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

OBJECTIVES The purpose of the present study is to describe changes over two decades (1 975 to 1995) in the incidence, in-hospital and long term case-fatality rate s associated with acute myocardial infarction (AMI) from a multihospital co mmunity-wide perspective. BACKGROUND Despite the magnitude of, and mortality associated with acute myocardial in farction (AMI), relatively limited population-based data are available to d escribe recent and temporal trends;, the attack and case-fatality rates ass ociated with AMI from a representative population-based perspective. METHODS The community-based study included 5,270 residents of the Worcester, Massac husetts, metropolitan area hospitalized with confirmed initial AMI in all m etropolitan Worcester, Massachusetts, hospitals (1990 census population = 4 37,000) 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 declin ed through 1995 (184 per 100,000) The crude and multivariable-adjusted in-h ospital case-fatality rates exhibited a consistent decline between 1975/197 8 (17.8%), 1986/1988 (17.0%) and 1993/1995 (11.7%). Although there were no statistically significant differences in the unadjusted long-term case-fata lity rates of discharged hospital survivors over the periods under study, d eclines in the multivariable-adjusted risk of dying within the first year a fter hospital discharge were observed between the earliest and most recentl y discharged patients with AMI. CONCLUSIONS The results of this population-based study of patients with validated initi al AMI provide encouragement for efforts directed at th, primary and second ary prevention of AMI given declining incidence and case-fatality rates. (C ) 1999 by the American College of Cardiology.