Improving survivorship following acute myocardial ...
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Improving survivorship following acute myocardial infarction: High resolution insights from national health records data Chris P Gale Professor of Cardiovascular Medicine, Honorary Consultant Cardiologist, Head of Clinical and Population Sciences, University of Leeds, UK [email protected] @cpgale3
Transcript of Improving survivorship following acute myocardial ...
Improving survivorship following acute myocardial infarction:
High resolution insights from national health records data
Chris P Gale
Professor of Cardiovascular Medicine,
Honorary Consultant Cardiologist,
Head of Clinical and Population Sciences,
University of Leeds, UK
[email protected] @cpgale3
Increasing incidence of CVD
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High Income Middle Income Total
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2000000
3000000
4000000
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6000000
1990 1995 2000 2005 2010 2015
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High Income Middle Income Total
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1,000,000
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3,000,000
4,000,000
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6,000,000
1990 1995 2000 2005 2010 2015
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cas
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High Income Middle Income Total
Men, CVD incidence
Women, CVD incidence
Diabetes, prevalence
Atlas Writing Group. Eur Heart J. 2018;39(7):508-579
Increasing incidence of NSTEMI
Yeh RW. N Engl J Med 2010;362:2155-2165
Decline in mortality following AMI
Gale CP. Eur Heart J. 2012;33:630–639
MINAP data sites, 2003 – 2013
Fundamental questions
• What is associated with the decline in early deaths from AMI?
• What are the opportunities to improve AMI survivorship?
• What does the future hold for improving AMI survivorship?
STEMI
National diffusion of PPCI service for STEMI
Hall M, Heart 2016, Jan 5 pii: heartjnl-2015-308616
NSTEMI
Temporal improvements in NSTEMI care
Hall M. JAMA. 2016 Sep 13;316(10):1073-82
Invasive coronary strategy explains NSTEMI temporal survival improvements
Hall M. JAMA. 2016 Sep 13;316(10):1073-82
Improved survival following AMI in Sweden compared with the UK
Chung SC. Lancet. 2014 Apr 12;383(9925):1305-12
Hospital variation in 30-day mortality in Sweden and the UK
Chung SC. BMJ 2015;351:bmj.h3913
Regional inequalities in 30-day mortality
Gale CP. Heart. 2011 Dec;97(23):1926-31
Gap between evidence and practice
Dondo T. BMJ Open 2016;6(7):e011600
Reduced survival among NSTEMI who do not receive eligible care
TR 0.44, 95% CI 0.41–0.45
Dondo T, EHJ Acute Cardiovasc Care, 2017 Aug;6(5):412-420
#measure2improve because #datasaveslives
Bebb O. EHJ 2017;38(13):974-982 Schiele F. Circ CVQO 2017;10(6)
Test and implement
Chew D. AHJ 201;170(5):995-104 e1
@UKGRIS
Multimorbidity and survival
Diabetes
Stroke
COPD or asthma
Heart failure
Renal failure
PVD
No long-term
condition
Hall M. Plos Medicine. 2018 Mar 6;15(3):e1002501
Creating ‘room’ to improve AMI survivorship
Dondo TB. JACC. 2017 Jun 6;69(22):2710-2720 Neal B. N Engl J Med 2017; 377:644-657
Fundamental answers
• What is associated with the decline in early deaths from AMI?• STEMI – National PPCI service• NSTEMI – The use of an invasive coronary strategy
• What are the opportunities to improve AMI survivorship?• Preventing missed opportunities for guideline-indicated care
• What does the future hold for improving AMI survivorship?• Improving guideline adherence, UKGRIS• Testing generic therapies to remove the redundant, REDUCE
trials• Repurposing therapies to new populations, SGLT2i
@cpgale3 [email protected]
