P6046Temporal trends of ST-elevation myocardial infarction incidence and 30-day mortality: a transatlantic comparison between Alberta, Canada and Northern England, United Kingdom
Bibliographic record
Abstract
Background/Introduction: Both the United Kingdom (UK) and Canada have publically funded health care systems; however, the evolution of ST-myocardial infarction (STEMI) care, with respect to the use of primary percutaneous coronary intervention (PPCI) and thrombolysis, has differed significantly across the two countries. Whether these differences in practice patterns have resulted in differing patient outcomes over time has not been previously examined. Purpose: We examined temporal trends in incidence, clinical characteristics, reperfusion strategies and mortality outcomes in patients hospitalized with STEMI in Alberta, Canada and Northern England, UK. Methods: We evaluated 11, 864 Albertans and 3, 694 Northern England patients enrolled between 01/01/04 and 12/31/13 in the Alberta Contemporary Acute Coronary Syndrome Patients Invasive Treatment Strategies (COAPT) and Algorithm for Comorbidities, Associations, Length of stay and Mortality (ACALM) registries, respectively. Poisson regression was used to assess trends in annual incidence rate per 100,000 population. Primary outcome was 30-day all-cause mortality. Results: The incidence of STEMI in Northern England has decreased over time (incident rate ratio [IRR]=0.93; p<0.001) while it has increased slightly in Alberta (IRR=1.02; p<0.001) (Figure). Over the study period, the mean age decreased in Alberta (61.9 [13.3] to 60.4 [12.6] years, p=0.009) and remained similar in Northern England (61.3 [13.1] to 59.5 [14.6] years, p=0.187). The mean Charlson risk score increased in Alberta (1.56 to 1.63, p=0.028) but remained similar in Northern England (1.62 to 1.76, p=0.18). Average length of stay decreased from 9.2 to 7.3 days (p<0.001) and 6.4 days to 4.9 days (p=0.02), respectively. PPCI rates in Northern England increased as the dominant strategy (2004–2013: 57% to 77%, p-trend<0.01) while in Alberta they remained consistent as part of a dual reperfusion strategy (2009–2013: 47.6% to 43.8% p-trend=0.11). While rates remained low and did not change over time in Alberta (p=0.22), there was a significant decline in 30-day mortality rates in Northern England (Figure, p≤0.01).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".