Analysing current trends in care of acute myocardial infarction using PERFECT data

Abstract

Introduction: This article in the supplement issue on the Performance, Effectiveness, and Costs of Treatment episodes (PERFECT)-project describes the PERFECT AMI (acute myocardial infarction) Database, which is developed to measure the performance of hospitals and hospital districts in Finland. We analyse annual trends and regional differences in performance indicators and whether the utilisation of services and costs of hospital care are related to improvement in survival of AMI patients.

Material and methods. The study population consists of ten annual cohorts (1998–2007) of patients hospitalised for AMI.

Results. Since 1998 the treatment pattern has changed rather radically, the utilisation rate of percutaneous coronary intervention (PCI) has increased and coronary procedures have been performed earlier after myocardial infarction. Outcome measured by various measures of mortality has improved considerably. However, trends in the development of the use of services and outcomes are not similar between hospital districts. An increase in cost was positively and statistically significantly related to decrease in mortality, but the effect was not very strong.

Conclusion. There is potential for decreased mortality from actions that do not increase the costs and for enhancing performance in the regions and hospitals with poor performance.

Key words::

• Follow-up studies
• hospital cost
• mortality
• myocardial infarction
• registries

Declaration of interest: Ilkka Tierala: Travel expenses for a congress sponsored by: AstraZeneca, Eli Lilly, Boston Scientific, St Jude. Member of advisory board or work as an expert for the following companies: AstraZeneca, Eli Lilly, Sanofi-Aventis.

Juha Hartikainen: Travel grant for a congress by the following companies: AstraZeneca, Sanofi-Aventis, St Jude, Bayer, Medtronic, Boston Scientific. Lecture sponsored by the following companies: St Jude, Eli Lilly, MSD, Medtronic. Member of advisory board or work as an expert for the following companies: AstraZeneca, Eli Lilly, Sanofi-Aventis, Boehringer Ingelheim.

Funding/Support: Research in the database has been supported by unrestricted grants from the Finnish Academy and Finnish Innovation Fund SITRA, the Finnish Funding Agency for Technology and Innovation.

Role of the sponsors: The funding sources for this study had no role in the design and conduct of the study; in the collection, management, analysis and interpretation of the data; or in the preparation, review or approval of the manuscript.

Notes

¹In an earlier protocol we also excluded patients that were discharged alive but had a length of stay, including transfers, of less than three days (10).

²Hospital days were defined to be related to AMI if the main diagnosis at discharge was ICD 10:120–125 or I44–I50.