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J Am Coll Cardiol, 1999; 33:1533-1539
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case–fatality rates of acute myocardial infarction: a community-wide perspective

Robert J. Goldberg, PhDa, Jorge Yarzebski, MD, MPHa, Darleen Lessard, MSa and Joel M. Gore, MD, FACCa

a Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Manuscript received August 11, 1998; revised manuscript received November 24, 1998, accepted January 14, 1999.

Reprint requests and correspondence: Robert J. Goldberg, PhD, Professor of Medicine & Epidemiology, Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, Massachusetts 01655
Rob.Goldberg{at}banyan.ummed.edu

OBJECTIVES

The purpose of the present study is to describe changes over two decades (1975 to 1995) in the incidence, in-hospital and long-term case–fatality rates associated with acute myocardial infarction (AMI) from a multihospital community-wide perspective.

BACKGROUND

Despite the magnitude of, and mortality associated with acute myocardial infarction (AMI), relatively limited population-based data are available to describe recent and temporal trends in the attack and case–fatality rates associated with AMI from a representative population-based perspective.

METHODS

The community-based study included 5,270 residents of the Worcester, Massachusetts, metropolitan area hospitalized with confirmed initial AMI in all metropolitan Worcester, Massachusetts, hospitals (1990 census population = 437,000) in 10 one-year periods between 1975 and 1995.

RESULTS

The age-adjusted incidence rates of initial AMI increased between 1975 (244 per 100,000) and 1981 (272 per 100,00), after which time these rates declined through 1995 (184 per 100,000). The crude and multivariable-adjusted in-hospital case–fatality rates exhibited a consistent decline between 1975/1978 (17.8%), 1986/1988 (17.0%) and 1993/1995 (11.7%). Although there were no statistically significant differences in the unadjusted long-term case–fatality rates of discharged hospital survivors over the periods under study, declines in the multivariable-adjusted risk of dying within the first year after hospital discharge were observed between the earliest and most recently discharged patients with AMI.

CONCLUSIONS

The results of this population-based study of patients with validated initial AMI provide encouragement for efforts directed at the primary and secondary prevention of AMI given declining incidence and case–fatality rates.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  CHD = coronary heart disease
  ICD = International Classification of Disease
  SMSA = standard metropolitan statistical area




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