Exploring sex differences in case fatality in acute myocardial infarction or coronary death events in the northern Sweden MONICA Project

OBJECTIVES: To investigate sex differences in reaching diagnosis, medical management and case fatality (CF) in acute myocardial infarction (AMI) in the population aged 35-64 years in northern Sweden. METHODS: Within the framework of the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases (MONICA) Project, definite AMI was monitored in people aged 35-64 years from 1989 through 1995 (target population 510 000 in 1991). SETTING: In a population based coronary register, all coronary events were recorded in nine hospitals in 1989-95. RESULTS: The number of events included in the definite coronary myocardial infarction register was 2483 men and 669 women. On admission, a higher proportion of men with definite AMI had chest pain or ECG changes typical for AMI (P < 0.0001). Disagreement between clinical diagnosis and classification by MONICA criteria occurred more often in women (P=0.008). A significantly higher proportion of men was admitted in the coronary care unit and they were significantly more often treated with thrombolytics, nitroglycerine, beta-blockers, or antiplatelet agents. Women received significantly more diuretics, inotropics or calcium antagonists. Diabetes, conferring a worse prognosis, was more common in women (20 vs. 15%; P=0.003). Prehospital CF was significantly higher in men (24.1 vs. 18.3%; P=0.005), but in patients treated in hospital, the CF was significantly lower in men (12.7 vs. 21.2%; P < 0.001). Total CF was equal in men and women. CONCLUSIONS: Several factors contributing to the excess in-hospital CF in women were identified, including greater problems in diagnosis of AMI in women which may be one of the reasons for less intensive treatment in women. Differences in co-morbidity, most notably diabetes and medical treatment between men and women with acute AMI may also have played a part.     

Attack rate, mortality and case fatality for acute myocardial infarction in Sweden during 1987-95. Results from the national AMI register in Sweden

OBJECTIVE: To assess trends in attack rate, mortality and case-fatality of acute myocardial infarction (AMI) in Sweden. SETTING: All 303 324 Swedes discharged from hospitals, or deceased, with a diagnosis of AMI between 1987 and 1995. DESIGN: Analysis based on the National AMI Register in Sweden. The National AMI Register was assembled by linking the records of the National Hospital Discharge Register and the National Cause of Death Register in Sweden. MAIN OUTCOME MEASURES: Age-standardized attack rate, mortality and case fatality rates for AMI. RESULTS: Between 1987 and 1995, the age-standardized attack rate of AMI declined by 11% for men and 10% for women, whilst mortality from AMI decreased by 14% for both sexes. The decrease was most pronounced for men below the age of 64, with a reduction of 22% in attack rate and nearly 30% in mortality. There was no change over time in the case fatality rates on the date of attack, including also deaths outside hospital, whilst case fatality within 28 days decreased from 49 to 45% amongst men, and 45 to 42% amongst women. This reduction persisted over 1 year of follow-up. CONCLUSIONS: The decrease in attack rate of AMI in Sweden may be attributed both to changes in risk factors amongst the population and to improved medical intervention. The decline in case fatality rates indicates that improved treatment of patients with AMI has contributed to the reduction in mortality. However, the high, and essentially unchanged, proportion of deaths outside hospital stresses the importance of disease prevention.     

Marked improvement in survival after acute myocardial infarction in middle-aged men but not in women. The Northern Sweden MONICA study 1985-94

OBJECTIVES: The aim of this study was to analyse time trends in survival after acute myocardial infarction with special emphasis on sex differences. DESIGN: Within the framework of the population-based WHO MONICA Project, all acute myocardial infarction events were recorded in the age group 25-64 years in northern Sweden during the period 1985-94. All first-ever myocardial infarction patients were followed for information on vital status. SUBJECTS: A total of 3397 men and 860 women with acute myocardial infarction, during the period between 1985 and 1994. MAIN OUTCOME MEASURES: Case fatality rates after first-ever acute myocardial infarction. RESULTS: When compared with the 1985-86 cohort, the age-adjusted odds ratio for death within 1 year after acute myocardial infarction was 0.59 (95% CI 0.46-0.76) in the 1993-94 male cohort but 0.99 (95% CI 0.61-1.60) in the female 1993-94 cohort. Corresponding age-adjusted proportions of death within 1 year were 33.3% and 22.9% in men and 27.5% and 27.3% in women in 1985-86 and 1993-94, respectively. The odds ratio for 3-year case fatality amongst those who survived the first 28 days was 0.34 (95% CI 0.21-0.55) in 1991-92 compared with 1985-86 in men and 0.91 (0.43-1.94) in women. CONCLUSION: Both short- and long-term survival after AMI have improved markedly in men over the last decade. There is a disturbing sex difference in that, during the same period, survival in women with AMI has not improved at all. This sex difference was not explained by differences in conventional prognostic factors.     

