Explaining the Decline in Coronary Heart Disease Mortality in Finland between 1982 and 1997

Abstract

In Finland since the 1980s, coronary heart disease mortality has declined more than might be predicted by risk factor reductions alone. The aim of this study was to assess how much of the decline could be attributed to improved treatments and risk factor reductions. The authors used the cell-based IMPACT mortality model to synthesize effectiveness of treatments and risk factor reductions with data on treatments administered to patients and trends in cardiovascular risk factors in the population. Cardiovascular risk factors were measured in random samples of patients in 1982 (n=8,501) and 1997 (n=4,500). Mortality and treatment data were obtained from the National Causes of Death Register, Hospital Discharge Register, social insurance data, and medical records. Estimated and observed changes in coronary heart disease mortality were used as main outcome measures. Between 1982 and 1997, coronary heart disease mortality rates declined by 63%, with 373 fewer deaths in 1997 than expected from baseline mortality rates in 1982. Improved treatments explained approximately 23% of the mortality reduction, and risk factors explained some 53-72% of the reduction. These findings highlight the value of a comprehensive strategy that promotes primary prevention programs and actively supports secondary prevention. It also emphasizes the importance of maximizing population coverage of effective treatments.

The analysis of compliance of pharmacotherapy of patients with myocardial infarction to the principles evidence-based medicine at the stage of rehabilitation in modern conditions

“…В Финлян-дии за период с 1982 по 1997 г. удалось снизить смертность от ССЗ на 63%. При этом анализ исхо-дов показал, что улучшение качества лечения сни-зило смертность на 23%, тогда как модификация факторов риска была ответственна за снижение смертности на 53-72% [12]. Исследователями отме-чено, что эти стратегии не всегда и не в полной мере реализованы в различных странах [3].…”

Dynamics in Medical Treatment of Ischemic Heart Disease in Clinical Practice

“…Finland with one of the highest IHD mortality rates in Europe in 1960-th years has achieved decline in this index by 75% due to implementation of the North Karelian preventive project [3]. Russia has also demonstrated some success in this field, even though rather modest: IHD mortality rates decreased by 11.1% from 2003 to 2012 years.…”

“…At that, decreased levels of risk factors in population may be explained by benefits of preventive programs. On the other side, improvement, of treatment methods plays an important role in the reduction of IHD fatal complications [3,[8][9][10][11].…”

Mortalidade por doenças do aparelho circulatório no município de Ribeirão Preto - SP, de 1980 a 2004

“…In the authors' view, incidence reduction mirrors the effects of primary prevention actions such as less common smoking habits, and lower cholesterol and blood pressure levels in the population. Case-fatality reduction, in its turn, mirrors the effects of secondary prevention -specific treatments such as angioplasty, myocardial revascularization surgeries, and the use of latest generation drugs 21,22 .…”

“…Secondary prevention has also been appointed by some authors as responsible for mortality rates decline. The estimated decline in Auckland, New Zealand, was 40% (1974 to 1981) 26 , having risen to 48% (1982 to 1993) 27 ; The Netherlands reported a 46% decline (1978 to 1985) 28 ; The United States, 43% (1980 to 1990) 29 , and Finland, 23% (1982 to 1997) 22 . The major cause for mortality rates decline in Taiwan was tertiary prevention resulting from intense investments in cardiac rehabilitation units combined with specific treatments 30 .…”