improving survivorship following acute myocardial
TRANSCRIPT
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
0
1
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3
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5
6
19
95
-99
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20
01
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02
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03
20
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14
Pre
vale
nce
o(%
)
High Income Middle Income Total
0
1000000
2000000
3000000
4000000
5000000
6000000
1990 1995 2000 2005 2010 2015
Nn
um
ber
of
new
cas
es
High Income Middle Income Total
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
1990 1995 2000 2005 2010 2015
Nn
um
ber
of
new
cas
es
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]