In-hospital mortality following acute myocardial infarction and stroke
Ischaemic heart diseases and stroke were two major causes of death in Latin America (see Chapter 3). These diseases carry significant health, economic, social, and non-financial costs associated with both mortality and the persistent disabilities suffered by many survivors. The quality of treatment following acute myocardial infarction (AMI) and stroke has advanced greatly over the past decades, thanks in part to the introduction of new technologies such as cholesterol and blood pressure lowering medications, thrombolysis, and angioplasty (OECD, 2015[1]). The case-fatality rate for both AMI and stroke is a useful measure of acute care quality. It reflects the processes of care, such as effective medical interventions, including early thrombolysis, angioplasty, or treatment with aspirin when appropriate and co-ordinated and timely transport of patients. At the same time, the measure could be also influenced by individual characteristics such as the typical severity of the AMI and stroke cases presented to hospitals.
Compared to the OECD average (6.9%), the age-sex standardised in-hospital case fatality of AMI within 30 days of admission was reported as low in Colombia (5.6%) and is highest in Mexico (27.5%) (Figure 7.4). For ischaemic stroke, the lowest case-fatality rates were reported in Costa Rica (6.7%) and in Brazil (11.7%), below the OECD average of 12.3%. Chile reported the highest rate of 15.2%, while Colombia was also over the OECD average (Figure 7.5).
Fatality rates for haemorrhagic stroke are significantly higher than for ischaemic stroke, but in 2021 countries that achieve better survival for one type do not necessarily do well in the other. Costa Rica leads the region with a rate of 8.1%, lower than the OECD average of 22.2%. Colombia (15.6%) and Chile (16.3%) have lower than OECD average rates. Mexico reported a 29.9% rate in 2017 (Figure 7.6).
Only five countries in the region could provide this type of quality-of-care data. This is less than in the previous edition of Health at a Glance Latin America and the Caribbean. Creating accurate and comparable quality-of-care indicators is an essential capacity to improve system performance. Greater efforts should be put in place to develop appropriate health system information infrastructure, along with building the capacities to produce and use the performance information.
While LAC countries have made important efforts in promoting healthier lifestyles to reduce the burden of cardiovascular disease (CVD), greater attention must be given to improving the quality of care provided to CVD patients. For instance, policies ensuring comprehensive primary care in compliance with recommended guidelines and financially accessible to everyone are key. at the same time, a system of accountability and transparency of healthcare can provide an accurate setting for important quality improvements. Such policies need to be supported by national frameworks to improve the quality of acute care for CVD, together with standards for the measurement and continuous quality improvement of emergency services and care provided in hospitals (OECD, 2015[1]).
The in-hospital case-fatality rate following AMI, ischemic and haemorrhagic stroke is defined as the number of people who die within 30 days of being admitted to hospital out of 100 patients admitted to hospital with these conditions. This indicator is based on unique hospital admissions and restricted to mortality within the same hospital, differences in practices in discharging and transferring patients may influence the findings. Standardised rates adjust for differences in age (45+ years) and sex and facilitate more meaningful international comparisons.
Data presented here do not take account of patients that are transferred to other hospitals during their care or reflect patients who died out of hospitals within 30 days. Using a unique patient identifier patient data can be linked across hospitals and with death registers to generate more robust indicators for national monitoring and international comparison. Currently, very few countries in Latin America and the Caribbean can track patients in this way and hence this form of indicator is not shown here.
References
[1] OECD (2015), Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, OECD Health Policy Studies, OECD Publishing, Paris, https://doi.org/10.1787/9789264233010-en.
Source: OECD Health Statistics 2020 and national data sources.
Source: OECD Health Statistics 2020 and national data sources.
Source: OECD Health Statistics 2020 and national data sources.