Trends in sudden cardiac death in the northern Sweden MONICA area 1985-99

OBJECTIVES: To describe time trends in sudden cardiac death (SCD) occurrences between 1985 and 1999. DESIGN: Cohort study with analysis of a database of all symptomatic and/or fatal acute myocardial infarctions (AMI) in the two northernmost counties in Sweden, partly north of the Arctic Circle. SUBJECTS: A total of 1139 cases of SCD amongst men and women aged 35-64 years. MAIN OUTCOME MEASURE: Sudden cardiac death. RESULTS: Amongst men the proportion of SCD to all AMI deaths (within 28 days of an AMI) was 38% and for women 31%. The mean yearly incidence of SCD in this age group was 65 per 100,000 men and 12 per 100,000 women. Amongst men the mean yearly incidence decreased by 1.8% (95% confidence interval -3.2 to -0.3) and amongst women the decrease was 1.0% (95% confidence interval -4.4 to 2.4). Diabetes mellitus was more common in women compared with men (24% vs. 14%, P = 0.001). Men suffered an SCD more often around noon and on Saturdays, whereas women suffered their SCD on Mondays and Fridays. For season, men and women behaved similarly with a winter peak, although statistical significance was reached only for men. CONCLUSIONS: The SCD decreased amongst men between 1985 and 1999. There was also a decrease amongst women during the same time period but not to a statistically significant degree, possibly caused by lack of statistical power due to small numbers.     

Trends of acute myocardial infarction morbidity and case fatality in East Germany since 1970

Because of the high risk factor levels and the high morbidityand mortality of cardiovascular diseases, a Myocardial InfarctionControl Programme was implemented in East Germany in the 1970s.To measure its effect, many myocardial infarction registershave operated in the country ever since, and despite some methodologicalproblems the results of these registers now make trend estimationspossible. In recent years, we observed no decline in the acutemyocardial infarction attack rates in the population aged 25–64years, and in men there was even a slight increase towards thelate 1980s. These sotnewhat d sex-spec trends run parallel tothe trends of the risk factor levels, as well as the cardiovascularmortality rates in men and women. There was no decline in thecase fatality rate either during that period. We have to conclude,therefore, that the aims of the Myocardial Infarction ControlProgramme have not been reached, and both primary and secondarymyocardial infarction prevention must be intensified Cardiovascularmorbidity and mortality, under the new conditions existing inEast Germany after unification must be reduced at least to thelevel observed in West Germany.     

Incidence, recurrence, and case fatality rates for myocardial infarction in southwestern France, 1985 to 1993

