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Original research article
Comparative trends in coronary heart disease subgroup hospitalisation rates in England and Australia
  1. Lee Nedkoff1,
  2. Raphael Goldacre2,
  3. Melanie Greenland1,
  4. Michael J Goldacre2,
  5. Derrick Lopez1,
  6. Nick Hall2,
  7. Matthew Knuiman1,
  8. Michael Hobbs1,
  9. Frank M Sanfilippo1,
  10. F Lucy Wright3
  1. 1 School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
  2. 2 Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
  3. 3 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to Dr Lee Nedkoff, School of Population and Global Health, The University of Western Australia, Perth, WA 6009, Australia; lee.nedkoff{at}


Background Population-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013.

Methods CHD hospitalisations for individuals aged 35–84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and ‘other CHD’). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression.

Results From 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004–2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: −7.1 %/year, 95% CI −7.2 to –7.0; women: −7.5 %/year, 95% CI −7.7 to –7.3; Australia: men: −8.5 %/year, 95% CI −8.6 to –8.4; women: −8.6 %/year, 95% CI −8.8 to –8.4). Other CHD rates increased in individuals aged 75–84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention.

Conclusions Since 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus.

  • acute coronary syndromes
  • chronic coronary disease
  • epidemiology
  • acute myocardial infarction
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  • Contributors LN and FLW conceived the study; LN, MG and RG carried out the data analysis; MJG, MH, DL and FMS provided input into methodology; MK and MG provided statistical advice; LN wrote the manuscript; all authors provided interpretation and critical revisions for the data and reviewed the manuscript.

  • Funding The work was supported by the National Health and Medical Research Council (NHMRC) of Australia (Grant number 572558) and a Research Collaboration Award from The University of Western Australia. LN is supported by an NHMRC Early Career Fellowship (1110337); RG is partly funded by Public Health England. The Big Data Institute has received funding from the Li Ka Shing and Robertson Foundations, the Medical Research Council, British Heart Foundation and is supported by the NIHR Oxford Biomedical Research Centre.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the Central and South Bristol Multi-Centre Research Ethics Committee (04/Q2006/176) for the English and ORLS record-linked data by the Unit of Health Care Epidemiology. Approval for use of the Western Australia data was obtained from the WA Department of Health and UWA Human Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

  • Patient consent for publication Not required.

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