Circulation, Vol 88, 2524-2531, Copyright © 1993 by American Heart Association
H Lowel, A Dobson, U Keil, B Herman, MS Hobbs, A Stewart, M Arstila, H Miettinen, H Mustaniemi and J Tuomilehto
BACKGROUND. Community-based registers participating in the MONICA Project
of the World Health Organization show markedly different attack and death
rates of coronary heart disease. This variation is a function of both the
incidence and case fatality occurring within countries. The contribution of
case fatality to the international variation in coronary heart disease
mortality rates is not well understood. METHODS AND RESULTS. The register
data from eight study populations--Augsburg and Bremen in Germany, Auckland
in New Zealand, Perth and Newcastle in Australia, and North Karelia,
Kuopio, and Turku/Loimaa in Finland--were compared. All patients with
definite myocardial infarction or coronary death aged 35 to 64 years
occurring in the study populations in 1985 through 1989 are the basis for
the case fatality calculations by different definitions: 28-day case
fatality for all cases, for hospitalized cases, and for hospitalized
24-hour survivors; out-of- hospital case fatality; and 24-hour case
fatality for hospitalized cases. Differences in case fatality were much
smaller than differences in attack and mortality rates in these
populations. About two thirds of deaths occurred before the patients
reached a hospital. The 28-day case fatality ranged from 37% for men in
Perth to 58% for women in Augsburg. Among those who reached the hospital
alive, 28-day case fatality was 13% to 27% for men and 20% to 35% for
women. In those who survived 24 hours from the onset of symptoms, 28-day
case fatality was 8% to 17% for men and 12% to 26% for women. CONCLUSIONS.
Differences in case fatality were not associated with differences in
coronary mortality rates between these populations. As most deaths occurred
before reaching a hospital, opportunities for reducing case fatality
through improved hospital care are limited. This emphasizes the primary
role of prevention in reducing coronary death rates.
ARTICLES
Coronary heart disease case fatality in four countries. A community study. The Acute Myocardial Infarction Register Teams of Auckland, Augsburg, Bremen, FINMONICA, Newcastle, and Perth
GSF-Institute of Epidemiology, Germany.
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