Cardiovascular disease is the major cause of death in Asia-Pacific, accounting for 35% of the total deaths in the region in 2019 (Zhao, 2021[1]). Ischaemic heart diseases and stroke were the two major causes of death in Asia-Pacific, accounting for 22.8% of total deaths in the WHO South-East Asia Region and 35.1% of all deaths in the WHO Western Pacific Region in 2021 (Institute for Health Metrics and Evaluation, 2024; indicator “Mortality and morbidity from cardiovascular disease” in Chapter 3). Additionally, both are associated with significant health, social and other non-financial costs, because of the persistent disabilities suffered by many survivors.
Quality, notably effectiveness of treatment following acute myocardial infarction (AMI) and stroke has improved significantly over the past decades. For AMI, in the last decade, novel diagnostic methods such as high-sensitivity cardiac troponin assays, as well as advanced imaging techniques, including cardiac MRI and CT angiography, have been introduced in high-income countries, contributing to improved patient outcomes through early diagnosis and timely treatment (Sachdeva et al., 2023[2]). Effectiveness of treatment for ischaemic stroke has also improved dramatically over the last decade, through early identification of suspected ischaemic stroke patients and timely acute reperfusion therapy. Countries can further improve quality of stroke care through timely transportation of patients, evidence‑based medical interventions and access to high-quality specialised facilities such as stroke units (OECD, 2015[3]).
For both AMI and stroke, the case‑fatality rate is a useful measure of acute care quality, reflecting notably the effectiveness of medical interventions, including early diagnosis, timely thrombolysis or treatment with aspirin when appropriate, and catherterisation, as well as co‑ordinated and timely transport of patients. For AMI, age‑standardised in-hospital case‑fatality rates within 30 days of admission were low in Australia (3.3%) and New Zealand (4.1%) and high in Singapore (9.9%) in 2021 (Figure 7.4). Beyond the quality of care provided in hospitals, differences in hospital transfers, average length of stay, emergency retrieval times and average severity of AMI and stroke may influence cross-country differences in 30‑day case‑fatality.
For ischemic stroke, the lowest case‑fatality rates were reported in Japan (2.9%) and Korea (3.3%), while New Zealand reported the highest rate of 5.9% (Figure 7.5). Fatality rates for haemorrhagic stroke are significantly higher than for ischemic stroke for all countries, and countries that achieve better survival for one type of stroke also tend to do well for the other. The lowest case‑fatality rates for haemorrhagic stroke were reported in Japan (11.4%), with Singapore reporting the highest rate of 19.1% (Figure 7.6). Given the initial steps of care for stroke patients are similar, this suggests that system-based factors play a role in explaining the differences across countries.
In Asia-Pacific countries, the case‑fatality rate and the cross-country differences in case‑fatality rates have decreased over the past decade. Thirty-day mortality rates were about the same before and during the pandemic, suggesting that the pandemic did not necessarily have negative impact on the quality of acute care, although reduced number of hospital admissions following acute cardiovascular events were reported in the initial phase of the pandemic in some countries and territories in the region (Tam et al., 2020[4]).
In view of improving quality of acute care, other countries in Asia-Pacific analyse and evaluate case‑fatality rates following acute cardiovascular events in recent years. These countries include China, Indonesia, Malaysia and Thailand (Long et al., 2022[5]; Limwattananon et al., 2020[6]; Kamarulariffin Kamarudin et al., 2022[7]; Juzar, Dafsah Arifa et al., 2022[8]). Case‑fatality rates for AMI and stroke could be monitored at the national level to regularly evaluate acute care quality, its difference across hospitals and changes over time.
