First and recurrent ischaemic heart disease events continue to decline in New Zealand, 2005–2015

Grey, Corina; Jackson, Rod; Wells, Susan; Wu, Billy; Poppe, Katrina; White, Harvey D.; Chan, Wing Cheuk; Kerr, Andrew

doi:10.1136/heartjnl-2017-311613

Cited by 20 publications

(14 citation statements)

References 27 publications

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“…44 Our risk models might have overestimated cardiovascular disease risk for primary prevention purposes because incidences from global regions used to recalibrate models were likely to include some recurrent events (although the extent of such overestimation is difficult to quantify). 53 Conversely, our risk models might have underestimated cardio vascular disease risk because population data used to estimate incidences were likely to include some people already on cardiovascular disease prevention therapies (eg, statins or anti-hypertensive medication). However, data available to us were insufficient to explore this issue in detail.…”

Section: Men Womenmentioning

confidence: 99%

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

Kaptoge¹,

Pennells²,

Bacquer³

et al. 2019

The Lancet Global Health

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685

459

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Background To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. Methods In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. Findings Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0•685 (95% CI 0•629-0•741) to 0•833 (0•783-0•882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. Interpretation We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide.

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Section: Men Womenmentioning

confidence: 99%

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

Kaptoge¹,

Pennells²,

Bacquer³

et al. 2019

The Lancet Global Health

Self Cite

685

459

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“…The steady decline in ACS incidence internationally reflects the efficacy of primary prevention treatments for IHD and their risk factors 3 4. This decline in ACS event rates is an important component of the previously reported reduction in IHD mortality in New Zealand over this period 9. The decline was observed for all ACS subtypes, although it was greatest for UA, which halved between 2006 and 2016.…”

Section: Discussionmentioning

confidence: 97%

“…Given the reported variability around the world, it is important to evaluate trends in ACS event rates and outcomes to guide clinical practice and implementation. Trends in first and recurrent ischaemic heart disease (IHD) events9 and ACS10 have been previously reported in New Zealand, but not by ACS subtype. Using the national health index unique identifier to link multiple national datasets, we examined trends in hospitalisations, invasive management and mortality by ACS subtype.…”

Section: Introductionmentioning

confidence: 93%

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

Wang

Grey²,

Jiang

et al. 2019

Heart

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ObjectivesRecent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand.MethodsAll ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex.ResultsOver the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA.ConclusionsWe observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation.

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“…Studies analysing the long-term trends in the incidence of and mortality from AMI in other countries have been, with some exceptions [2][3][4][5] , restricted to shorter time periods, selected subpopulations or AMI subtypes, or have presented earlier data [6][7][8][9][10][11][12][13][14] . While trends in AMI prevalence, hospitalizations and mortality in the Czech Republic up to 2010 were published [15][16][17] , long-term trends in survival after AMI have not been analysed and described yet.…”

Section: Introductionmentioning

confidence: 99%

Long-term trends in the incidence, treatment, hospital fatality and subsequent mortality from acute myocardial infarction in the Czech Republic

et al. 2021

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Aims. Studies on the incidence, acute and subsequent mortality from myocardial infarction are limited mostly to selected clinical cohorts and populations and cover relatively short periods. Our aim was to describe and analyse long-term trends on a national scale. Methods. Acute myocardial infarction (AMI) was defined by the International Classification of Diseases (ICD)10; codes I21 and I22. Our natiowide 1994-2016 data on AMI mortality were obtained from the official mortality statistics (Czech Bureau of Statistics), data on morbidity (hospitalizations) from the National Register of Hospitalizations (Institute for Health Information and Statistics). For further analyses, data from the Czech EUROASPIRE I-V and Czech IMPACT studies were used. Results. Over the 1994-2016 period the total number of AMI cases per year decreased from 34,084 to 19,015, that of patients hospitalized for AMI from 22,373 to 15,419, the total number of deaths due to AMI from 14,834 to 4,673, in those treated because of AMI from 3,794 to 1,137, and hospital fatality in patients treated for AMI decreased from 17% to 7.5%. Over the years 1997-2016, the one-year all-cause mortality rate after AMI declined from 25.1 to 17.9%, cardiovascular (CV) mortality from 22.3 to 14.2%, five-year all-cause mortality from 41.7 to 34%, and CV mortality from 34.1 to 23.6%. Conclusion. The Czech Republic has witnessed a pronounced decrease in AMI incidence and fatality and, consequently, long-term mortality. The decreasing incidence and improving course of AMI are due to progress in primary prevention, in acute coronary care and interventional cardiology, and in secondary coronary heart disease (CHD) prevention.

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First and recurrent ischaemic heart disease events continue to decline in New Zealand, 2005–2015

Abstract: The substantial decline in IHD hospitalisations and mortality observed in New Zealanders with and without prior IHD between 2005 and 2015 suggests that primary and secondary prevention efforts have been effective in reducing the occurrence of IHD events.

Cited by 20 publications

References 27 publications

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

Long-term trends in the incidence, treatment, hospital fatality and subsequent mortality from acute myocardial infarction in the Czech Republic

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