Differences in treatments and outcomes of acute myocardial infarction between a high- and a middle-income country – A comparison of nationwide data from Germany and Indonesia
S A Lange, J Koeppe, W Sugiyanto, J Feld, C Engelbertz, J Mawardi, A Ghufron Mukti, H Reinecke, P Pujowaskito, S WenangAbstract
Background
Comparisons of healthcare processes between high-income and middle-income countries serve to highlight differences and similarities in terms of diseases, treatment methods, and survival rates. This enables emerging countries to tailor their future healthcare systems to specific needs and make targeted improvements. For more than two decades, care for acute myocardial infarction (AMI) in Germany (GER) has been a leader in the nationwide provision of cardiac catheterization laboratories, which enable 24/7 interventional AMI treatment. Indonesia, as one of the middle-income countries, is the fourth most populous country in the world and has 1.5% of its total population suffering from heart disease, including AMI.
Methods
For this purpose, we compared all inpatient cases of AMI in Germany (DESTATIS) with all inpatient AMI cases in Indonesia (IDN) for the treatment year 2023.
Results
The incidence of AMI is 65.6 per 100,000 inhabitants in IDN and 225.7 per 100,000 inhabitants in GER. The proportion of women in AMI is almost identical in both populations, at 31% in IDN and 32% in GER. The median age for AMI in IDN was 59 (IQR 14 years), which was 11 years earlier than the median age for AMI in GER (70 IQR 21 years). Relevant complications during inpatient treatment, such as hemorrhagic stroke, bleeding, acute renal failure, and shock, were more common in Germany. However, AMI patients in GER were less likely to have an acute stroke. With regard to acute AMI therapy, patients in IDN received lysis therapy seven times more often and cardiac catheterization 3.7 less often than patients in GER. However, the majority of AMI patients in IDN received neither one nor the other form of therapy. The inpatient AMI mortality was 11.0% in IDN and 7.9% in GER.
Conclusion
Compared to GER, the incidence of AMI is lower in IDN, but the patients affected are younger and their in-hospital mortality is higher, possibly due to the lower number of cardiac catheterizations and PCI procedures.