The development of a National Action Plan on AMR was initiated by the Ministry of Health in 2016. Falling smoking prevalence and the introduction of local cardiac services from the mid-1990s explain part of the steady decline in heart disease. Yet Malta records relatively high levels of deaths within 30 days of admission to hospital for acute myocardial infarction, at 9.5 per 100 admissions among those aged 45 years and older, compared with 7.4 in the EU and 5.5 in Italy (2013) Similarly, higher-than-EU-average case-fatality rates were recorded for people hospitalised for stroke. Taken together, this may point to potentially systemic challenges in providing high quality treatment in the acute sector, although further investigation of the data is needed to better understand the causes for Malta’s lower performance on these indicators.