Surveillance of ischaemic heart disease: results from the Italian MONICA populations

Background The major objectives are to report on coronary event mortality, incidence and attack rates and changes over time observed in the Italian MO NICA populations and to assess if trends are consistent when different dise ase definitions are considered. An analysis of diagnostic agreement between clinical and MONICA categories is presented in the context of developing a model for estimating disease incidence in a population, based on currently available data. Methods Data were provided by the three Italian MONICA (MONItoring trends a nd determinants of CArdiovascular diseases) registers. The areas of Brianza and Friuli, both located in northern Italy, completed the 10-year period o f registration. Data from the MONICA Latina area, located close to Rome, we re limited to the first 3 years of registration. These data are used for as sessing geographical differences in rates in the mid-1980s and estimating t he diagnostic agreement between International Classification of Diseases (I CD) codes and MONICA categories. Two diagnostic aggregates have been used: the standard MONICA diagnostic definition for myocardial infarction (MI), w hich includes non-fatal definite myocardial infarction and fatal coronary e vents, and the coronary event definition which includes, in addition, non-f atal possible myocardial infarctions. Results From the mid-1980s to the mid-1990s, a considerable reduction in al l-cause, cardiovascular and coronary mortality rates occurred in the monito red populations. Data from the MONICA registers confirm the accuracy of off icial reports of death rates and changes in Italy. Comparisons of time diff erences in attack and incidence rates of myocardial infarction and all coro nary events indicate that the impact of the more severe manifestations of c oronary heart diseases (fatal coronary event and acute MI) reduced during t he period of observation, but when less severe events (minor myocardial inf arction and angina pectoris) are considered, the overall impact of the dise ase on the population remained stable. Conclusion Epidemiological Surveillance of coronary syndromes is relevant o ver this time period of impressive changes in prevention and treatment. Con tinuing restrictions in available resources necessitate the development of simplified registration systems.