Mortality due to coronary heart disease has declined substantially over recent decades (see section on “Mortality from circulatory diseases” in Chapter 3). Reductions in smoking (see section on “Smoking and vaping” in Chapter 4) and improvements in treatment for heart diseases have contributed to this decline. Despite this progress, AMI (heart attack) remains one of the leading causes of death and the main cause of cardiovascular death in many OECD countries, highlighting the needs for further reductions in risk factors and care quality improvements (OECD/The King's Fund, 2020[1]; OECD, 2025[2]).
Metrics of 30‑day mortality after hospital admission for AMI are reflective of processes of care, such as timely transport of patients and timely and effective medical interventions. As such, the indicator is influenced not only by the quality of acute care provided in hospitals – such as percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery – but also by quality and timeliness of pre‑hospital diagnosis and treatment including the use of automated external defibrillator (AED) and administration of medications, co‑ordinated ambulance dispatch and efficient patient transportation to hospitals, and providing adequate diagnosis and treatment. Thirty-day mortality rates are also related to differences in patterns of hospital transfers, length of stay and AMI severity.
Figure 6.24 shows mortality rates within 30 days of admission to hospital for AMI using unlinked data – that is, only counting deaths that occurred in the hospital where the patient was initially admitted – among patients aged 45 and over. The lowest rates in 2023 were in Iceland, Norway, the Netherlands, Australia and Sweden (less than 4%) while the highest rates were in Mexico (23%) and Latvia (14%).
Figure 6.25. shows the same 30‑day mortality rate but calculated based on linked data, whereby the deaths are recorded regardless of where they occurred after hospital admission (in the hospital where the patient was initially admitted, after transfer to another hospital or after being discharged). Based on these linked data, AMI mortality rates in 2023 ranged from 5% in Iceland and the Netherlands to 15% in Latvia.
Case fatality rates for AMI decreased substantially before the pandemic between 2013 and 2019 but there has been little improvement since 2019. Across OECD countries, the average rate fell from 8.2% to 6.7% for same‑hospital deaths and from 10.7% to 8.9% for deaths in and out of hospital between 2013 and 2019 but in 2023 the average rate was 6.5% for same‑hospital deaths (Figure 6.24) and 8.6% for deaths in and out of hospital (Figure 6.25.). However, there were a few exceptions: the 30‑day mortality rate for AMI declined substantially in Japan, and a significant increase was observed in Türkiye and Poland since 2019. In Japan, a professional society responsible for certification of professionals and providers in cardiovascular interventions introduced a benchmarking mechanism for quality of PCI in 2018, and benchmarking results – covering 90% of PCI conducted in the country, are reported at the provider level to facilitate quality improvement (Saito et al., 2024[3]).
The mortality rate within 24 hours of hospital admission, which usually excludes deaths in the ambulance or hospital emergency department, was below 1.5 per 100 patients in Iceland, Canada and Australia but above 3.5 per 100 patients in Lithuania and Latvia in 2023 (Figure 6.26). Pre‑hospital access to effective care is crucial for short-term outcomes for AMI patients. To ensure timely delivery of treatment, countries are increasingly allowing citizens to use an AED without prior training. Several OECD countries also overcame regulatory hurdles to allow non-medical pre‑hospital staff to perform certain medical tasks such as diagnosis, prescription and administration of medicines. In Australia, ambulance officers can administer medications according to protocols, and their role has progressively increased in scope as has the sophistication of their training (OECD, 2025[2]; Putland, Morgan and Fujisawa, forthcoming[4]).
