Background-Survivors of nonfatal coronary heart disease (CHD) can reduce their risk of further events by various preventive interventions. The impact of such measures as delivered over 11 years, on population rates of subsequent major CHD events, has not been extensively studied. This study determined population trends in the prevalence of clinically manifest CHD and the proportion of major CHD events that occur in this population. Methods and Results-A population longitudinal person-based event-linked file of CHD extracted from State HospitalMorbidity Data and Death Registry for 1980 to 2005 was used to identify, for each year from 1995 to 2005, survivors who had a hospitalization for CHD over the previous 15 years (population with established CHD), and to examine the occurrence of CHD death and hospitalization with a principal diagnosis of myocardial infarction in both populations with and without established CHD. The average annual age-standardized prevalence of CHD in the Perth metropolitan region (population 1.6 million) was 28 373 (8.8%) in men and 14 966 (4.0%) in women. Age-specific prevalence increased exponentially with age, from Ͻ1% in 35 to 39 age group to 42% in 80 to 84 age group in men and half that in women. The percentage of total CHD events (nϭ28 941) that occurred in the population with established CHD was approximately 43% in both men and women, 55% and 51%, respectively, for CHD death and 35% and 36% for nonfatal myocardial infarction. Conclusions-More than 40% of major CHD events annually occur in persons with manifest disease, highlighting the imperative to implement systems of care that support effective secondary prevention. (Circ Cardiovasc Qual Outcomes.
, MBBS, DPhil (Oxon), FRACP, FAFPHM Background-The incidence of myocardial infarction has declined during the past 4 decades in many populations.However, there are limited population data measuring trends in acute coronary syndromes (ACS). We therefore examined temporal trends in the incidence of hospitalized ACS by age and sex in a population-based cohort. Methods and Results-The Western Australian Data Linkage System, a repository of linked administrative health data, was used to identify 29 421 incident ACS hospitalizations between 1996 and 2007. Poisson log-linear regression models were used to calculate incidence rate changes. Age-standardized incidence rates of ACS declined annually in men by 1.7% (95% confidence interval [CI], Ϫ2.1 to Ϫ1.3) and in women by 1.6% (95% CI, Ϫ2.1 to Ϫ1.0). These declining rates were underpinned by annual reductions in the incidence of unstable angina (men, Ϫ3.0%; 95% CI, Ϫ3.7 to Ϫ2.4; women, Ϫ2.5; 95% CI, Ϫ3.3 to Ϫ1.7), whereas annual changes in myocardial infarction incidence were less (men, Ϫ1.0%; 95% CI, Ϫ1.5 to Ϫ0.5; women, Ϫ0.8%; 95% CI, Ϫ1.6 to 0). However, the overall trends masked age group differences, with ACS incidence increasing annually in 35-to 54-year-old women (2.3%; 95% CI, 1.0 to 3.8), predominantly driven by increasing incidence of myocardial infarction. Conclusions-The age-standardized incidence of ACS decreased significantly in Western Australia from 1996 to 2007. However, an increase in ACS incidence in women ages 35 to 54 years is troubling and warrants further investigation. (Circ Cardiovasc Qual Outcomes. 2011;4:557-564.)
BackgroundTroponins (highly sensitive biomarkers of myocardial damage) increase counts of myocardial infarction (MI) in clinical practice, but their impact on trends in admission rates for MI in National statistics is uncertain.MethodsCases coded as MI or other cardiac diagnoses in the Hospital Morbidity Data Collection (MI-HMDC) in Western Australia in 1998 and 2003 were classified using revised criteria for MI developed by an International panel convened by the American Heart Association (AHA criteria) using information on symptoms, ECGs and cardiac biomarkers abstracted from samples of medical notes. Age-sex standardized rates of MI-HMDC were compared with rates of MI based on AHA criteria including troponins (MI-AHA) or traditional biomarkers only (MI-AHAck).ResultsBetween 1998 and 2003, rates of MI-HMDC decreased by 3.5% whereas rates of MI-AHA increased by 17%, a difference largely due to increased false-negative cases in the HMDC associated with marked increased use of troponin tests in cardiac admissions generally, and progressively lower test thresholds. In contrast, rates of MI-AHAck declined by 18%.ConclusionsIncreasing misclassification of MI-AHA by the HMDC may be due to reluctance by clinicians to diagnose MI based on relatively small increases in troponin levels. These influences are likely to continue. Monitoring MI using AHA criteria will require calibration of commercially available troponin tests and agreement on lower diagnostic thresholds for epidemiological studies. Declining rates of MI-AHAck are consistent with long-standing trends in MI in Western Australia, suggesting that neither MI-HMDC nor MI-AHA reflect the true underlying population trends in MI.
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