Time trends in the occurrence and outcome of acute myocardial infarction and coronary heart disease death between 1986 and 1996 - (A New Jersey statewide study)

Most reports of the decrease in age-adjusted coronary heart disease (CHD) a re based on databases with upper age cut-offs that exclude approximately ha lf of the events. We report changes in rates of acute myocardial infarction (AMI) and of out-of-hospital coronary death between 1986 and 1996 among Ne w Jersey residents greater than or equal to 15 years old. Data on patients discharged with the diagnosis of AMI from nonfederal acute care hospitals i n the state (n = 270,091) and all records in the New Jersey death registrat ion files with CHD (n = 172,175) listed as the cause of death from 1986 to 1996 (total study n = 442,266) were analyzed. The rate of hospitalized AMI cases in the state remained essentially unchanged during these 11 years, wh ereas in-hospital and 30-day case fatality among all age groups and both se xes declined. Age-adjusted CHD rates showed a decrease in fatal events, a s maller decrease in total events, and a slight increase in nonfatal events. The proportion of fatal CHD events occurring out-of-hospital decreased espe cially among men. The median age at occurrence of events increased by 1 yea r. Despite a decrease in CHD mortality, the rate of nonfatal events increas ed, especially among persons greater than or equal to 75 years old. Thus, t he decrease in age-adjusted CHD mortality is not all due to treatment and t rue prevention of CHID, but the disease simply occurs at an older age. (C) 2001 by Excerpta Medica, Inc.