Explaining trends in Scottish coronary heart disease mortality between 2000 and 2010 using IMPACTSEC model: retrospective analysis using routine data

Hotchkiss, J. W.; Davies, Carolyn; Dundas, Ruth; Hawkins, Nathaniel M.; Jhund, Pardeep S.; Scholes, Shaun; Bajekal, Madhavi; O’Flaherty, Martı́n; Critchley, Julia; Leyland, Alastair H.; Capewell, Simon

doi:10.1136/bmj.g1088

Cited by 57 publications

(66 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[4,11] This model integrates nationwide data at two time points to explain an observed change in mortality. The IMPACT model was developed to (1) model CHD mortality trends and incorporates time trends in uptake of evidence-based acute phase and secondary prevention treatments, in addition to time trends in major CHD risk factors and (2) estimate the relative change in CHD mortality associated with each of these items.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007

et al. 2016

View full text Add to dashboard Cite

ObjectiveWe set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors.MethodsWe used the IMPACT-SEC model. Nationwide information was obtained on changes between 1997 and 2007 in the use of 42 treatments and in cardiovascular risk factor levels in adults, aged 25 or over. The primary outcome was the number of CHD deaths prevented or postponed.ResultsThe age-standardized CHD mortality fell by 48% from 269 to 141 per 100.000, with remarkably similar relative declines across socioeconomic groups. This resulted in 11,200 fewer CHD deaths in 2007 than expected. The model was able to explain 72% of the mortality decline. Approximately 37% (95% CI: 10%-80%) of the decline was attributable to changes in acute phase and secondary prevention treatments: the largest contributions came from treating patients in the community with heart failure (11%) or chronic angina (9%). Approximately 36% (24%-67%) was attributable to decreases in risk factors: blood pressure (30%), total cholesterol levels (10%), smoking (5%) and physical inactivity (1%). Ten% more deaths could have been prevented if body mass index and diabetes would not have increased. Overall, these findings did not vary across socioeconomic groups, although within socioeconomic groups the contribution of risk factors differed.ConclusionCHD mortality has recently halved in The Netherlands. Equally large contributions have come from the increased use of acute and secondary prevention treatments and from improvements in population risk factors (including primary prevention treatments). Increases in obesity and diabetes represent a major challenge for future prevention policies.

show abstract

Section: Methodsmentioning

confidence: 99%

“…[4,11] CHD burden tends to differ by socioeconomic circumstances (SEC), with incidence and mortality generally being lower in more affluent groups. Socioeconomic inequalities also exist in the Netherlands, although of smaller magnitude compared to the UK.…”

Section: Introductionmentioning

confidence: 99%

Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007

et al. 2016

View full text Add to dashboard Cite

show abstract

“…These improvements are a consequence of many factors including public health improvement, better acute and long term care combined with better engagement of primary care in prevention and management of CVD. The IMPACT model evaluated the reasons for the declining coronary heart disease (CHD) mortality in England between 2000 and 2007 and similar analyses have been undertaken for Scotland and Northern Ireland 5 6. For England the model explained about 86% of the mortality fall, with 34% of this due to decreases in the major cardiovascular risk factors in the population, with reductions in smoking and cholesterol, and improved physical activity levels.…”

Section: Section 1: Cardiovascular Disease Preventionmentioning

confidence: 99%

Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)

Board¹

2014

Heart

466

196

View full text Add to dashboard Cite

“…[4][5][6][7][8] These studies based their estimates on ecological data or mathematical modeling of aggregate data. Few studies used individual person data, 9,10 and the studies were limited to population subgroups and did not study out-of-hospital CHD or subtypes of MI.…”

Section: Editorial See P 8 Clinical Perspective On P 81mentioning

confidence: 99%

Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population

et al. 2016

View full text Add to dashboard Cite

Both changes in the rates of out-of-hospital CHD deaths and hospitalization rates and the outcome of myocardial infarction (MI) with ST-segment elevation (STEMI) and non-ST-segment elevation (non-STEMI) will affect mortality. Editorial see p 8 Clinical Perspective on p 81It has been suggested that 45% to 75% of the decrease in deaths from CHD can be attributed to decreases in smoking, blood pressure, and cholesterol. [4][5][6][7][8] These studies based their estimates on ecological data or mathematical modeling of aggregate data. Few studies used individual person data, 9,10 and the studies were limited to population subgroups and did not study out-of-hospital CHD or subtypes of MI.We used individual person data from repeated surveys of a general population to study the rates of out-of-hospital CHD; the incidence, treatment, and outcome of hospitalized STEMI and non-STEMI; and the impact of changes in coronary risk factor levels during the years 1995 to 2010. Methods Study PopulationThe Tromsø Study is a population-based, prospective study of various health issues and chronic diseases. It consists of 6 surveys of both sexes conducted in the municipality of Tromsø, Norway, from Background-Few studies have used individual person data to study whether contemporary trends in the incidence of coronary heart disease are associated with changes in modifiable coronary risk factors. Methods and Results-We identified 29 582 healthy men and women ≥25 years of age who participated in 3 population surveys conducted between 1994 and 2008 in Tromsø, Norway. Age-and sex-adjusted incidence rates were calculated for coronary heart disease overall, out-of-hospital sudden death, and hospitalized ST-segment-elevation and non-STsegment-elevation myocardial infarction. We measured coronary risk factors at each survey and estimated the relationship between changes in risk factors and changes in incidence trends. A total of 1845 participants had an incident acute coronary heart disease event during 375 064 person-years of follow-up from 1994 to 2010. The age-and sex-adjusted incidence of total coronary heart disease decreased by 3% (95% confidence interval, 2.0-4.0; P<0.001) each year. This decline was driven by decreases in out-of-hospital sudden death and hospitalized ST-segment-elevation myocardial infarction. Changes in coronary risk factors accounted for 66% (95% confidence interval, 48-97; P<0.001) of the decline in total coronary heart disease. Favorable changes in cholesterol contributed 32% to the decline, whereas blood pressure, smoking, and physical activity each contributed 14%, 13%, and 9%, respectively. Conclusions-We observed a substantial decline in the incidence of coronary heart disease that was driven by reductions in out-of-hospital sudden death and hospitalized ST-segment-elevation myocardial infarction. Changes in modifiable coronary risk factors accounted for 66% of the decline in coronary heart disease events.

show abstract

Explaining trends in Scottish coronary heart disease mortality between 2000 and 2010 using IMPACTSEC model: retrospective analysis using routine data

Cited by 57 publications

References 17 publications

Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007

Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007

Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3)

Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population

Contact Info

Product

Resources

About