Copyright © 2000 by the European Society of Cardiology.
Trends in case-fatality in 117718 patients admitted with acute myocardial infarction in Scotland
a Department of Public Health, University of Glasgow, Glasgow, Scotland
b Information and Statistics Division, Edinburgh, Scotland
c Greater Glasgow Health Board, Glasgow, Scotland
d Department of Cardiology, Glasgow Western Infirmary, Glasgow, Scotland
revised June 20, 2000; accepted June 21, 2000
Abstract
Objectives To analyse short- and long-term case-fatality trends following admission to hospital with a first acute myocardial infarction, in men and women between 1986 and 1995, after adjusting for risk factors known to influence survival.
Design A Scottish-wide retrospective cohort study.
Setting The Linked Scottish Morbidity Record Database was analysed. This contains accurate data on all hospital admissions since 1981, for the Scottish population of 5·1 million. It is linked to the Registrar General's death certificate data.
Subjects All 117718 patients admitted to Scottish hospitals with a principal diagnosis of first acute myocardial infarction (ICD-9 code 410) between 1986 and 1995.
Main Outcome Measures The outcome was death, both in and out of hospital, from any cause, at 30 days, 1 year, 5 and 10 years.
Results Overall case-fatality following hospital admission with acute myocardial infarction was 22·2%, 31·4%, 51·1% and 64·0% at 1 month, 1 year, 5 and 10 years, respectively. Multivariate analyses identified statistically significant independent prognostic factors. Thirty day mortality increased twofold for each decade of increasing age, and increased with any prior admission to hospital. When comparing the most deprived category to that of the most affluent, men had a 10% increased mortality (P<0·01), whilst women had an increased mortality of 4% (not significant). After adjustment for age, sex, deprivation and prior admission to hospital, case-fatality rates fell significantly between 1986 and 1995. Short-term case-fatality fell by 46% in men (27% in women) and long-term by 34% in men (30% in women) (bothP <0·001).
Conclusions Population-based case-fatality rates in Scotland have fallen dramatically since 1986, particularly in men. The increasing survival in patients admitted to hospital suggests that the trial-based efficacy of modern therapies is now translating into population-based effectiveness. However, an individual's life expectancy still halves after a diagnosis of acute myocardial infarction. Of the variables that we could examine, age was the most powerful predictor of prognosis.
Key Words: Acute myocardial infarction, mortality, coronary heart disease, trends
f1 Correspondence: Professor Simon Capewell, Department of Public Health, University of Liverpool, Liverpool, L69 3GB, U.K.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. Briffa, S Hickling, M Knuiman, M Hobbs, J Hung, F M Sanfilippo, K Jamrozik, and P L Thompson Long term survival after evidence based treatment of acute myocardial infarction and revascularisation: follow-up of population based Perth MONICA cohort, 1984-2005 BMJ, January 26, 2009; 338(jan26_2): b36 - b36. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M O'Flaherty, E Ford, S Allender, P Scarborough, and S Capewell Coronary heart disease trends in England and Wales from 1984 to 2004: concealed levelling of mortality rates among young adults Heart, February 1, 2008; 94(2): 178 - 181. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Ford, U. A. Ajani, J. B. Croft, J. A. Critchley, D. R. Labarthe, T. E. Kottke, W. H. Giles, and S. Capewell Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980-2000 N. Engl. J. Med., June 7, 2007; 356(23): 2388 - 2398. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. Kabir, K. Bennett, E. Shelley, B. Unal, J. Critchley, J. Feely, and S. Capewell Life-years-gained from population risk factor changes and modern cardiology treatments in Ireland Eur J Public Health, April 1, 2007; 17(2): 193 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P Buch, S Rasmussen, G H Gislason, J N Rasmussen, L Kober, N Gadsboll, S Stender, M Madsen, C Torp-Pedersen, and S Z Abildstrom Temporal decline in the prognostic impact of a recurrent acute myocardial infarction 1985 to 2002 Heart, February 1, 2007; 93(2): 210 - 215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Capewell, N F Murphy, K MacIntyre, S Frame, S Stewart, J W T Chalmers, J Boyd, A Finlayson, A Redpath, and J J V McMurray Short-term and long-term outcomes in 133 429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990-2000: population-based cohort study Heart, November 1, 2006; 92(11): 1563 - 1570. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Gemmell, R F Heller, K Payne, R Edwards, M Roland, and P Durrington Potential population impact of the UK government strategy for reducing the burden of coronary heart disease in England: comparing primary and secondary prevention strategies. Qual. Saf. Health Care, October 1, 2006; 15(5): 339 - 343. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Capewell Commentary: Predicting future coronary heart disease deaths in Finland and elsewhere Int. J. Epidemiol., October 1, 2006; 35(5): 1253 - 1254. [Full Text] [PDF]
|
|
|
|
 |
|
 K. Manderbacka, T. Hetemaa, I. Keskimaki, P. Luukkainen, S. Koskinen, and A. Reunanen Are there socioeconomic differences in myocardial infarction event rates and fatality among patients with angina pectoris? J Epidemiol Community Health, May 1, 2006; 60(5): 442 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I Gemmell, R F Heller, P McElduff, K Payne, G Butler, R Edwards, M Roland, and P Durrington Population impact of stricter adherence to recommendations for pharmacological and lifestyle interventions over one year in patients with coronary heart disease J Epidemiol Community Health, December 1, 2005; 59(12): 1041 - 1046. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Ford and S. Liu Invited Commentary: Acne in Adolescence--Protecting the Heart but Damaging the Prostate Later in Life? Am. J. Epidemiol., June 15, 2005; 161(12): 1102 - 1106. [Full Text] [PDF]
|
|
|
|
|
|
N F Murphy, K MacIntyre, S Stewart, S Capewell, and J J V McMurray Reduced between-hospital variation in short term survival after acute myocardial infarction: the result of improved cardiac care? Heart, June 1, 2005; 91(6): 726 - 730. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Unal, J. A. Critchley, D. Fidan, and S. Capewell Life-Years Gained From Modern Cardiological Treatments and Population Risk Factor Changes in England and Wales, 1981-2000 Am J Public Health, January 1, 2005; 95(1): 103 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. S Channer Primary angioplasty should be first line treatment for acute myocardial infarction: AGAINST BMJ, May 22, 2004; 328(7450): 1256 - 1257. [Full Text]
|
|
|
|
 |
|
 L. N. Graham, P. A. Smith, R. J. Huggett, J. B. Stoker, A. F. Mackintosh, and D. A.S.G. Mary Sympathetic Drive in Anterior and Inferior Uncomplicated Acute Myocardial Infarction Circulation, May 18, 2004; 109(19): 2285 - 2289. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Velazquez, M. A. Pfeffer, J. V. McMurray, A. P. Maggioni, J.-L. Rouleau, F. Van de Werf, L. Kober, H. D. White, K. Swedberg, J. D. Leimberger, et al. VALsartan In Acute myocardial iNfarcTion (VALIANT) trial: baseline characteristics in context Eur J Heart Fail, August 1, 2003; 5(4): 537 - 544. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Critchley and S. Capewell Mortality Risk Reduction Associated With Smoking Cessation in Patients With Coronary Heart Disease: A Systematic Review JAMA, July 2, 2003; 290(1): 86 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. MacIntyre, S. Stewart, S. Capewell, J. W. T. Chalmers, J. P. Pell, J. Boyd, A. Finlayson, A. Redpath, H. Gilmour, and J. J. V. McMurray Gender and survival: a population-based study of 201,114 men and women following a first acute myocardial infarction J. Am. Coll. Cardiol., September 1, 2001; 38(3): 729 - 735. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Rosolova and J. Simon Are the data on trends in case-fatality in patients with acute myocardial infarction observed in Scotland applicable across Europe? Eur. Heart J., June 2, 2001; 22(12): 979 - 980. [PDF]
|
|