Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study
Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study
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DOI：
10.1136/bmj.f7379
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发表时间：
2013-12-10
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目的报告急性心肌梗死事件和病死率的趋势，并分析这些死亡率的变化对按性别、年龄和地理区域划分的急性心肌梗死总死亡率变化的相对贡献。设计基于抽样调查的研究，将常规医院和死亡率数据联系起来。研究背景：英国，所有年龄段因急性心肌梗死住院或突然死于急性心肌梗死的840人 175人。主要结果衡量急性心肌梗死事件、30天病死率和总死亡率。结果从2002年到2010年，英国年龄标化总死亡率下降了约一半，而年龄标准化的事件和病例死亡率都下降了约三分之一。在男性中，急性心肌梗死事件、病死率和总死亡率分别以年均4.8%(95%可信区间3.0%至6.5%)、3.6%(3.4%至3.7%)和8.6%(5.4%至11.6%)的速度下降。在女性中，相应的数字分别为4.5%(1.7%至7.1%)、4.2%(4.0%至4.3%)和9.1%(4.5%至13.6%)。总体而言，事件和病例死亡率的降低对急性心肌梗死死亡率下降的相对贡献率男性分别为57%和43%，女性分别为52%和48%；然而，相对贡献因年龄、性别和地理区域而不同。结论21世纪头10年英国急性心肌梗死死亡下降的一半以上可归因于事件发生率的下降，略低于一半可归因于30天存活率的改善。在过去十年中，急性心肌梗死的预防和急性医疗都有助于降低急性心肌梗死的死亡率。
ObjectiveTo report trends in event and case fatality rates for acute myocardial infarction and examine the relative contributions of changes in these rates to changes in total mortality from acute myocardial infarction by sex, age, and geographical region between 2002 and 2010.DesignPopulation based study using person linked routine hospital and mortality data.SettingEngland.Participants840 175 people of all ages who were admitted to hospital for acute myocardial infarction or died suddenly from acute myocardial infarction.Main outcome measuresAcute myocardial infarction event, 30 day case fatality, and total mortality rates.ResultsFrom 2002 to 2010 in England, the age standardised total mortality rate fell by about half, whereas the age standardised event and case fatality rates both declined by about one third. In men, the acute myocardial infarction event, case fatality, and total mortality rates declined at an average annual rate of, respectively, 4.8% (95% confidence interval 3.0% to 6.5%), 3.6% (3.4% to 3.7%), and 8.6% (5.4% to 11.6%). In women, the corresponding figures were 4.5% (1.7% to 7.1%), 4.2% (4.0% to 4.3%), and 9.1% (4.5% to 13.6%). Overall, the relative contributions of the reductions in event and case fatality rates to the decline in acute myocardial infarction mortality rate were, respectively, 57% and 43% in men and 52% and 48% in women; however, the relative contributions differed by age, sex, and geographical region.ConclusionsJust over half of the decline in deaths from acute myocardial infarction during the 2000s in England can be attributed to a decline in event rate and just less than half to improved survival at 30 days. Both prevention of acute myocardial infarction and acute medical treatment have contributed to the decline in deaths from acute myocardial infarction over the past decade.