Doctoral defence: Piret Asser "From registry to reality: insights into myocardial infarction care and prevention across Estonia and Europe”

On the 12th of December 2025 Piret Asser will defend her thesis „From registry to reality: insights into myocardial infarction care and prevention across Estonia and Europe”.

Supervisors:
Professor of Cardiology Jaan Eha, University of Tartu
Professor of Mathematical Statistics Krista Fischer, University of Tartu
Researcher Fellow in Cardiology Tiia Ainla, University of Tartu
Researcher Fellow in Cardiology Toomas Marandi, University of Tartu

Opponent:
Emeritus Professor Markku Sakari Nieminen, University of Helsinki (Finland)

Summary:
Post–heart attack (myocardial infarction, MI) mortality in Estonia has fallen over recent decades, but the decline is slower than in the Nordic countries and has lately lost pace. One reason is a changing patient mix: emergency rooms see more younger people with high metabolic risk (patients who are overweight, with type 2 diabetes and high blood pressure) alongside very elderly patients with multiple conditions. The “typical” MI patient is rare and different risk profiles need different solutions. Estonia’s biggest unused lever is systematic post-MI follow-up and secondary prevention.

In her PhD thesis, cardiologist Piret Asser investigated data from the Estonian Myocardial Infarction Registry (EMIR) and compared it with registries from Sweden, Norway and Hungary. Estonia’s acute hospital care has improved markedly: the path from ambulance to catheterisation is shorter, blocked arteries are opened faster, and evidence-based medicines reach patients more reliably. The gap appears after discharge. Compared with the Nordics, long-term mortality remains higher, driven by delays in seeking help, undertreatment of high-risk patients, and uneven follow-up.

The thesis also underscores the heart–kidney link. Even mild kidney impairment in younger MI patients is associated with higher mortality. In older adults, other illnesses keep absolute risk high. Because the kidneys regulate blood pressure, fluid balance and inflammation, declining renal function quietly amplifies cardiovascular risk.

Nordic experience shows what works: after MI, discharge is only the starting line, rehabilitation as standard, follow-up plans with personal targets, and registry-based feedback. Estonia is moving this way and medication adherence has improved, yet a consistent, nationwide aftercare pathway is still taking shape. The next big gains will come after the hospital—from organised follow-up, rehabilitation and steadfast secondary prevention.