Exploring variations of acute myocardial infarction coding, management and 30-day mortality in Latvia: the nationwide linked administrative data study

Background. According to statistics of Organisation for Economic Cooperation and Development (OECD) Latvia has one of the highest 30-day mortality for acute myocardial infarction (AMI). To explain the causes of it, the output data used in the calculation of this indicator was analysed at a hospital level to explore the variations in AMI coding and management. Aim. The aim of the current study was to investigate which factors can explain high mortality rates in AMI cases. Methods. Data from Health services reimbursement system linked to the data at Causes of death reg-istry from 2014 – 2017 were analysed. Defined exclusion criteria were applied and 11675 emergency AMI admissions to 20 hospitals were indexed. Evaluating the inter-hospital differences in non-ST elevation myocardial infarction (NSTEMI) revealed significant inconsistency in coding of NSTEMI events. There-fore the 30-day mortality and the factors influencing it, was exclusively analysed for 9168 ST elevation myocardial infarction (STEMI) cases. The outcomes of different reperfusion scenarios were analysed for five groups of hospitals of size, location, the availability of percutaneous coronary interventions and cardiac surgery. The multivariable logistic regression was employed to adjust the results for potential explanatory variables as patient age, gender, comorbidities, the distance between their residence and hospitals.Results. 30-day mortality for all indexed AMI admissions (17,4%) was in line with the value of the in-dicator in OECD reports. However only 21,5% of all cases have been coded as NSTEMI (12,2% mortality). The mortality of the patients with STEMI have reached 18,8% composed by mortality in range from 13,7% for patients directly admitted to tertiary university hospitals to 23,7% for patients initially admitted to local hospitals. Significant variations in mortality between reperfusion scenarios as well as the variations in the frequency of application reperfusion methods between hospital groups were observed. Some variation in mortality between hospital groups persisted also after adjustment to the reperfusion therapy scenario and other potential confounders.Conclusion. The improvement of coding practice is needed to measure the actual AMI mortality in Latvia. Among patients with STEMI, there are wide inter-hospital variations in care and mortality. There is a substantial room for improvements in all types of hospitals to increase reperfusion rates and to reduce delays in initiation of it. Acknowledgements. The study was part of the University of Latvia and the Centre for Disease Pre-vention and Control joint project “Transparency and health care system data - towards public monitoring for quality and efficiency”.

(17) (PDF) Abstracts 2019-1-Medicina (3). Available from: https://www.researchgate.net/publication/333866613_Abstracts_2019-1-Medicina_3 [accessed Oct 28 2021].