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Comparison of hospital variation in acute myocardial infarction care and outcome between Sweden and United Kingdom: population based cohort study using nationwide clinical registries

BMJ 2015; 351 doi: (Published 07 August 2015) Cite this as: BMJ 2015;351:h3913

Variation may be due to more heterogeneity of population in UK than in Sweden

Dear Editor:

I read with interest the article.(1)

The observed disparity needs to be explained clearly.

One of the factors could be, unlike in Sweden, the UK population is more heterogenous (a significant part of the population is from Asian, African and from other continents). It is a well known fact that Asians and Africans develop acute myocardial infarction (AMI) a decade or more earlier than whites.2 As Asians and Africans with AMI are a decade or so younger than whites, they therefore have less morbidity and mortality due to AMI. As there are many areas in the UK that are densely populated with Asians and Africans, the hospitals in these locations will have lesser mortality than the hospitals located in areas densely populated areas with whites because of the age difference of the patients: a major factor of early mortality in AMI.

However, in Sweden most of the population are white, so most victims of acute myocardial infarction are elderly having almost similar morbidity and mortality patterns. Therefore less variation in the outcome in Sweden is an expected finding.

1. BMJ 2015;351:H 3913

2. Mc Keigue PM,Miller GJ, Marmot MG. Coronary heart disease in south asians overseas: a review. J Clin Epidemiol. 1989;42:597-609

Competing interests: No competing interests

14 August 2015
Rajeev Gupta
Consultant Cardiologist
Kalba Hospital, Kalba, Sharjah, United Arab Emirates( UAE)
PO Box 11195, Kalba, Sharjah