Stroke is the second leading cause of death worldwide. Around 85% of strokes in the UK are ischaemic (when a clot blocks blood flow to part of the brain), while the remaining 15% are haemorrhagic (when a blood vessel bursts and bleeds into the brain).
Coronary heart disease (CHD) is the leading cause of death worldwide. One of the main symptoms of CHD is myocardial infarction, or heart attack, when blood flow to the heart is blocked, usually by a clot.
Mortality rates following a stroke or heart attack allow us to better understand the quality of acute care services that are provided for these two common conditions. Here we look at 30-day mortality rates (mortality rates within 30 days of hospital admission) for ischaemic stroke, haemorrhagic stroke and acute myocardial infarction (AMI).
Mortality rates, which can be used as a proxy for the quality of acute stroke care, have been stable or declining over time in all of the Organisation for Economic Co-operation and Development (OECD) comparator countries. In the UK, 30-day mortality after admission to hospital for ischaemic stroke (based on linked data) decreased from 18.3 per 100 patients in 2008 to 11.6 per 100 patients in 2013, but the rate has since stayed roughly constant. In 2017, the UK had the second highest 30-day mortality rate of the comparator countries. New Zealand had the highest 30-day mortality rate at 12.2 per 100 patients, while the Netherlands’ mortality rate was the lowest at 5.7 per 100 patients.
While haemorrhagic strokes are less common than ischaemic strokes, they are generally more severe and have a higher mortality rate. In the UK, the 30-day mortality rate after admission to hospital for haemorrhagic stroke (based on linked data) decreased from 37.1 per 100 patients in 2008 to 30 per 100 patients in 2013, and has remained roughly constant since then. The UK’s mortality rate is relatively high compared to other OECD countries. In 2017, the UK’s mortality rate for haemorrhagic stroke was lower than that of Denmark (34.6 per 100 patients), but higher than that of Portugal (22.9 per 100 patients) and Sweden (23.1 per 100 patients).
In the UK, the Sentinel Stroke National Audit Programme (SSNAP) found that research into the treatment and management of haemorrhagic stroke has lagged behind that for ischaemic stroke. However, research has increased over the last five years, and the audit recommends that new evidence-based findings should now be translated into routine clinical practice to improve outcomes for haemorrhagic stroke.
Though the decline in mortality rates over time is positive, it is important to note that differences in routine data collection and stroke care around the world make international comparisons challenging.
Similar to strokes, acute myocardial infarctions (AMIs) require early diagnosis and fast specialist treatment, together with cardiac rehabilitation in order to reduce the probability of recurrent heart attacks or death, and improve quality of life.
The 30-day mortality rates after admission to hospital for AMI (based on linked data) have decreased over time in most of the comparator countries. Between 2008 and 2017, the 30-day AMI mortality rate in the UK decreased from 11.9 per 100 patients to 8.6 per 100 patients. However, the UK has consistently had a relatively high mortality rate compared to the other countries included here. In 2017, only Finland had a higher 30-day mortality rate for AMI, at 8.8 per 100 patients.
About this data
Definitions and comparability for the indicators are taken directly from the OECD report Health at a Glance 2019: OECD indicators. Detailed information about the definitions and the source and methods for each country can be found here.
The case-fatality rate measures the percentage of people aged 45 and over who die within 30 days following admission to hospital for a specific acute condition. Rates based on unlinked data refer to a situation where the death occurred in the same hospital as the initial admission. Rates based on linked data refer to a situation where the death occurred in the same hospital, a different hospital, or out of hospital. While the linked data based method is considered more robust, it requires a unique patient identifier to link the data across the relevant datasets which is not available in all countries.
Rates are age-sex standardised to the 2010 OECD population aged 45+ admitted to hospital for a specific acute condition such as AMI and ischaemic stroke.