Towards evidence-based management: A nationwide administrative data-based audit of acute myocardial infarction in Latvia

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Abstract
When care for an individual patient is determined by evidence-based medical guidelines, the management of the whole clinical process also needs to be based on evidence. In Latvia, an careful retrospective data analysis is needed to suggest evidence-based organizational interventions for the care of acute myocardial infarction (AMI), since a 30-day AMI mortality here remains one of the highest among the OECD Member States. An audit based on Healthcare reimbursement data linked to the causes of death registry from 2014-2018 was performed. Analysed 11 065 ST-elevation AMI cases reveals lower mortality for patients directly admitted to hospitals able to perform percutaneous coronary intervention (preferred reperfusion option according to guidelines) compared to patients initially admitted to a large group of local hospitals (able to perform only thrombolysis-based reperfusion). However, no statistically significant type-of-hospital effect for this group of hospitals is found, when other factors - including treatment type - are accounted for in logistic regression analysis of factors influencing AMI-mortality. That combined with vastly improved survival opportunities if any reperfusion procedure is used suggests that decreasing the proportion of non-reperfusion patients by applying any reperfusion procedure might be one of the main directions for the improvement of AMI outcomes in Latvia.

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