Care of myocardial infarction: Sweden excels

The development of new evidence based diagnostic methods, drugs, interventions and medical devices in the cardiovascular field in general, and in acute myocardial infarction (AMI) in particular, has been dramatic the last 30 years. During the same period a substantial decrease in the mortality after AMI has been noted in most western countries, including Sweden1. This could partly be explained by the adoption of new and better diagnostic methods and treatments2, 3. Attributes of the care system, such as organisational culture (e.g. flexibility and willingness to change), care pathways and type of financial incentives play an important role for the adoption of new methods and therapies. However, changes in risk factor patterns in the general population seem equally important for explaining the decrease in mortality3. Thus, these facts emphasize the importance of a comprehensive strategy that promotes development and implementation of evidence-based medical methods and treatment measures as well as measures to improve public health (primary prevention). It also means that outcome measures such as mortality after AMI, do not only reflect the performance of the health care system but also reflect the general public health.