Heart attack death rate in U.S. far greater than other high-income countries

GALVESTON, Texas — On paper, U.S. hospitals are supposedly very good at treating heart attack patients. American medical facilities typically have access to the latest healthcare technology and generally boast low readmission rates among heart attack patients. Troublingly, however, new research from the University of Texas Medical Branch at Galveston reports that America’s heart attack death rate is one of the highest among studied high-income nations.

All in all, the study reports major discrepancies in heart care and outcomes among heart attack patients across the six assessed high income countries. Considering there is an international agreement that explicitly states how heart attacks should be treated, this is really quite puzzling.

“No health care system seemed to be excelling in every aspect of heart attack care,” says study co-author Dr. Peter Cram, professor and chair of internal medicine at the University of Texas Medical Center at Galveston, in a university release.

Dr. Cram and his colleague Dr. Bruce Landon from Harvard created the International Health System Research Collaborative to compare heart attack treatments and outcomes across various high-income countries. During this project in particular, data was examined pertaining to a group of patients ages 66 or older who had been admitted to a hospital with a heart attack in one of the six high income countries between 2011- 2017.

The six high-income countries included were: USA, Canada, Taiwan, England, Netherlands, and Israel. Importantly, all six of those countries boast highly developed healthcare systems and accessible administrative data. The nations differ considerably, though, when it comes to other healthcare aspects like financing, organization, and international rankings performances.

For what it’s worth, the United States did well regarding cardiac revascularization, or procedures for treating coronary artery blockages. America also showed low hospital readmission rates. But, and it’s a rather big but, the U.S. mortality rate was “concernedly high” in comparison to the other countries. Although, Taiwan also showed a rather high mortality rate as well.

“The U.S. seems to focus really hard on those technologically advanced new and shiny things,” Dr. Cram says. “Maybe, from a policy perspective, we should focus more on the mortality rate instead of getting people in and out of the hospital.”

In comparison, both England and the Netherlands had lower mortality, but also far lower revascularization rates. “It seems to be about tradeoffs,” Dr. Cram says.  “Israel really seemed to be an exception, the only country that really seemed to perform well across all measures. 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.”

The reason behind this observed higher mortality rate after one year among American and Taiwanese heart attack patients is a mystery for now.

“What is happening to our patients who have had heart attacks after they leave the hospital?” Dr. Cram comments. “Is it gaps in wealth? Is it obesity rates? Is it people not taking recommended medications? We don’t know.”

That being said, those lingering questions provide a clear idea of what to focus on during the next round of research.

“From a U.S. perspective, our heart attack care is good, but the one-year mortality rate is concerning,” Dr. Cram concludes. “If dying is one of the things we want to prevent, then we have work to do.”

The study is published in The BMJ.

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