Mortality due to coronary heart disease has declined substantially over the past decade (see indicator “Mortality from circulatory diseases” in Chapter 3). Nonetheless, acute myocardial infarction (AMI) remains the leading cause of cardiovascular death in many EU countries, highlighting the need for further reductions in risk factors and care quality improvements (OECD/The King's Fund, 2020[1]). The COVID‑19 crisis has also revealed the need to maintain access to high-quality acute care for AMI during public health emergencies.
Metrics of 30‑day mortality after AMI hospital admission reflect processes of care, such as timely transport of patients and effective medical interventions. However, the indicator is influenced not only by the quality of care provided in hospitals but also by differences in the length of stay and AMI severity across countries. Figure 6.13 shows mortality rates within 30 days of admission to hospital for AMI using unlinked data – that is, only counting deaths that occurred in the hospital where the patient was initially admitted, among patients aged 45 and over. The lowest rates in 2021 were in Iceland, the Netherlands, Norway and Sweden (3.6% or less) while the highest rates were in Latvia (over 15%), followed by Estonia (11.3%) and Lithuania (10.3%).
Figure 6.14 shows the same 30‑day mortality rate but calculated based on linked data, whereby the deaths are recorded regardless of where they occurred after hospital admission (in the hospital where the patient was initially admitted, after transfer to another hospital, or after being discharged). Based on these linked data, the AMI mortality rates in 2021 ranged from 3.2% in the Netherlands to 17.9% in Latvia.
According to both indicators, case fatality rates for AMI increased slightly in most countries between 2019 and 2021, except in Belgium, Iceland and Norway, where they decreased. Across EU countries, the average rate rose from 6.6% to 7.2% for same‑hospital deaths and from 9.2% to 10.2% for deaths in and out of hospital. Case fatality rates increased especially in countries that had rates above the EU average before the pandemic. For same‑hospital deaths, the increase was marked in Estonia, Türkiye, Latvia and Romania, and a substantial increase was also observed for deaths in and out of hospital in Estonia, the Slovak Republic, Malta and Slovenia.
The increasing rate might reflect challenges faced by many health systems in ensuring timely access to acute care during the COVID‑19 crisis. In most countries reporting 2021 data, the number of people admitted to hospital due to AMI decreased from 2019. A number of studies in EU and other OECD countries point out that, during the pandemic, the average severity of AMI patients admitted to hospital increased due to hesitancy in seeking care, particularly among those with milder conditions. Further, the time from the onset of symptoms to treatment was prolonged due to later patient presentations at hospitals and longer processing time at hospital before initiating a needed procedure. Cross-country analysis of recent 30‑day case fatality trends is also challenging because people with underlying cardiovascular conditions tend to be more vulnerable to dying from COVID‑19 infection, while at the same time COVID‑19 infection itself is associated with an increased risk of different types of cardiovascular diseases – both ischaemic heart disease and cerebrovascular diseases (Zuin et al., 2023[2]).
While timely provision of high-quality care is required from the onset of AMI, 30‑day mortality rates only capture the quality of care provided once patients are admitted to hospital. Pre‑hospital access to healthcare such as emergency medical services is also crucial for outcomes of AMI patients.
