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(Circulation. 2003;108:691.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Decline in Out-of-Hospital Coronary Heart Disease Deaths Has Contributed the Main Part to the Overall Decline in Coronary Heart Disease Mortality Rates Among Persons 35 to 64 Years of Age in Finland

The FINAMI Study

V. Salomaa, MD, PhD; M. Ketonen, MD, PhD; H. Koukkunen, MD; P. Immonen-Räihä, MD, PhD; T. Jerkkola, MD; P. Kärjä-Koskenkari, MD; M. Mähönen, MD, PhD; M. Niemelä, MD; K. Kuulasmaa, PhD; P. Palomäki, MD, PhD; J. Mustonen, MD, PhD; M. Arstila, MD, PhD; T. Vuorenmaa, MD, PhD; A. Lehtonen, MD, PhD; S. Lehto, MD, PhD; H. Miettinen, MD, PhD; J. Torppa, MSc; J. Tuomilehto, MD, PhD; Y.A. Kesäniemi, MD, PhD; K. Pyörälä, MD, PhD

From KTL-National Public Health Institute, Helsinki, Finland (V.S., M.M., K.K., J. Torppa, J. Tuomilehhhto, M.N.); Kuopio University Hospital, Kuopio, Finland (H.K., S.L., K.P.); Jyväskylä Central Hospital, Jyväskylä, Finland (H.M.); Central Hospital of North Karelia, Joensuu, Finland (M.K., P.P., J.M.); Oulu University Hospital and Biocenter Oulu, Oulu, Finland (T.J., P.K.-K., Y.A.K.); Raisio Regional Hospital, Raisio, Finland (P.I.-R.); Turku Town Hospital (A.L.) and University Hospital of Turku (M.A., T.V.), Turku, Finland.

Correspondence to Veikko Salomaa, KTL-National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, FIN-00300 Helsinki, Finland. E-mail veikko.salomaa{at}ktl.fi

Received December 11, 2002; de novo received March 3, 2003; revision received May 20, 2003; accepted May 21, 2003.

Background— Out-of-hospital deaths constitute the majority of all coronary heart disease (CHD) deaths and are therefore of considerable public health significance.

Methods and Results— We used population-based myocardial infarction register data to examine trends in out-of-hospital CHD deaths in Finland during 1983 to 1997. We included in out-of-hospital deaths also deaths in the emergency room and all deaths within 1 hour after the onset of symptoms. Altogether, 3494 such events were included in the analyses. The proportion of out-of-hospital deaths of all CHD deaths depended on age and gender. In the age group 35 to 64 years, it was 73% among men and 60% among women. These proportions did not change during the study. The annual average decline in the age-standardized out-of-hospital CHD death rate was 6.1% (95% CI, -7.3, -5.0%) among men and 7.0% (-10.0, -4.0%) among women. These declines contributed among men 70% and among women 58% to the overall decline in CHD mortality rate. In all, 58% of the male and 52% of the female victims of out-of-hospital CHD death had a history of symptomatic CHD. Among men with a prior history of myocardial infarction, the annual average decline in out-of-hospital CHD deaths was 5.3% (-7.2, -3.2%), and among men without such history the decline was 2.9% (-4.4, -1.5%). Among women, the corresponding changes were -7.8% (-14.2, -1.5%) and -4.5% (-8.0, -1.0%).

Conclusions— The decline in out-of-hospital CHD deaths has contributed the main part to the overall decline in CHD mortality rates among persons 35 to 64 years of age in Finland.

Key Words: coronary disease • myocardial infarction • population • mortality

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