Send to

Choose Destination
Eur Heart J Qual Care Clin Outcomes. 2016 Jul 1;2(3):172-183. doi: 10.1093/ehjqcco/qcw004.

Using big data from health records from four countries to evaluate chronic disease outcomes: a study in 114 364 survivors of myocardial infarction.

Author information

Farr Institute of Health Informatics Research, University College London, London, UK.
Statisticon AB, Uppsala, Sweden.
Retrospective Observational Studies, Evidera, Lexington, MA, USA.
Department of Pharmacology, CIC Bordeaux CIC1401 INSERM, University of Bordeaux, Bordeaux, France.
Department of Mathematics, National and Kapodistrian University of Athens, Athens, Greece.
Hôpital Européen Georges Pompidou, Paris, France.
Epidemiology, AstraZeneca Rueil-Malmaison, Rueil-Malmaison, France.
Real World Evidence, AstraZeneca Luton, Luton, UK.
Medical Department, AstraZeneca Nordic-Baltic, Oslo, Norway.
Global Payer Evidence and Pricing, AstraZeneca R&D, Cambridge, UK.
Global Medicines Development, AstraZeneca Gothenburg, Mölndal, Sweden.
Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
Department of Medicine, Karolinska Institutet, Huddinge, Sweden.
Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.



To assess the international validity of using hospital record data to compare long-term outcomes in heart attack survivors.

Methods and results:

We used samples of national, ongoing, unselected record sources to assess three outcomes: cause death; a composite of myocardial infarction (MI), stroke, and all-cause death; and hospitalized bleeding. Patients aged 65 years and older entered the study 1 year following the most recent discharge for acute MI in 2002-11 [n = 54 841 (Sweden), 53 909 (USA), 4653 (England), and 961 (France)]. Across each of the four countries, we found consistent associations with 12 baseline prognostic factors and each of the three outcomes. In each country, we observed high 3-year crude cumulative risks of all-cause death (from 19.6% [England] to 30.2% [USA]); the composite of MI, stroke, or death [from 26.0% (France) to 36.2% (USA)]; and hospitalized bleeding [from 3.1% (France) to 5.3% (USA)]. After adjustments for baseline risk factors, risks were similar across all countries [relative risks (RRs) compared with Sweden not statistically significant], but higher in the USA for all-cause death [RR USA vs. Sweden, 1.14 (95% confidence interval 1.04-1.26)] and hospitalized bleeding [RR USA vs. Sweden, 1.54 (1.21-1.96)].


The validity of using hospital record data is supported by the consistency of estimates across four countries of a high adjusted risk of death, further MI, and stroke in the chronic phase after MI. The possibility that adjusted risks of mortality and bleeding are higher in the USA warrants further study.

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center