Dataset Information

National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994-2004.

ABSTRACT:

Background

Rates of death from cardiovascular and cerebrovascular diseases have been steadily declining over the past few decades. Whether such declines are occurring to a similar degree for common disorders such as acute myocardial infarction, heart failure and stroke is uncertain. We examined recent national trends in mortality and rates of hospital admission for these 3 conditions.

Methods

We analyzed mortality data from Statistic Canada's Canadian Mortality Database and data on hospital admissions from the Canadian Institute for Health Information's Hospital Morbidity Database for the period 1994-2004. We determined age- and sex-standardized rates of death and hospital admissions per 100,000 population aged 20 years and over as well as in-hospital case-fatality rates.

Results

The overall age- and sex-standardized rate of death from cardiovascular disease in Canada declined 30.0%, from 360.6 per 100,000 in 1994 to 252.5 per 100 000 in 2004. During the same period, the rate fell 38.1% for acute myocardial infarction, 23.5% for heart failure and 28.2% for stroke, with improvements observed across most age and sex groups. The age- and sex-standardized rate of hospital admissions decreased 27.6% for stroke and 27.2% for heart failure. The rate for acute myocardial infarction fell only 9.2%. In contrast, the relative decline in the in-hospital case-fatality rate was greatest for acute myocardial infarction (33.1%; p < 0.001). Much smaller relative improvements in case-fatality rates were noted for heart failure (8.1%) and stroke (8.9%).

Interpretation

The rates of death and hospital admissions for acute myocardial infarction, heart failure and stroke in Canada changed at different rates over the 10-year study period. Awareness of these trends may guide future efforts for health promotion and health care planning and help to determine priorities for research and treatment.

SUBMITTER: Tu JV

PROVIDER: S-EPMC2696549 | biostudies-literature | 2009 Jun

REPOSITORIES: biostudies-literature

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Publications

National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994-2004.

Tu Jack V JV Nardi Lorelei L Fang Jiming J Liu Juan J Khalid Laila L Johansen Helen H

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20090601 13

<h4>Background</h4>Rates of death from cardiovascular and cerebrovascular diseases have been steadily declining over the past few decades. Whether such declines are occurring to a similar degree for common disorders such as acute myocardial infarction, heart failure and stroke is uncertain. We examined recent national trends in mortality and rates of hospital admission for these 3 conditions.<h4>Methods</h4>We analyzed mortality data from Statistic Canada's Canadian Mortality Database and data o ...[more]

PMID: 19546444

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Project description:ImportanceTrans-fatty acids (TFAs) have deleterious cardiovascular effects. Restrictions on their use were initiated in 11 New York State (NYS) counties between 2007 and 2011. The US Food and Drug Administration plans a nationwide restriction in 2018. Public health implications of TFA restrictions are not well understood.ObjectiveTo determine whether TFA restrictions in NYS counties were associated with fewer hospital admissions for myocardial infarction (MI) and stroke compared with NYS counties without restrictions.Design, setting, and participantsWe conducted a retrospective observational pre-post study of residents in counties with TFA restrictions vs counties without restrictions from 2002 to 2013 using NYS Department of Health's Statewide Planning and Research Cooperative System and census population estimates. In this natural experiment, we included those residents who were hospitalized for MI or stroke. The data analysis was conducted from December 2014 through July 2016.ExposureResiding in a county where TFAs were restricted.Main outcomes and measuresThe primary outcome was a composite of MI and stroke events based on primary discharge diagnostic codes from hospital admissions in NYS. Admission rates were calculated by year, age, sex, and county of residence. A difference-in-differences regression design was used to compare admission rates in populations with and without TFA restrictions. Restrictions were only implemented in highly urban counties, based on US Department of Agriculture Economic Research Service Urban Influence Codes. Nonrestriction counties of similar urbanicity were chosen to make a comparison population. Temporal trends and county characteristics were accounted for using fixed effects by county and year, as well as linear time trends by county. We adjusted for age, sex, and commuting between restriction and nonrestriction counties.ResultsIn 2006, the year before the first restrictions were implemented, there were 8.4 million adults (53.6% female) in highly urban counties with TFA restrictions and 3.3 million adults (52.3% female) in highly urban counties without restrictions. Twenty-five counties were included in the nonrestriction population and 11 in the restriction population. Three or more years after restriction implementation, the population with TFA restrictions experienced significant additional decline beyond temporal trends in MI and stroke events combined (-6.2%; 95% CI, -9.2% to -3.2%; P?<?.001) and MI (-7.8%; 95% CI, -12.7% to -2.8%; P?=?.002) and a nonsignificant decline in stroke (-3.6%; 95% CI, -7.6% to 0.4%; P?=?.08) compared with the nonrestriction populations.Conclusions and relevanceThe NYS populations with TFA restrictions experienced fewer cardiovascular events, beyond temporal trends, compared with those without restrictions.

