Population-wide mortality trends among patients hospitalized for acute myocardial infarction
Subtitle: the Ontario experience, 1981-1991
By: C. D. Naylor, E. Chen.
Contributors: Naylor, C. D.; Chen, E.; Institute for Clinical Evaluative Sciences in Ontario.
Series: ICES working paper series -- no. 24
Publisher: Institute for Clinical Evaluative Sciences in Ontario
Published: 1994
Place of publication: Ontario
Language: eng
Number of pages: 23
Subjects: Hospital Mortality -- trends; Myocardial Infarction -- mortality; Age Factors; Aged; Length of Stay; Sex Factors; Female; Humans; Male; Ontario
Description: OBJECTIVE. Determine population-based trends in in-hospital case fatality from acute myocardial infarction. BACKGROUND. The in-hospital prognosis for patients with acute myocardial infarction should be improving owing to adoption of treatments proven in randomized trials, e.g. thrombolytic agents, beta-blockers, aspirin, and anticoagulants.  However, all trials are subject to selection biases, eligibility is limited for some therapies, and proven therapies may be underused even among eligible patients. METHODS. Using administrative data from all acute general hospitals in Ontario, Canada we analyzed 17,489, 17,839, 18,393, 18,794, 18,716 and 19,748 records of patients with a primary discharge diagnosis of myocardial infarction for fiscal years of 1981, 1983, 1985, 1987, 1989 and 1991, respectively. RESULTS. After age-sex adjustment, the overall relative reduction in in-hospital CFR for the 10 year-period was 26.9% (99% confidence interval (CI), 26.8% to 26.9%), corresponding to an absolute reduction of 6% (99% CI, 5.6% to 6.4%).  Age-sex standardized CFR fell minimally from 22.3% in 1981 to 21.4% in 1985, followed by a highly significant decline to 16.3% in 1991.  Analyses relating comparative mortality to days of hospitalization confirmed that declining mortality was not an artefact of falling length of stay. CONCLUSIONS. There have been encouraging population-wide improvements in survival after AMI over the past six years. Further improvements may require development of new therapies that can be more widely applied to this patient population.
Notes: April 1994.

Includes bibliographical references. (33 ref.)