1 national trends in rates of death and hospital admissions related to acute myocardial infarction,...
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National trends in rates of death and hospital admissions related to acute myocardial
infarction, heart failure and stroke, 1994–2004
CIHR Team Grant in Cardiovascular Outcomes Research
Jack V. Tu MD PhD, Lorelei Nardi MSc, Jiming Fang PhD, Juan Liu MD, Laila Khalid MD, Helen Johansen PhD,
for the Canadian Cardiovascular Outcomes Research Team
CCORT• CCORT is a group of over 30 outcomes researchers from
5 provinces (NS, QC, ON, AB, BC) who are working together on projects to measure and improve the quality of cardiac care in Canada
• Funded by a CIHR Team Grant in Cardiovascular Outcomes Research
• Institute for Clinical Evaluative Sciences (ICES) in Toronto is the national coordinating centre for CCORT
• www.ccort.ca
CIHR Team Grant in Cardiovascular Outcomes Research
Purpose of Study• To examine national trends between 1994 and
2004, in hospitalizations and death rates for acute myocardial infarction, heart failure and stroke
• To see whether the rate of change for these three conditions has been similar or different
CIHR Team Grant in Cardiovascular Outcomes Research
Methods• We analyzed mortality data from Statistic Canada’s
Canadian Mortality Database and data on hospital admissions from the Canadian Institute for Health Information’s Hospital Morbidity Database for the period 1994-2004
• We determined age- and sex-standardized rates of death and hospital admissions per 100,000 population aged 20 years and over as well as in-hospital case-fatality rates
CIHR Team Grant in Cardiovascular Outcomes Research
Overview• The following is a set of slides that highlight key findings
from the original manuscript including the following:– Decrease in mortality rates– Decrease in hospital admission rates– Decrease in in-hospital case-fatality rates– Differences between men and women in relation to mortality
and hospitalization rates• Please feel free to use these slides to disseminate this
information
CIHR Team Grant in Cardiovascular Outcomes Research
Trends in the rates of death, hospital admissions and in-hospital case fatality associated with acute myocardial infarction, heart failure and stroke in Canada, 1994-2004
Age- and sex-specific rates of death by cardiovascular disease per 100,000 population aged 20 and over in Canada, 1994-2004
Age- and sex-standardized rates of death from acute myocardial infarction, heart failure and stroke per 100,000 population aged 20 and over in Canada, 1994-2004. Rates are standardized to the Canadian 1991 census population
Decline in age- and sex-standardized mortality rates for acute myocardial infarction, heart failure and
stroke in Canada, 1994-2004
19.6
102.5
70.2
15
63.450.4
0
10
20
30
40
50
60
70
80
90
100
110
Acute myocardial infarction Heart failure Stroke
Rat
e pe
r 10
0,00
0
1994
2004
38.1%
23.5%
28.2%
Age-standardized mortality rates for cardiovascular disease in women and men in Canada, 1994-2004
0
50
100
150
200
250
300
350
400
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Rat
e p
er 1
00,0
00
women
men
32.3% 27.5%
Decline in age-standardized mortality rates for cardiovascular disease in women and men in Canada, 1994-2004
346.4375.4
251 254.1
0
50
100
150
200
250
300
350
400
women men
Rate
per
100
,000 1994
2004
27.5% 32.3%
Percentage of female and male deaths for acute myocardial infarction, heart failure, stroke and cardiovascular disease in
Canada, 1994-2004
50.549.3
59.357.9
60.159.2
43.641.9
49.5
50.7
40.742.139.940.7
56.458.1
0
10
20
30
40
50
60
1994 2004 1994 2004 1994 2004 1994 2004
Acute myocardial infarction Heart failure Stroke CVD
% women
men
Age- and sex-standardized rates of hospital admissions because of acute myocardial infarction, heart failure and stroke per 100,000 population aged 20 and over in Canada, 1994-2004. Rates are standardized to the Canadian 1991
census population.
Decline in age-and sex-standardized rate of hospital admissions for acute myocardial infarction, heart
failure and stroke in Canada, 1994-2004
227
260.1 266.9
206.2 189.3 193.3
0
100
200
300
Acute myocardial infarction Heart failure Stroke
Rat
e pe
r 10
0,00
0
1994
2004
9.2%27.2% 27.6%
Percentage of women and men hospitalized for acute myocardial infarction, heart failure and stroke in Canada, 1994-
2004
49.749.150.650.4
3735.4
50.450.849.449.7
63.164.6
0
10
20
30
40
50
60
70
1994 2004 1994 2004 1994 2004
Acute myocardial infarction Heart failure Stroke
Hos
pita
l adm
issi
ons,
%
women
men
Age- and sex-adjusted in-hospital case-fatality rates among patients with acute myocardial infarction, heart failure and stroke in Canada, 1994-2004. Rates are
standardized to the Canadian 1991 census population.
Decline in age- and sex-adjusted in-hospital case-fatality rates for acute myocardial infarction, heart failure and
stroke in Canada, 1994-2004
15.8
11.1
14.5 14.4
10.29.7
0
2
4
6
8
10
12
14
16
18
Acute myocardial infarction Heart failure Stroke
In-h
ospi
tal c
ase-
fata
lity
rate
, %
1994
2004
33.1% 8.1%
8.9%
Age- and sex-specific rates of hospital admissions by cardiovascular disease per 100,000 population aged 20 and over in Canada, 1994-2004
Increase in average age of patients being hospitalized for acute mycardial infarction, heart failure and stroke in Canada,
1994-2004
68
71
7779
74 75
62
64
66
68
70
72
74
76
78
80
1994 2004 1994 2004 1994 2004
Acute myocardial infarction Heart failure Stroke
Ave
rage
age
Average age
Conclusions• Mortality, hospitalization and in-hospital case-fatality rates
for heart disease decreased significantly between 1994-2004• For the first time in Canada, more women than men died from
cardiovascular disease in 2000• Efforts to prevent cardiovascular disease have been
successful but may have delayed the onset of disease until people are older
• Further prevention, treatment and national surveillance of cardiovascular disease is continuously required as it is still the leading cause of death in Canada
Reasons for mortality decline• Better heart disease prevention
– Decreasing smoking rates– Greater awareness and control of hypertension– Decreasing cholesterol levels (i.e. statins)
• Better heart disease treatment– Aspirin, beta-blockers, ACE inhibitors, statins, etc.– Fibrinolytics (clot-busting drugs), – Primary angioplasty, CABG surgery
Funding• This study was supported by a Team Grant in
Cardiovascular Outcomes Research to the Canadian Cardiovascular Outcomes Research Team from the Canadian Institutes of Health Research
CIHR Team Grant in Cardiovascular Outcomes Research