Inpatient deaths from acute myocardial infarction, 1982-92: analysis of data in the Nottingham heart attack register
BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7101.159 (Published 19 July 1997) Cite this as: BMJ 1997;315:159
- Nigel Brown, research fellow in cardiologya,
- Tracey Young, research assistantb,
- David Gray, reader in medicinea,
- Allan M Skene, directorb,
- John R Hampton, professor of cardiologya
- a Division of Cardiovascular Medicine, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH
- b British Heart Foundation Cardiovascular Statistics Unit, Department of Mathematics, University of Nottingham, Nottingham
- Correspondence to: Dr Brown
- Accepted 15 April 1997
Abstract
Objective: To assess longitudinal trends in admissions, management, and inpatient mortality from acute myocardial infarction over 10 years.
Design: Retrospective analysis based on the Nottingham heart attack register.
Setting: Two district general hospitals serving a defined urban and rural population.
Subjects: All patients admitted with a confirmed acute myocardial infarction during 1982-4 and 1989-92 (excluding 1991, when data were not collected).
Main outcome measures: Numbers of patients, background characteristics, time from onset of symptoms to admission, ward of admission, treatment, and inpatient mortality.
Results: Admissions with acute myocardial infarction increased from 719 cases in 1982 to 960 in 1992. The mean age increased from 62.1 years to 66.6 years (P<0.001), the duration of stay fell from 8.7 days to 7.2 days (P<0.001), and the proportion of patients aged 75 years and over admitted to a coronary care unit increased significantly from 29.1% to 61.2%. A higher proportion of patients were admitted to hospital within 6 hours of onset of their symptoms in 1989-92 than in 1982-4, but 15% were still admitted after the time window for thrombolysis. Use of ß blockers increased threefold between 1982 and 1992, aspirin was used in over 70% of patients after 1989, and thrombolytic use increased 1.3-fold between 1989 and 1992. Age and sex adjusted odds ratios for inpatient mortality remained unchanged over the study period.
Conclusions: Despite an increasing uptake of the “proved” treatments, inpatient mortality from myocardial infarction did not change between 1982 and 1992.
Key messages
During 1982-92 major changes in management of myocardial infarction in an unselected population have been guided by the results of randomised trials
Adjusted odds ratios for deaths in hospital from acute myocardial infarction did not change over this period despite an overall fall in recorded deaths from ischaemic heart disease in Nottingham
The use of existing treatments needs to be optimised and new management strategies need to be introduced if inpatient mortality from myocardial infarction is to be reduced
Footnotes
- Accepted 15 April 1997