gms | German Medical Science

Hospital mortality and 30-day mortality after acute myocardial infarction (AMI) are patient outcomes that are reported by the OECD and used as indicators to assess the quality of acute care in health systems in international comparisons.

AMI hospital mortality in European countries as reported by the OECD has decreased continuously since 2000 (https://stats.oecd.org/). However, its level and trend have been very divers. AMI hospital mortality in 2019 in Germany (8.5%) was markedly higher than in the Netherlands (2.9%) and Norway (3.2%). For France, the most recent figure was 5.6% in 2015. If AMI hospital mortality is interpreted as an indicator for quality of acute care, these differences would hint at major problems in health care quality in Germany, and at a superior quality in the Netherlands and the Nordic countries. Comparing the countries’ health spending and availability of cardiologists or PCI facilities, this conclusion is surprising, as Germany ranks among the top countries for these aspects .

Looking into the reasons for the large differences in AMI hospital mortality we found that the indicator is only slightly related, if at all, to features of quality of acute care. Rather, it is strongly influenced by aspects of organization of patient registration and the structure of a health system. E.g. non-registration of day cases as patients leads to lower calculated mortality. The OECD indicator ‘AMI hospital mortality’ can only be used in a limited way for valid comparisons of patient outcome and quality of care.

30-day mortality after AMI is more suitable for comparing patient outcomes, as it is less influenced by organizational aspects not related to quality of care. Due to the strict data protection regulations, 30-day-mortality after AMI is not routinely available in Germany, as it requires a follow-up of patient outcome after discharge. However, it can be analysed using secondary data sources.

AMI registries also report AMI hospital and/or 30-day mortality. However, these results are neither validly comparable. Patient populations included in registries and in analyses from secondary data sources differ - which affects the reported outcomes.

We are seeking to collaborate with researchers in France and other countries in order to jointly analyse secondary data sources or registry data on outcomes after AMI. For relevant research questions relating to patient outcome, we would like to define agreed inclusion and exclusion criteria for patients to be included in the joint analyses. With patient populations having similar characteristics, we would be able to come to more valid conclusions regarding the quality of acute care and patient outcomes.

Currently, a cooperation with Swedish researchers is in an early stage. Contact has been established with researchers from the French FAST-MI registry. Additionally, we would like to include information on AMI patients and their care from the French health databases (Système National des Données de Santé, SNDS) in our project. We would welcome colleagues with knowledge of the structure and content of the SNDS data sources to join us in a joint project proposal for funding.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.