CORONARY HEART-DISEASE CASE-FATALITY IN 4 COUNTRIES - A COMMUNITY STUDY

Background. Community-based registers participating in the MONICA Proj ect of the World Health Organization show markedly different attack an d death rates of coronary heart disease. This variation is a function of both the incidence and case fatality occurring within countries. Th e contribution of case fatality to the international variation in coro nary heart disease mortality rates is not well understood. Methods and Results. The register data from eight study populations-Augsburg and Bremen in Germany, Auckland in New Zealand, Perth and Newcastle in Aus tralia, and North Karelia, Kuopio, and Turku/Loimaa in Finland-were co mpared. All patients with definite myocardial infarction or coronary d eath aged 35 to 64 years occurring in the study populations in 1985 th rough 1989 are the basis for the case fatality calculations by differe nt definitions: 28-day case fatality for all cases, for hospitalized c ases, and for hospitalized 24-hour survivors; out-of-hospital case fat ality; and 24-hour case fatality for hospitalized cases. Differences i n case fatality were much smaller than differences in attack and morta lity rates in these populations. About two thirds of deaths occurred b efore the patients reached a hospital. The 28-day case fatality ranged from 37% for men in Perth to 58% for women in Augsburg. Among those w ho reached the hospital alive, 28-day case fatality was 13% to 27% for men and 20% to 35% for women. In those who survived 24 hours from the onset of symptoms, 28-day case fatality was 8% to 17% for men and 12% to 26% for women. Conclusions. Differences in case fatality were not associated with differences in coronary mortality rates between these populations. As most deaths occurred before reaching a hospital, oppor tunities for reducing case fatality through improved hospital care are limited. This emphasizes the primary role of prevention in reducing c oronary death rates.