On 13. September 2019 Aet Saar will defend her doctoral thesis „Aet Saar, „Acute myocardial infarction in Estonia 2001–2014: towards risk based prevention and management“.
professor Jaan Eha, UT
research fellow Tiia Ainla, UT
research fellow Toomas Marandi, UT
professor Krista Fischer, UT
professor emeritus Markku Sakari Nieminen, Medical Faculty, University of Helsinki, Finland
Mortality from cardiovascular disease, more specifically ischaemic heart disease and myocardial infarction, has shown substiantial decrease over the last decades in Estonia, but remains higher than an European average. More effective prevention and improved treatment after MI should be a priority to achieve better outcomes.
The cornerstone of prevention is identifying the highest risk individuals and treating them to reduce the risk of developing myocardial infarction. The intensity of preventive therapy should match the individual’s risk level – higher risk warrants more intensive treatment and guidelines recommend using risk scores for risk estimation. However, the predictive ability of risk scores has not been previously evaluated in Estonia. The current study found that the US PCE (Pooled Cohort Equations) and European SCORE performed at acceptable level in their original form and should be used for guiding management decisions in the prevention of cardiovascular disease. The UK QRISK2 markedly underestimated the risk and requires modification prior to use.
There has been an increase in the use of guideline-recommended therapies in myocardial infarction treatment over the period of 2001–2014 in Estonia. The current study showed an improved survival after myocardial infarction over the same time course, which was seen despite the increased mean age of the patients and rising burden of other diseases. Paradoxically, the improvement in treatment quality was more pronounced in patients with lower baseline mortality risk, while patients with higher mortality risk received less guideline-recommended treatments. The study also demonstrated the equalization of treatment quality between Estonian secondary and tertiary care hospitals – by the year 2011 the prognosis did not depend on the hospital type where a patient with myocardial infarction was initially hospitalized.