The countries compared were England, the Netherlands, Taiwan, Israel, Canada, and the United States which were selected because they all have highly developed healthcare systems and accessible administrative data but differ in international rankings, organization, overall performance, and financing.
In this study, data was examined for patients aged 66+ who were admitted to hospital with a heart attack between 2011-2017 in these countries. Heart attacks were examined because this is a common condition with established international diagnostic criteria and general consensus regarding evidence-based treatments that are easy to track with widely available data.
While doing well with cardiac revascularization, procedures to treat blockages in the coronary arteries, and readmission rates, America’s mortality rate was higher than other countries and was “concernedly high” as was Taiwan, according to Cram. “The U.S. seems to focus really hard on those technologically advanced new and shiny things,” said Cram. “Maybe, from a policy perspective, we should focus more on the mortality rate instead of getting people in and out of the hospital.”
The Netherlands and England had lower mortality rates but have much lower revascularization rates. According to Cram “It seems to be about tradeoffs. Israel really seemed to be an exception, the only country that really seemed to perform well across all measures.” Adding that “We previously didn’t know this. “We should be comparing ourselves to high-income countries as a mechanism for identifying where we are performing well and where we should focus our improvement efforts.”
Although the data is revealing, it is not complete as what is accounting for the higher mortality rates within America and Taiwan after one year for heart attack patients remains unclear. But the questions this uncertainty point to where more research is required.
“What is happening to our patients who have had heart attacks after they leave the hospital?” says Cram “Is it gaps in wealth? Is it obesity rates? Is it people not taking recommended medications? We don’t know.”
“From a U.S. perspective, our heart attack care is good, but the one-year mortality rate is concerning,” Cram said. “If dying is one of the things we want to prevent, then we have work to do.”
