Trends in case-fatality in 117 718 patients admitted with acute myocardialinfarction in Scotland

Objectives To analyse short- and long-term case-fatality trends following a dmission to hospital with a first acute myocardial infarction, in men and w omen between 1986 and 1995, after adjusting for risk factors known to influ ence survival. Design A Scottish-wide retrospective cohort study. Setting The Linked Scottish Morbidity Record Database was analysed. This co ntains accurate data on all hospital admissions since 1981, for the Scottis h population of 5.1 million, It is linked to the Registrar General's death certificate data. Subjects All 117 718 patients admitted to Scottish hospitals with a princip al diagnosis of first acute myocardial infarction (ICD-9 code 410) between 1986 and 1995. Main Outcome Measures The outcome was death, both in and out of hospital, f rom any cause, at 30 days, 1 year, 5 and 10 years. Results Overall case-fatality following hospital admission with acute myoca rdial infarction was 22.2%, 31.4%, 51.1% and 64.0% at 1 month, 1 year, 5 an d 10 years, respectively. Multivariate analyses identified statistically si gnificant independent prognostic factors. Thirty day mortality increased tw ofold for each decade of increasing age, and increased with any prior admis sion to hospital. When comparing the most deprived category to that of the most affluent, men had a 10% increased mortality (P<0.01), whilst women had an increased mortality of 4% (not significant). After adjustment for age, sex, deprivation and prior admission to hospital, case-fatality rates fell significantly between 1986 and 1995. Short-term case-fatality fell by 46% i n men (27% in women) and long-term by 34% in men (30% in women) (both P<0.0 01). Conclusions Population-based case-fatality rates in Scotland have fallen dr amatically since 1986, particularly in men. The increasing survival in pati ents admitted to hospital suggests that the trial-based efficacy of modern therapies is now translating into population-based effectiveness. However: an individual's life expectancy still halves after a diagnosis of acute myo cardial infarction. Of the variables that we could examine, age was the mos t powerful predictor of prognosis. (Eur Heart J 2000: 21: 1833-1830, doi:10 .1053/euhj,2000, 2318) (C) 2000 The European Society of Cardiology.