Trends in acute coronary heart disease mortality, morbidity, and medical care from 1985 through 1997 - The Minnesota Heart Survey

Background-Coronary heart disease (CHD) mortality continued to decline from 1985 to 1997. Methods and Results-We tabulated CHD deaths (ICD-9 codes 410 through 414) i n the Minneapolis/St Paul, Minnesota, area. For 1985, 1990, and 1995, train ed nurses abstracted the hospital records of patients 30 to 74 years old wi th a discharge diagnosis of acute CHD (ICD-9 codes 410 or 411). Acute myoca rdial infarction (AMI) events were validated and followed for 3-year all-ca use mortality. Between 1985 and 1997, age-adjusted CHD mortality rates in M inneapolis/St: Paul fell 47% and 51% in men and women, respectively; the co mparable declines in US whites were 34% and 29%, In-hospital mortality decl ined faster than out-of-hospital mortality. The rate of AMI (ICD-9 code 410 ) hospital discharges declined almost 20% between 1985 and 1995, whereas th e discharge rate for unstable angina (ICD-9 code 411) increased substantial ly. The incidence of hospitalized definite AMI declined approximate to 10%, whereas recurrence rates fell 20% to 30%. Three-year case fatality rates a fter hospitalized AMI decreased consistently by 31% and 41% in men and wome n, respectively. In-hospital administration of thrombolytic therapy, emerge ncy angioplasty, ACE inhibitors, P-blockers, heparin, and aspirin increased greatly. Conclusions-Declining out-of-hospital death rates, declining incidence and recurrence of AMI in the population, and marked improvements in the surviva l of AMI patients all contributed to the 1985 to 1997 decline of CHD mortal ity in the Minneapolis/St Paul metropolitan area. The effects of early and late medical care seem to have had the greatest contribution to rates durin g this time period.