Cardiovascular disease in the Netherlands, 1975 to 1995: decline in mortality, but increasing numbers of patients with chronic conditions

Objective-To examine the relation between trends over time in mortality and hospital morbidity caused by cardiovascular diseases in the Design-Trend analysis Poisson regression of national data on mortality and hospital admissions from 1975 to 1995; Subjects-The Dutch population. Results-All cardiovascular diseases combined were responsible for 39% of al l deaths and 16% of all hospital admissions in 1995. From 1975 to 1995, age adjusted cardiovascular mortality declined by an annual. change of -2.0% ( 95% confidence intervals (CI) -2.1% to -1.9%), while in the same period age adjusted discharge rates increased annually by 1.3% (95% CI 1.1% to 1.5%). Around 60% of the gain in life expectancy in this period was related to lo wer cardiovascular mortality. For mortality, major reductions were seen in coronary heart disease (annual change -2.9%) and in stroke (-2.1%), whereas the increase in hospital admissions was mainly caused by chronic manifesta tions of coronary heart: disease (5.1%), heart failure (2.1%), and diseases of the arteries (1.8%). In recent years, the gap between men and women at risk of dying from coronary heart: disease became smaller for those aged le ss than or equal to 65 years. Conclusions-Our findings of a decrease in cardiovascular mortality and an i ncrease in admission rates for chronic conditions such as heart failure, ch ronic coronary syndromes, and diseases of the arteries, support the hypothe sis that the longer survival of many patients with heart diseases is leadin g to a growing pool of patients at increased risk for subsequent: cardiovas cular complications in various countries.