OBJECTIVE—To assess the impact of incidence, recurrence, and case fatality rates for myocardial infarction on coronary heart disease mortality in southwestern France between 1985 and 1993.
DESIGN—Toulouse-MONICA myocardial infarction register.
SETTINGS AND PATIENTS—All subjects aged 35 to 64 years living in the French department of Haute-Garonne.
INTERVENTIONS—All coronary artery disease events between 1985 and 1993.
MAIN OUTCOME MEASURES—7210 events collected by the register between 1985 and 1993.
RESULTS—In men, adjusted attack, total, and out of hospital mortality decreased by 2% (95% confidence interval (CI), −3.8% to −0.1%), 6.2% (95% CI −8.4% to −4.0%), and 4.2% (95% CI −7.0% to −1.5%) a year, respectively (p < 0.05). Incidence and recurrence rates decreased by 2% (95% CI −4.1% to −0.1%, p < 0.05) and 1.9% (95% CI −5.9% to 2.2%) a year (NS). In women, attack, total, and out of hospital mortality decreased by 1.7% (95% CI −5.2% to 1.8%), 4.8% (95% CI −9.6% to 0.1%), and 2.6% (95% CI −9.4% to 4.1%) a year, respectively; incidence decreased by 2% (95% CI −6.5% to 2.5%) and recurrence increased by 1.4% (95% CI −9.8% to 12.6%) a year (all NS). In men, total, incident, and recurrent 28 day case fatality decreased by 3.8% (95% CI −4.8% to −2.8%), 3.2% (95% CI −4.1% to −2.3%), and 6.4% (95% CI −9.5% to −3.3%) a year, respectively (p < 0.05). For women, the corresponding decreases were 3.3% (95% CI −6.1% to −0.6%), 3.3% (95% CI −13.2% to 6.6%), and 11.7% (95% CI −24.6% to 1.3%) a year, but only the decrease in total 28 day case fatality reached significance. In both sexes, the reduction in case fatality contributed nearly 70% of the decrease in myocardial infarction mortality.
CONCLUSIONS—In southwestern France, the decrease in myocardial infarction mortality mainly reflects improvements in acute management rather than prevention.


Keywords: myocardial infarction; case fatality     

急性心肌梗死血运重建术后远期预后的相关因素

目的:探讨急性心肌梗死（AM I）后接受血运重建术（PC I,CABG）的患者左室功能与病死率、心源性再住院率的关系,从而了解血运重建术是否能改善左室衰竭患者的预后。方法:分析我院1999-012003-02住院患者102例,根据左室射血分数（LVEF）值分成3组,LVEF≤40%（15例）,40%相似文献   

The mortality and case fatality rates in acute myocardial infarction in Finland. The results of Helsinki Coronary Register during 1970-1977

In 1970 the Helsinki Coronary Register gathered data on 1191AMI cases and 470 deaths from AMI of Helsinki residents under65 years of age. Since then the mortality (deaths within thefirst 28 days per 1000 habitants of Helsinki) from AMI declinedby 1.8% a year during the period 1970–1977, and therewere no statistically significant differences in trends betweenwomen and men, or between different age groups (P>0.10).The case fatality rate varied from 39% in 1970 to 35% in 1977,and the statistical analysis could not reveal any significantpermanent decreasing trend in any age or sex group. These results,together with our previously reported AMI incidence trends,show that at least in 1970–1977 the declining trend inmortality from AMI was due to an equal fall in the incidenceof AMI. Therefore there is reason to think that the effect isdue to the prevention of AMI, rather than to more effectiveacute care.     

Diabetes as a risk factor for stroke. A population perspective

Summary Stroke incidence, case fatality and mortality in diabetic patients were compared to non-diabetic subjects in a 35–74-year-old population in northern Sweden (target population 241,000). During an 8-year period, 1,544 stroke events in diabetic patients and 4,826 events in non-diabetic subjects were recorded. The crude incidence of stroke was 1,000 per 100,000 in the diabetic men vs 247 in the non-diabetic men (relative risk 4.1; 95% confidence interval 3.2–5.2). Among diabetic women, the crude incidence was 757 per 100,000 and 152 in non-diabetic women (relative risk 5.8; 95% confidence interval 3.7–6.9). The 28-day case fatality among men was similar in the diabetic and non-diabetic stroke patients (18.6 vs 17.1%; p=0.311), but significantly higher in diabetic women compared with non-diabetic women (22.2 vs 17.9%; p=0.02). When compared with the non-diabetic population, the overall mortality from stroke in the diabetic population (first and recurrent) was 4.4-times higher in male and 5.1-times higher in the female patients. Hypertension, atrial fibrillation, heart failure or myocardial infarction were all significantly more common in diabetic than in non-diabetic stroke patients. The population attributable risk, a crude estimate of all strokes ascribed to diabetes mellitus, was 18% in men and 22% in women. In Sweden, about 50 strokes are annually directly attributed to diabetes in a population of 100,000 in this age group.Abbreviations MONICA Multinational Monitoring of Trends and Determinants in Cardiovascular Disease - ICD International Classification of Diseases - CT computerised tomography - CI confidence interval - RR relative risk - CF case fatality     

Large improvements in major cardiovascular risk factors in the population of northern Sweden: the MONICA study 1986-2009

