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Improved outcomes i...
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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- Szummer, Karolina (author)
- Karolinska Institute,Karolinska Institutet,Karolinska Institute, Sweden; Karolinska University Hospital, Sweden
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- Wallentin, Lars, 1943- (author)
- Uppsala University,Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Uppsala University, Sweden
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- Lindhagen, Lars (author)
- Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Institutionen för medicinska vetenskaper,Uppsala University, Sweden
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- Alfredsson, Joakim (author)
- Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Erlinge, David (author)
- Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund University, Sweden
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- Held, Claes, 1956- (author)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,Uppsala University, Sweden
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- James, Stefan K, 1964- (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Uppsala University, Sweden
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- Kellerth, Thomas (author)
- Orebro Univ Hosp, Dept Cardiol, Orebro, Sweden.,Örebro University Hospital, Sweden
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- Lindahl, Bertil, 1957- (author)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Uppsala University, Sweden
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- Ravn-Fischer, Annica (author)
- Sahlgrens Univ Hosp, Dept Mol & Clin Med, Inst Med, Gothenburg, Sweden.,Sahlgrens University Hospital, Sweden
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- Rydberg, Erik (author)
- Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund University, Sweden
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- Yndigegn, Troels (author)
- Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Skåne University Hospital,Lund University, Sweden
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- Jernberg, Tomas (author)
- Karolinska Institute,Karolinska Institutet,Danderyd Hospital, Sweden
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(creator_code:org_t)
- 2017-08-29
- 2017
- English.
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In: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 38:41, s. 3056-3065
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Abstract
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- Aims Impact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented. Methods and results 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. Conclusion 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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Registry
- Myocardial infarction
- Time-trends
- Outcomes
- Journal Article
Publication and Content Type
- ref (subject category)
- art (subject category)
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Szummer, Karolin ...
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Wallentin, Lars, ...
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Lindhagen, Lars
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Alfredsson, Joak ...
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Erlinge, David
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Held, Claes, 195 ...
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James, Stefan K, ...
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Kellerth, Thomas
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Lindahl, Bertil, ...
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Ravn-Fischer, An ...
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Rydberg, Erik
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Yndigegn, Troels
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Jernberg, Tomas
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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European Heart J ...
- By the university
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Uppsala University
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Karolinska Institutet
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Lund University
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Linköping University