of patients who died from myocardial infarction without having been hospitalised (see Indicator 87). The quality of hotline, emergency, ambulance and other nonhospital services affects this indicator as well. The indicator is subject to sources of error. Given the low percentage of autopsies performed on the elderly, diagnosis of the cause of death is less certain when the patient dies without having been initially hospitalised. Diagnostic variations affect the results. However, following up hospitalisation for infarction only would be skewed by the percentage of cases that had never been hospitalised. In other words, a large proportion of non-hospitalised patients would make the percentage of recurrences seem lower. The inclusion of other ischaemic heart disease has probably reduced the uncertainty associated with diagnosing the cause of death among non-hospitalised patients.
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Reperfusion Therapy for Patients with ST-segment Elevation Myocardial Infarction (STEMI)
STEMI is caused by an occlusion of a coronary artery. Myocardial infarction with concurrent left bundle branch block (LBBB) on the EKG also raises a strong suspicion of acute myocardial infarction. Patients with STEMI need immediate primary percutaneous coronary intervention (PCI) or thrombolytic therapy. To minimise cardiac damage, as well as the risk of future heart failure and death, treatment should begin as soon as possible after the onset of symptoms and the diagnosis. Reperfusion therapy consists primarily of PCI and thrombolytic therapy. Acute coronary angiography that does not lead to PCI is also included. Primary PCI, the predominant treatment in most Swedish counties these days, was performed at 29 hospitals in 2011. The national guidelines recommend primary PCI as the first-line treatment, relegating thrombolytic therapy to situations in which the former method would cause a delay of more than 90 minutes. Regardless of which method is selected, the guidelines prioritise reperfusion therapy for STEMI and LBBB. The indicator reflects the percentage of myocardial infarction patients with STsegment elevation or LBBB on the EKG who received acute reperfusion therapy. The indicator was used by the national guidelines for follow-up purposes and by the RIKS-HIA Quality Index for myocardial infarction care in 2011. The results are reported at the county level only, based on where the patient was admitted. The comparison for 2011 covered 3 912 patients aged 79 or younger, including more than 900 women, for whom less than 12 hours passed between the onset of symptoms and first EKG.
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QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012