Abstract. Eriksson M, Holmgren L, Janlert U, Jansson J‐H, Lundblad D, Stegmayr B, Söderberg S, Eliasson M (Department of Public Health and Clinical Medicine, Umeå University, Umeå; Research Department, Norrbotten County Council, Luleå; Department of Medicine, Skellefteå Hospital, Skellefteå; Department of Medicine, Sunderby Hospital, Luleå; and National Board of Health and Welfare, Stockholm, Sweden). Large improvements in major cardiovascular risk factors in the population of northern Sweden: the MONICA study 1986–2009. J Intern Med 2011; 269 : 219–231. Objectives. The incidence of cardiovascular disease has declined rapidly in Sweden since the 1980s. We explored changes in major cardiovascular risk factors in northern Sweden between 1986 and 2009. Design. Since 1986, six population surveys have been carried out in northern Sweden using procedures of the World Health Organization MONICA project. The population age range was 25–64 years in 1986 and 1990, and 25–74 years from 1994. Trends were analysed using generalized linear models. Results. A total of 10 586 subjects were included in the surveys. Blood pressure decreased by 4.9/3.9 mmHg in women and 1.8/1.5 mmHg in men aged 25–64 years between 1986 and 2009. In men and women aged 65–74 years, the decrease was 12.6/6.1 mmHg between 1994 and 2009. From 1994, the use of blood pressure‐lowering drugs increased, particularly among the older subgroup. The prevalence of smoking halved between 1986 and 2009; 11% of women and 9% of men were smokers in 2009. Cholesterol levels decreased by 0.9 mmol L^?1 in the younger age group (25–64 years), and the use of lipid‐lowering agents increased from 1994. Among subjects aged 25–64 years, one in five was obese in 2009, which was twice as many as in 1986, and body mass index (BMI) increased by 1.5 kg m^?2, corresponding to an increase in weight of 4 kg. There was no further increase in BMI from 2004. The prevalence of diabetes did not change between 1986 and 2009. The proportion that received a university education increased markedly in all age groups, especially in women, during the study period. Conclusions. Significant improvements were observed in major cardiovascular risk factors in northern Sweden between 1986 and 2009.     

Comparative analysis of COVID‐19 case fatality rate between two waves in Nepal

The first COVID‐19 case in Nepal was reported on January 23, 2020. Then infection, then, started to spread gradually, and October marked the most devastating increase in COVID‐19 cases of the year 2020. Compared with the October 2020 peak in Nepal, the May 2021 peak of COVID‐19 observed 2‐ and 10‐fold rise in new cases and deaths per day, respectively. Given that this surprising increase in the death rate was not observed in other countries, this study analyzed the COVID‐19 case fatality rates between the two peaks in Nepal. We found an increase in death rates among younger adults and people without comorbidities.     

Favourable trends in the incidence and outcome of myocardial infarction in nondiabetic, but not in diabetic, subjects: findings from the MONICA myocardial infarction registry in northern Sweden in 1989-2000

BACKGROUND: The aim of this study was to compare time trends in incidence, case fatality and mortality due to myocardial infarction (MI) in patients with or without diabetes. METHODS: This study was based on the Northern Sweden MONICA Project MI registry with a target population of about 200,000 inhabitants in the age group 35--64 years in the two northernmost counties of Sweden. During 1989--2000, 6254 patients who had had an MI according to MONICA criteria were included in this study: 4569 patients had a first MI and 1685 had a recurrent MI. Sixteen per cent of the men and 20% of the women had had diabetes mellitus diagnosed prior the MI. RESULTS: Over the 12-year period, there was a declining trend in incidence and case fatality in first MI. Also, the event rates (first ever and recurrent MI) declined in men without diabetes. In women without diabetes favourable time trends were seen in first ever MI, recurrent MI and in case fatality. There were no favourable time trends for any of these outcomes in patients with diabetes. CONCLUSION: In nondiabetic subjects below the age of 65, the incidence of, and case-fatality in, MI declined. This led to a decreased mortality over the 12-year period. These favourable trends over time were not observed in diabetic subjects.     

