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High rate of CHD-related deaths in Sweden occurred out-of-hospital
Dudas K. Circulation. 2011;123:46-52.
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Three in four coronary heart disease-related deaths in Swedish patients who experienced a first major coronary event happened outside the hospital setting, according to study data.
“Case fatality associated with a first coronary event is often underestimated when only those who survive to reach a hospital are considered,” the researchers wrote. “Few studies have examined long-term trends in case fatality associated with a major coronary event that occurs out of the hospital.”
This lack of data led Kerstin Dudas, PhD, and colleagues to conduct a study of all case participants (n=384,597; age 35-84 years) with a first major coronary event in Sweden between 1991 and 2006.
According to researchers, 111,319 patients (28.9%) without previous hospitalization for acute MI died out-of-hospital with CHD as the primary cause of death, whereas 36,552 patients (9.5%) died within 28 days of first hospitalization for acute MI.
During the study period, out-of-hospital deaths as a proportion of all major coronary events declined (adjusted mean annual decrease, 2.2%), although the greatest reduction was reported in the hospitalized group (adjusted mean annual decrease, 5.8%). Conversely, in the out-of-hospital group, male sex and younger age (35-54 years) were associated with a 4% increased event risk each successive calendar year.
“The great majority of all fatal coronary events occur outside the hospital, and this proportion is increasing, particularly among younger individuals,” the researchers said, adding that primary prevention and persuading individuals to seek hospital treatment at the onset of a major coronary event symptom are increasingly important measures in reducing CHD-related fatality.
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