Comparative trends in coronary heart disease subgroup hospitalisation rates in England and Australia

Abstract

BackgroundPopulation-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013.MethodsCHD hospitalisations for individuals aged 35–84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and ‘other CHD’). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression.ResultsFrom 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004–2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: −7.1 %/year, 95% CI −7.2 to –7.0; women: −7.5 %/year, 95% CI −7.7 to –7.3; Australia: men: −8.5 %/year, 95% CI −8.6 to –8.4; women: −8.6 %/year, 95% CI −8.8 to –8.4). Other CHD rates increased in individuals aged 75–84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention.ConclusionsSince 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus.

Long-term trends in population-based hospitalisation rates for myocardial infarction in England: a national database study of 3.5 million admissions, 1968–2016

“…1 2 In England, too, these latter downward trends have been seen for deaths from CHD, 2 3 and specifically from MI. 4 5 Despite this, CHD remains a major cause of morbidity, 6 and it costs England's National Health Service (NHS) over £950 million per year. 2 Hospital admission rates for MI are an important measure of CHD burden in the population, but have generally been reported in studies covering relatively short time periods.…”

<p>Temporal Trends of the Incidence of Ischemic Heart Disease in Iran Over 15 Years: A Comprehensive Report from a Multi-Centric Hospital-Based Registry</p>

“…Previous reports from some western countries showed that the adjusted incidence trend of IHD or MI decreased over the same time period. 20,22 A binational study of more than 7 million IHD hospitalizations in England and Australia highlighted that the age-adjusted hospitalization rates for total IHD declined in Australia from 1996 to 2013 (with an average annual percent change of −3.0); meanwhile, IHD 25 Previous studies showed that the trends of agestandardized IHD mortality declined in high-income western regions from 1980 to 2010, but they increased in South Asia, Central Asia, East Asia, and Eastern Europe.…”

“…17 In CD-ICD-10 method, subgroups of IHD included myocardial infarction (MI) (I21 and I22), unstable angina (I20.0), stable angina (I20.1-I20.9), and other IHD such as chronic IHD (I25), other acute IHD (I24), and complications following acute MI (I23). 20 IHD patients were identified based on primary diagnoses or underlying causes of death and the secondary diagnoses at discharge from hospital or contributory causes of death from death certificate. In WHO-MONICA method, events are classified as firstever or recurrent and fatal or non-fatal.…”

A Versatile Big Data Health System for Australia: Driving Improvements in Cardiovascular Health

“…Comprehensive Big Data systems will allow studies of whole populations over many decades to be performed in a timelyand cost-effective manner. Whole-of-population coverage importantly provides the power to identify even marginal shifts in outcomes as a result of new policies or interventions, to detect changes in population groups where numbers of cardiovascular events are relatively low but rising (such as in younger women [23]), and for long-term follow-up along the life course, with better opportunities for inferring cause, with adjustment for confounders. Population-based data provide complete coverage of communities, ensuring inclusiveness and generalisability of results.…”