Falling hospital mortality for acute myocardial infarction in Quebec hospitals

OBJECTIVE: To present in-hospital mortality trends for acute myocardial inf arction (AMI). DESIGN: Observational study using the Quebec administrative hospital databa se, which records all hospitalizations for AMI, for the period 1986 to 1996 . RESULTS: From 1986 to 1996, the case fatality rate for AMI decreased from 1 8.4% to 12.7% despite an increase in the total number of admissions, due to an ageing population. Men and women have had similar yearly mortality redu ctions - 7.6% versus 7.4%, respectively - although the absolute case fatali ty rate remains significantly higher for women. The mortality reduction for men was constant over the decade, while the decline for women was more pro nounced over the last five years. Improving case fatality rates were also o bserved in the elderly and again were most evident from 1991 to 1996. CONCLUSIONS: These data show a sharp decline in case fatality rates for AMI patients treated in Quebec hospitals from 1986 to 1996, suggesting that tr eatment advances observed in clinical trials are being applied at a populat ion level. While improved survival has been observed in all patient groups, the data suggest that the part of the decline in mortality may be due to i ncreased penetration of proven treatment strategies in women and the elderl y.