Alarmingly high occurrence and case fatality of acute coronary heart disease events in Estonia: results from the Tallinn AMI register 1991–94

OBJECTIVE: The purpose of this study was to produce stable estimates for the incidence, attack and mortality rates and case fatality of acute myocardial infarction (AMI) in Tallinn, the capital of Estonia. RESEARCH DESIGN AND METHODS: The Tallinn AMI register covers the population aged 25-64 years and official residents of Tallinn. The register follows the WHO MONICA project protocols in the data collection and diagnostic evaluation of the suspected AMI events and CHD death. RESULTS: Age-standardized annual incidence, attack rate and mortality in men aged 35-64 years were high, varying from (per 100000 per year) 352, 499 and 208, respectively, in 1991 to 438, 628 and 317, respectively, in 1993. In addition, in women, annual incidence, attack rate and mortality were high, varying from (per 100000 per year) 82, 100 and 31, respectively, in 1991 to 110 and 142 in 1993 for the incidence and attack rate, and to 61 in 1992 for mortality. The percentage of out-of-hospital coronary death (sudden death) increased in men from 33 to 52% and in women from 24 to 42% during 1991-94, and the 28-day case fatality increased in men from 42 to 58%, and in women from 32 to 50%. In Tallinn, women with AMI were treated as actively as men with invasive treatment (thrombolysis, angioplasty, bypass surgery) during the acute phase of MI. CONCLUSIONS: The incidence, attack rate and mortality of AMI were high in both men and women in Tallinn. The high 28-day case fatality observed was primarily due to the high proportion of out-of-hospital deaths.     

急性脑卒中患者血压特点的分析

目的研究急性脑卒中患者血压影响因素及动态血压特点。方法82例发病在7天内的急性脑卒中患者。记录患者住院诊室血压及24 h动态血压。血压≥140/90 mm Hg(1 mm Hg=0.133 kPa)为诊室血压升高;24 h动态血压平均值≥130/80 mm Hg、日间平均值≥135/85 mm Hg、夜间平均值≥125/75 mm Hg为动态血压升高。结果既往高血压病史对急性脑卒中患者诊室血压升高有影响(P<0.05)。有高血压病史者平均诊室血压(146.02±18.89)/(86.36±11.52)mm Hg,无高血压病史者平均诊室血压(136.22±14.63)/(82.61±11.86)mm Hg,二者收缩压水平差异有显著性意义(P<0.05)。急性脑卒中患者动态血压表现为夜间血压负荷增加,24 h平均血压于发病后4~5天明显升高,6~7天降低。诊室血压升高与诊室血压正常比较,血压形态均以非杓形和反杓形为主,2组差异无显著性意义(P>0.05)。结论急性脑卒中诊室血压升高与高血压病史有关,急性脑卒中随发病时间延长,血压呈下降趋势。     

Incidence, comorbidity, case fatality and readmission of hospitalized stroke patients in Canada

BACKGROUND: Stroke is a leading cause of death and disability, and poses a significant burden of care for those who survive. OBJECTIVES: To estimate the incidence of hospitalization for stroke and describe the impact of age, sex and comorbidity on in-hospital mortality, length of stay and readmission rates. METHODS: Health insurance numbers were used to link acute care hospitalizations across Canada in 1999/2000 for stroke patients with no discharges for a stroke within the preceding five years. Patients were followed up for one year from the date of their initial admission. RESULTS: The numbers of men (15,367) and women (16,740) in the study were similar. The incidence of all types of stroke (International Classification of Diseases, ninth revision, codes 430, 431 and 434/436) for hospitalized men and women was 14.4 per 10,000, with a 15-fold rise from 8.7 for the age group of 45 to 64 years to 131.9 per 10,000 for the age group 80 years and older. For the index episode, stroke patients spent an average of 21.0 days in the hospital, and 18.2% died in the hospital within 28 days. Of those who survived the first episode, 10.3% were readmitted to the hospital within one year with a recurrent stroke, and overall 37.1% were readmitted for any cause (including stroke). Among these stroke patients, hypertension was codiagnosed in 35%; diabetes in 17%; arrhythmia in 15%; ischemic heart disease in 13.6%; and congestive heart failure in 5%. CONCLUSIONS: Hospital records linked by patient identification can produce more accurate national estimates of patients hospitalized with stroke than any current countrywide surveillance system.