as Sweden's, the authors claim.

A key reason for the striking difference between the two countries is that British patients are not receiving the best possible treatment, say the experts.

Professor Harry Hemingway, from University College London, who led the research published in The Lancet medical journal, said: " Our findings are a cause for concern. The uptake and use of new technologies and effective treatments recommended in guidelines has been far quicker in Sweden. This has contributed to large differences in the management and outcomes of patients."

The team assessed quality of care and outcomes for all heart attack patients treated in hospital in the UK and Sweden over a seven-year period between 2004 and 2010.

In total, records relating to 391,077 patients from 242 hospitals in the UK and 119,786 from 86 hospitals in Sweden were assessed and analysed.

The results showed that 30 days after a heart attack, 10.5% of patients discharged from hospital were dead in the UK compared with 7.6% in Sweden.

At the start of the study the difference was even more stark, with almost 50% more patients dying in the UK. By 2010 the size of the gap had reduced to 20%.

Taking into account age and sex differences, heart attack severity, risk factors including rates of smoking and diabetes, and other influences, the scientists estimated that over the study period 11,263 British lives could have been saved by matching Swedish standards.

Co-author Dr Tomas Jernberg, from the Karolinska University Hospital in Sweden, said: "Our findings suggest that failure to get the best treatment is one likely reason why short-term survival for heart attack patients is lower in the UK."

In particular, procedures to open up constricted coronary arteries, such as balloon angioplasty and stent placement, were used more often and earlier in Sweden, where they were applied in 59% of cases compared with 22% in the UK.

Recommended drugs such as beta blockers were also less likely to be prescribed to British patients discharged from hospital after treatment for a heart attack.

Writing in The Lancet, the researchers conclude: "We found clinically important differences in the care and outcomes of patients with acute myocardial infarction (heart attack) in Sweden and the UK.

"International comparisons of care and outcome registries might inform new research and policy initiatives to improve the quality of health systems."

Dr Mike Knapton, associate medical director at the British Heart Foundation, said: "Through access to patient health records, researchers have been able to highlight significant differences to heart attack survival rates in the UK and Sweden.

"The reasons behind the differing survival rates are complex, but one explanation could be the speed with which the two countries adopted primary angioplasty as an emergency treatment.

"Sweden's early adoption meant they saw the benefits quicker and this is reflected in the figures. However, the UK has caught up and last year the majority of patients received this treatment.

"The lesson here for the UK is that we need to be led by the research and introduce pioneering practices quickly and on a large scale."

Professor Huon Gray, national clinical director (cardiac) at NHS England, said: "The advanced treatment patients now receive in the UK means heart attack death rates have fallen from one in four in the 1970s, to one in 20 now, but we know more needs to be done and we are working hard to further improve survival rates.

"Since NHS England was established in 2013, we have been driving improvements in outcomes by asking commissioners across England to set out clear and measurable plans for reducing premature mortality in 2014/15 and we are supporting them by providing advice about the clinical priorities, including in relation to heart disease.

"Over 2004-10, the UK was slower to introduce the use of angioplasty than Sweden. We had particularly good performance when using previously proven treatments and a feasibility study was undertaken to determine whether the use of angioplasty in a UK setting was most appropriate and to ensure that it would be introduced safely and effectively. Following the completion of this study, there was rapid uptake."