Geographical variation in healthcare utilisation and medical practice in acute myocardial infarction
In Norway, approximately 13,000 heart attacks are treated annually across 53 hospitals. There are gender differences in the incidence of heart attacks, with nearly two-thirds of patients being men. The median age for acute heart attacks is 69 years for men and 78 years for women. Age-adjusted incidence rates vary geographically and are highest in the northernmost counties. Age-adjusted survival after 30 days is 94% following hospital admission for acute heart attacks, but many patients experience significant impairment in mental and physical function and reduced health after the event. Therefore, good quality of care before admission, during the hospital stay, and after discharge is crucial.
About the Project
Internationally, many studies have been conducted on variations in practice and the use of
health services for acute myocardial infarction. However, few studies contribute explanations for the observed variation, and many studies lack national coverage. There are also few studies examining the consequences of variation. To the extent that this is done, mortality is the primary measure. Despite some variation in results for the selected quality indicators in the registries, the mortality rate within 30 days after acute myocardial infarction is overall low in Norway compared to other countries. However, some variation in 30-day mortality after acute myocardial infarction has been shown among patients residing in different catchment areas in Northern Norway.
Some variation in the quality of treatment offered at different hospitals has been reported. For some of the indicators, the quality of treatment provided to patients residing in the various health trusts' catchment areas has also been examined, thereby assessing whether the health trusts' "duty of care" is being upheld. A number of national quality indicators have been introduced, as well as several management indicators for measuring unjustified variation in myocardial infarction. In this project, we will delve deeper into the causes of geographical variation in acute treatment and rehabilitation. We will investigate the justification and consequences of varying health service usage, medical practice, and treatment quality.
Project Aim
The main aim of this PhD project is to generate knowledge about the extent of and possible explanations for geographical and other unjustified variations in health service usage and medical practice in the treatment of acute myocardial infarction in Norway. This includes studying which factors at the patient level, family level, and municipal and health trust level may help explain any geographical variations. Additionally, we will examine whether geographical variation in the acute phase is associated with geographical variation in the use of health and welfare services later in the course of treatment.
The project seeks to illuminate the following themes:
Project Research Questions
- Geographical variation in revascularisation within the recommended time for STEMI – extent and explanations
- Geographical variation in follow-up after acute myocardial infarction – extent and explanations
- Paper I: Exploring variation in timely reperfusion treatment in ST-segment elevation myocardial infarction in Norway: a national register-based cohort study
- Paper II: The relation between delayed reperfusion treatment and reduced left ventricular ejection fraction in patients with ST-segment elevation myocardial infarction: a national prospective cohort study
Project participants
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Eva Stensland
Project Manager
Director SKDE, research responsible
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Bård Uleberg
PhD fellow