Project description:BACKGROUND:Little information is available on how primary and comorbid acute myocardial infarction contribute to the mortality burden of acute myocardial infarction, the share of these deaths that occur during or after a hospital admission, and the reasons for hospital admission of those who died from acute myocardial infarction. Our aim was to fill in these gaps in the knowledge about deaths and hospital admissions due to acute myocardial infarction. METHODS:We used individually linked national hospital admission and mortality data for England from 2006 to 2010 to identify all primary and comorbid diagnoses of acute myocardial infarction during hospital stay and their associated fatality rates (during or within 28 days of being in hospital). Data were obtained from the UK Small Area Health Statistics Unit and supplied by the Health and Social Care Information Centre (now NHS Digital) and the Office of National Statistics. We calculated event rates (reported as per 100?000 population for relevant age and sex groups) and case-fatality rate for primary acute myocardial infarction diagnosed during the first physician encounter or during subsequent encounters, and acute myocardial infarction diagnosed only as a comorbidity. We also calculated what proportion of deaths from acute myocardial infarction occurred in people who had been in hospital on or within the 28 days preceding death, and whether acute myocardial infarction was one of the recorded diagnoses in such admissions. FINDINGS:Acute myocardial infarction was diagnosed in the first physician encounter in 307?496 (69%) of 446?744 admissions with a diagnosis of acute myocardial infarction, in the second or later physician encounter in 52?374 (12%) admissions, and recorded only as a comorbidity in 86?874 (19%) admissions. Patients with comorbid diagnoses of acute myocardial infarction had two to three times the case-fatality rate of patients in whom acute myocardial infarction was a primary diagnosis. 135?950 deaths were recorded as being caused by acute myocardial infarction as the underlying cause of death, of which 66?490 (49%) occurred in patients who were in hospital on the day of death or in the 28 days preceding death. AMI was the primary diagnosis in 32?695 (49%) of these 66?490 patients (27?678 [42%] diagnosed in the first physician encounter and 5017 [8%] in a second or subsequent encounter), was a comorbid diagnosis in 12?118 (18%), and was not mentioned at all in the remaining 21?677 (33%). The most common causes of admission in people who did not have an acute myocardial infarction diagnosis but went on to die of acute myocardial infarction as the underlying cause of death were other circulatory conditions (7566 [35%] of 21?677 deaths), symptomatic diagnoses including non-specific chest pain, dyspnoea and syncope (1368 [6%] deaths), and respiratory disorders (2662 [12%] deaths), mainly pneumonia and chronic obstructive airways disease. INTERPRETATION:As many acute myocardial infarction deaths occurring within 28 days of being in hospital follow a non-acute myocardial infarction admission as follow an acute myocardial infarction admission. These people are often diagnosed with other circulatory disorders or symptoms of circulatory disturbance. Further investigation is needed to establish whether there are symptoms and information that can be used to predict the risk of a fatal acute myocardial infarction in such patients, which can contribute to reducing the mortality burden of acute myocardial infarction. FUNDING:Wellcome Trust, Medical Research Council, Public Health England, National Institute for Health Research.

Dataset Information

National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994-2004.

Background

Methods

Results

Interpretation

Publications

National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994-2004.

Similar Datasets

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