Objectives To examine recent trends in first and recurrent ischaemic heart disease (IHD) deaths and hospitalisations.
Methods Using anonymous patient-linkage of routinely collected data, all New Zealanders aged 35–84 years who experienced an International Statistical Classification of Diseases and Related Health Problems I(CD)-coded IHD hospitalisation and/or IHD death between 1 January 2005 and 31 December 2015 were identified. A 10-year look-back period was used to differentiate those experiencing first from recurrent events. Age-standardised hospitalisation and mortality rates were calculated for each calendar year and trends compared by sex and age.
Results 160 109 people experienced at least one IHD event (259 678 hospitalisations and 35 548 deaths) over the 11-year study period, and there was a steady decline in numbers (from almost 24 000 in 2005 to just over 16 000 in 2015) and in age-standardised rates each year. With the exception of deaths in younger (35–64 years) women with prior IHD, there was a significant decline in IHD events in men and women of all ages, with and without a history of IHD. The decline in IHD mortality was greater for those experiencing a first rather than recurrent IHD event (3.8%–5.2% vs 0%–3.7% annually on average). In contrast, the decline in IHD hospitalisations was greater for those experiencing a recurrent compared with a first IHD event (5.6%–7.3% vs 3.2%–5.7% annually on average).
Conclusions The substantial decline in IHD hospitalisations and mortality observed in New Zealanders with and without prior IHD between 2005 and 2015 suggests that primary and secondary prevention efforts have been effective in reducing the occurrence of IHD events.
- Coronary artery disease
- Acute myocardial infarction
- Acute coronary syndromes
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Contributors CG, RJ and AJK designed the study. CG, KP and BW acquired the data. CG analysed the data and all authors interpreted the data. CG drafted the work and all authors revised it critically for important intellectual content. All authors approved of the version to be published. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in thestudy and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This research project has been supported by the Health Research Council (grant number 11/800). This research was supported by Health Research Council Clinical Research Training Fellowship (grant number 11/814) and a National Heart Foundation Research Fellowship (grant number 3709384). Researchers are independent from funders. The study funders/sponsors had no role in the study design, collection, analysis or interpretation of data.
Competing interests All authors have completed the Unified Competing Interest format at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that HW has had grants from Sanofi Aventis, Eli Lilly, National Institute of Health, Merck Sharpe & Dohm, AstraZeneca, GlaxoSmithKline, Omthera Pharmaceuticals, Pfizer New Zealand, Intarcia Therapeutics, Elsai, DalGen Products and Services, Daiichi Sankyo Pharma Development for research outside the submitted work. SW has received a grant from Roche Pharmaceuticals for research outside the submitted work. CG, RJ, WCC, KP, BW and AJK have no conflicts of interest to declare.
Ethics approval Multi-Region Ethics Committee; Northern Region Ethics Committee Y.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Technical appendix, statistical code and dataset available on request from the corresponding author at firstname.lastname@example.org. Consent was not obtained but the presented data are anonymised and risk of identification is minimal. Applications will only be granted and data provided after agreement from our contributing providers and the Ministry of Health and after ethical approval by the New Zealand Multi-Region Ethics Committee.
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