Mortality from heart failure, acute myocardial infarction and other ischaemic heart disease in England and Oxford: a trend study of multiple-cause-coded death certification

Abstract

BackgroundAge-standardised death rates from acute myocardial infarction (AMI) and ischaemic heart disease (IHD) have been declining in most developed countries. However, the magnitude of such reductions and how they impact on death from heart failure are less certain. We sought to assess and compare temporal trends in mortality from heart failure, AMI and non-AMI IHD over a 30-year period in England.MethodsWe analysed death registration data for multiple-cause-coded mortality for all deaths in people aged 35 years and over in England from 1995 to 2010, population 52 million, and in a regional population (Oxford region) from 1981 to 2010, population 2.5 million, for which data on all causes of death were available.ResultsConsidering all ages and both sexes combined, during the 30-year observation period, age-standardised and sex-standardised mortality rates based on all certified causes of death declined by 60% for heart failure, 80% for AMI and 46% for non-AMI IHD. These longer term trends observed in the Oxford region were consistent with those for the whole of England from 1995 to 2010, with no evidence of a plateau in recent years. Although proportional reductions in rates differed by age and sex, even in those aged 85 years or more, there were substantial reductions in mortality rates in the all-England data set (50%, 66% and 20% for heart failure, AMI and non-AMI IHD, respectively).ConclusionsThis study shows large and sustained reductions in age-specific and sex-specific and standardised death rates from heart failure, as well as from AMI and non-AMI IHD, over a 30-year period in England.

Epidemiology and aetiology of heart failure

“…10). Likewise, in England between 1981 and 2010, age-standardized death rates for HF decreased from 130.6 to 51.8 per 100,000 people 67 . The steepest declines were noted among middle-aged individuals between 55 and 64 years 67 .…”

“…Likewise, in England between 1981 and 2010, age-standardized death rates for HF decreased from 130.6 to 51.8 per 100,000 people 67 . The steepest declines were noted among middle-aged individuals between 55 and 64 years 67 . National estimates for Sweden in 2010 reported the 5-year HF survival rate as 48%, with 320 deaths per 100,000 person-years for women and 300 deaths per 100,000 person-years for men 39 .…”

Nursing care protocol for patients with a ventricular assist device

“…The left dysfunction presents reduced contractility of the left ventricle (LV) with subsequent reduction of the cardiac output and ejection fraction (EF). The right dysfunction presents no pulmonary edema and presence of signs of systemic congestion (jugular distension, hepatomegaly, ascites, lower limb edema) (2)(3) . Heart failure is caused by hypertension, ischemia (coronary artery disease), valvular dysfunction, and cardiomyopathies, such as Chagas, hyperthropic, idiopathic, restrictive, and alcoholic ones (1)(2) .…”

“…Hypertension and dilated cardiomyopathy are relevant factors in the evolution of HF. Ischemia is one of the most common causes of decompensated HF as it causes a reduction in the myocardial contractility (2) . Patients with HF presenting hemodynamic instability require periodical hospitalizations in order to improve their clinical condition through the use of inotropic agents and mechanical circulatory support (MCS), such as ventricular assist devices (VADs) (4) .…”

“…Such changes are responsible for the increased incidence of cardiovascular diseases. Two million new cases of heart failure (HF) are diagnosed every year in developed countries, w twenty-three million people are affected globally, representing a major public health problem (1)(2) . Heart failure is a progressive condition of the cardiac muscle with frequent situations of immunological, mechanical, neurohormonal, and ischemic disorders that may cause changes in the structure of the pericardium and cardiac endothelium (2) .…”