Variation in care and outcome following myocardial infarction

Research describing variation in hospital treatment and outcomes has improved care for patients with acute myocardial infarction. Studies, particularly from the United States, have shown significant differences in hospitals’ use of evidence based tests and treatments for acute myocardial infarction including aspirin, β blockers, and angiotensin converting enzyme inhibitors.1 In response, major US organizations developed a set of core process measures for treatments considered to be standard of care.2 Hospitals’ performance on these measures were publicly reported and used to guide reimbursement.3 Subsequently, research identified significant variation in hospitals’ outcomes for acute myocardial infarction, including rates of 30 day readmission and mortality.4 The federal government has used hospitals’ performance on these metrics to exact financial penalties on institutions with worse than expected 30 day outcomes.5

It is with this focus on quality of healthcare that Chung and colleagues in the linked paper (doi:10.1136/bmj.h3913) describe variation in guideline recommended treatments and outcomes for patients admitted with acute myocardial infarction in the United Kingdom and Sweden.6 The authors examined nationwide registry data from all hospitals providing care for acute myocardial infarction in both countries between 2004 and 2010. They found that variation in …