Heart attack mortality rate higher in the US compared to other high-income countries

The study, published May 4 in The BMJ, found substantial differences in care for heart attack patients across six high income countries despite international agreement on how heart attacks should be treated.

"No health care system seemed to be excelling in every aspect of heart attack care," said Dr. Peter Cram, professor and chair of internal medicine at the University of Texas Medical Center at Galveston, who is one of the authors of the study.

Cram and collaborator Dr. Bruce Landon from Harvard developed the International Health System Research Collaborative to compare treatment and outcomes across high income countries. For this particular study, they examined data for patients 66 and older who were admitted to a hospital with a heart attack in six high income countries between 2011 and 2017.

The countries they compared were the United States, Canada, England, Netherlands, Israel and Taiwan. Researchers chose these countries because they all have highly developed healthcare systems and accessible administrative data, but they differ in their financing, organization and overall performance in international rankings.

Researchers chose to look at heart attacks, a common condition with established international diagnostic criteria and consensus about evidence-based treatments that is easy track with widely available data.

While the United States did well with cardiac revascularization -- procedures to treat blockages in the coronary arteries -- and had low hospital readmission rates, the U.S. mortality rate along with Taiwan was higher than other countries and "concernedly high," Cram said.

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

By comparison, England and the Netherlands seemed to have lower mortality but far lower revascularization rates.

"It seems to be about tradeoffs," Cram said. "Israel really seemed to be an exception, the only country that really seemed to perform well across all measures."

The data is revealing.

"We previously didn't know this," Cram said. "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."

What accounts for the higher mortality rate after one year for heart attack patients in the United States and Taiwan is not clear.

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

But the questions point to where more research is needed.

"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."