Clinical InvestigationCoronary Artery DiseaseTrends in community mortality due to coronary heart disease
Section snippets
Methods
Death datatapes were obtained from the Massachusetts Department of Public Health for purposes of the present investigation. The study sample was restricted to adult residents (≥25 years) of the Worcester metropolitan area (2000 estimated census = 478,000) who died over the period 1990 to 2001. This period was chosen for purposes of examining trends in hospital and out-of-hospital deaths due to CHD since location of death was not coded on Massachusetts death certificates prior to 1989. These
Magnitude of Deaths due to CHD
Over the twelve year period under study, there were a total of 9479 deaths attributed to CHD in greater Worcester residents. Of these, 3177 (34%) occurred in the hospital setting while the remainder occurred out-of-hospital. Of the out-of-hospital deaths, 1844 (29%) occurred in personal residences while an additional 2377 deaths (38%) occurred among nursing home residents.
A total of 4158 deaths attributed to AMI occurred in greater Worcester residents between 1990 and 2001. Of these, 1661 (40%)
Discussion
The results of the present investigation show encouraging declines in death rates due to CHD and AMI over time in the greater Worcester population. Between 1990 and 2001, the age-adjusted death rate from CHD fell by 42% while the age-adjusted death rates from AMI declined by 47%. Out-of-hospital deaths attributed to CHD declined by an average of 1.6% per year while hospital deaths from CHD decreased by more than 4% annually between 1990 and 2001. Over this period, annual hospital death rates
References (14)
- et al.
Incidence and case fatality rates of acute myocardial infarction (1975-1984): the Worcester Heart Attack Study
Am Heart J
(1988) - et al.
A two-decades (1975-1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: a community-wide perspective
J Am Coll Cardiol
(1999) - et al.
Decade long trends (1986-1997) in the medical management of patients with acute myocardial infarction: a community-wide perspective
Am Heart J
(2001) - et al.
Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota
Mayo Clin Proc
(2000) Morbidity and mortality: 2004 chartbook on cardiovascular, lung, and blood diseases
U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health
(2004)- et al.
The recent decline in mortality from coronary heart disease, 1980-1990: the effects of secular trends in risk factors and treatment
JAMA
(1997) - et al.
Recent changes in the attack rates and survival rates of acute myocardial infarction (1975-1981): the Worcester Heart Attack Study
JAMA
(1986)
Cited by (49)
Trends of in-hospital and out-of-hospital coronary heart disease mortality in French registries during the period 2000 to 2016
2022, Annals of EpidemiologyCitation Excerpt :In our study, between 2000 and 2016, in- and out-of-hospital ACE mortality rates decreased in both sexes, with in-hospital mortality decreasing more steeply. These trends are consistent with previous observations [4,8–10,20,21], and extend the conclusions of those observations to a more contemporary cohort, using the most recent diagnosis criteria for myocardial infarction. Analysis by age group, however, revealed that the steeper decrease in-hospital mortality was primarily driven by trends in the oldest age group (55–74 age group), which seems to have largely benefitted from improvements in CHD diagnosis and management in the acute phase.
The role of public health versus invasive coronary interventions in the decline of coronary heart disease mortality
2021, Annals of EpidemiologyCitation Excerpt :Our finding of a greater decline in CHD mortality in those without a prior history of CHD differs from previous studies, which showed a decline in both outpatient and inpatient age-adjusted death rates because of CHD and MI in both men and women, but the decline was more pronounced in the inpatient than the outpatient setting (where the majority of CHD mortality presently occurs) [15–17]. Goldberg et al. showed that the CHD decline was smaller in the elderly than younger populations, and the authors speculated this was because of improved treatment of CHD, allowing persons to survive into their 80s before dying from CHD [15]. The decline itself plateaued toward the latter part of the study, suggesting that further decline will depend on new therapeutic approaches.
Cardiac aetiology of cardiac arrest: Percutaneous coronary interventions during and after cardiopulmonary resuscitation
2013, Best Practice and Research: Clinical AnaesthesiologyProdromal symptoms of out-of-hospital cardiac arrests: A report from a large-scale population-based cohort study
2013, ResuscitationCitation Excerpt :Out-of-hospital cardiac arrest (OHCA) is a common public health problem accounting for more than 60% of deaths from cardiovascular diseases.1–3 Although fatalities from acute myocardial infarction (AMI) have been decreasing mainly due to recent substantial advances in in-hospital treatments, many AMI patients die before arriving at a hospital.4 In Japan, approximately 60,000 OHCAs of cardiac origin occur every year, and the number has been steadily increasing.5,6
Current Applications of Cardiac Troponin T for the Diagnosis of Myocardial Damage
2013, Advances in Clinical ChemistryCitation Excerpt :Because the necrotic process from the subendocardium to the subepicardium is time dependent, early reperfusion is essential for effective treatment. Community studies performed in the 1950s and 1960s demonstrated high fatality 1-month rates (40–50%) for patients with presumed myocardial infarction or acute coronary syndrome with half occurring in the first 2 h [43–45]. Hospital mortality rates were substantially better (25–30%).
Recent trends in post-discharge mortality among patients with an initial acute myocardial infarction
2012, American Journal of Cardiology
Grant support for this project was provided by the National Heart, Lung and Blood Institute (R01 HL35434).