TRENDS IN THE INCIDENCE OF MYOCARDIAL-INFARCTION AND IN MORTALITY DUETO CORONARY HEART-DISEASE, 1987 TO 1994

Background and Methods To clarify the determinants of contemporary tre nds in mortality from coronary heart disease (CHD), we conducted surve illance of hospital admissions for myocardial infarction and of in-hos pital and out-of-hospital deaths due to CHD among 35-to-74-year-old re sidents of four communities of varying size in the United States (a to tal of 352,481 persons in 1994). Between 1987 and 1994, we estimate th at there were 11,869 hospitalizations for myocardial infarction (on th e basis of 8572 hospitalizations sampled) and 3407 fatal coronary even ts (3023 sampled). Results The largest average annual decrease in mort ality due to CHD occurred among white men (change in mortality, -4.7 p ercent; 95 percent confidence interval, -2.2 to -7.1 percent), followe d by white women (-4.5 percent; 95 percent confidence interval, -0.7 t o -8.2 percent), black women (-4.1 percent; 95 percent confidence inte rval, -10.3 to +2.5 percent), and black men (-2.5 percent; 95 percent confidence interval, -6.9 to +2.2 percent). Overall, in-hospital morta lity from CHD fell by 5.1 percent per year, whereas out-of-hospital mo rtality declined by 3.6 percent per year. There was no evidence of a d ecline in the incidence of hospitalization for a first myocardial infa rction among either men or women; in fact, such hospital admissions in creased by 7.4 percent per year (95 percent confidence interval, 0.5 t o 14.8 percent) among black women and 2.9 percent per year (95 percent confidence interval, -3.6 to +9.9 percent) among black men. Rates of recurrent myocardial infarction decreased, and survival after myocardi al infarction improved. Conclusions From 1987 to 1994, we observed a s table or slightly increasing incidence of hospitalization for myocardi al infarction. Nevertheless, there were significant annual decreases i n mortality from CHD. The decline in mortality in the four communities we studied may be due largely to improvements in the treatment and se condary prevention of myocardial infarction. (N Engl J Med 1998;339:86 1-7) (C)1998, Massachusetts Medical Society.