(Circulation. 2001;104:19.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Trends in Acute Coronary Heart Disease Mortality, Morbidity, and Medical Care From 1985 Through 1997
The Minnesota Heart Survey
From the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis.
Correspondence to Paul G. McGovern, PhD, Division of Epidemiology, School of Public Health, 1300 South 2nd Street, Suite 300, Minneapolis, MN 55454-1015. E-mail mcgovern{at}epi.umn.edu
Background—Coronary heart disease (CHD) mortality continued to decline from 1985 to 1997.
Methods and Results—We
tabulated CHD deaths (ICD-9 codes 410 through 414) in the
Minneapolis/St Paul, Minnesota, area. For 1985, 1990, and 1995, trained
nurses abstracted the hospital records of patients 30 to 74 years
old with a discharge diagnosis of acute CHD (ICD-9 codes 410 or 411).
Acute myocardial infarction (AMI) events were validated and followed
for 3-year all-cause mortality. Between 1985 and 1997, age-adjusted CHD
mortality rates in Minneapolis/St Paul fell 47% and 51% in men and
women, respectively; the comparable declines in US whites were 34% and
29%. In-hospital mortality declined faster than out-of-hospital
mortality. The rate of AMI (ICD-9 code 410) hospital discharges
declined almost 20% between 1985 and 1995, whereas the discharge rate
for unstable angina (ICD-9 code 411) increased substantially. The
incidence of hospitalized definite AMI declined 
10%, whereas
recurrence rates fell 20% to 30%. Three-year case fatality
rates after hospitalized AMI decreased consistently by 31% and
41% in men and women, respectively. In-hospital administration of
thrombolytic therapy, emergency angioplasty, ACE
inhibitors, ß-blockers, heparin, and aspirin increased
greatly.
Conclusions—Declining out-of-hospital death rates, declining incidence and recurrence of AMI in the population, and marked improvements in the survival of AMI patients all contributed to the 1985 to 1997 decline of CHD mortality in the Minneapolis/St Paul metropolitan area. The effects of early and late medical care seem to have had the greatest contribution to rates during this time period.
Key Words: heart diseases • myocardial infarction • incidence • survival
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