Abstract 1402: High Rates of Recurrent Ischaemic Heart Disease Necessitate Better Secondary Prevention
Introduction Preventing recurrent MI and IHD death is pivotal to optimizing patient well-being and continuing the decline in IHD mortality in Western countries. However, the magnitude and impact of secondary prevention efforts expressed by longitudinal trends in hospitalized MI plus IHD death by initial or recurrent events is unknown.
Hypothesis We examined major IHD event trends from 1995–2005 by comparing data for 1995–97 with 2003– 05 in 35– 84 year old urban residents free of hospitalized IHD for 15years.
Methods Using the Western Australia Data Linkage System, we defined IHD cases by ICD code as the sum of:
nonfatal MI from principal discharge diagnosis or alternatively from any discharge diagnosis field, and
any-cause death within 28days of an IHD admission or IHD as cause of death in patients not hospitalized. Transfers and rehospitalization within 28days were counted as one event.
Results From 1995–2005 there were 20,930 incident and 17,005 recurrent major IHD events. Recurrent IHD was lower in 2003– 05 (42%) than in 1995–97 (48%). Similarly, IHD deaths in patients previously hospitalized for nonfatal MI fell from 65% in 1995–97 to 55% in 2003– 05. These relative differences in IHD events persisted whether the definition of nonfatal MI was broadened to cover any diagnostic field. The prevalence of IHD rose markedly with age from 0% in 35–39 year old men to 43% in 80 – 84 year old men in 1995–97 versus 0% to 38% in 2003– 05. The comparative proportions for women by the same age strata were 0% to 23% for both periods. The average annual prevalence of IHD was constant, being double among males than females, at 8.3% versus 4.2% respectively.
Conclusions In 1995–97 half of nonfatal MIs and IHD deaths occurred in those surviving a previous hospitalization with MI. A decade later despite a 6% absolute decline in major IHD events the challenge for more effective secondary preventive efforts and optimizing well-being is very real.