(Circulation. 1997;96:3849-3859.)
© 1997 American Heart Association, Inc.
Articles |
Population Versus Clinical View of Case Fatality From Acute Coronary Heart Disease
Results From the WHO MONICA Project 1985–1990
From the Institute of Epidemiology and Social Medicine, University of Münster (Germany) (L.C., U.K.); the Department of Biostatistics, University of North Carolina, Chapel Hill (L.C.); GSF-Institute of Epidemiology, Neuherberg, Germany (U.K., H.L.); Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, NSW, Australia (A.D.); MONICA Data Centre, Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (M.M., K.K., A.-M.R.); and the Cardiovascular Epidemiology Unit, MONICA Quality Control Centre for Event Registration, University of Dundee (Scotland) (H.T.-P.).
Correspondence to Dr Ulrich Keil, Institute of Epidemiology and Social Medicine, University of Münster, Domagkstr. 3, D-48129 Münster, Germany. E-mail Keilu{at}uni-muenster.de
Background The clinical view of case fatality (CF) from acute myocardial infarction (AMI) in those reaching the hospital alive is different from the population view. Registration of both hospitalized AMI cases and out-of-hospital coronary heart disease (CHD) deaths in the WHO MONICA Project allows both views to be reconciled. The WHO MONICA Project provides the largest data set worldwide to explore the relationship between CHD CF and age, sex, coronary event rate, and first versus recurrent event.
Methods and Results All 79 669 events of definite AMI or possible coronary death, occurring from 1985 to 90 among 5 725 762 people, 35 to 64 years of age, in 29 MONICA populations are the basis for CF calculations. Age-adjusted CF (percentage of CHD events that were fatal) was calculated across populations, stratified for different time periods, and related to age, sex, and CHD event rate. Median 28-day population CF was 49% (range, 35% to 60%) in men and 51% (range, 34% to 70%) in women and was particularly higher in women than men in populations in which CHD event rates were low. Median 28-day CF for hospitalized events was much lower: in men 22% (range, 15% to 36%) and in women 27% (range, 19% to 46%). Among hospitalized events CF was twice as high for recurrent as for first events.
Conclusions Overall 28-day CF is halved for hospitalized events compared with all events and again nearly halved for hospitalized 24-hour survivors. Because approximately two thirds of 28-day CHD deaths in men and women occurred before reaching the hospital, opportunities for reducing CF through improved care in the acute event are limited. Major emphasis should be on primary and secondary prevention.
Key Words: coronary disease • epidemiology • population • registries • MONICA Project • myocardial infarction
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