1 National trends in rates of death and hospital admissions related to acute myocardial infarction,...

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National trends in rates of death and hospital admissions related to acute myocardial

infarction, heart failure and stroke, 1994–2004

CIHR Team Grant in Cardiovascular Outcomes Research

Jack V. Tu MD PhD, Lorelei Nardi MSc, Jiming Fang PhD, Juan Liu MD, Laila Khalid MD, Helen Johansen PhD,

for the Canadian Cardiovascular Outcomes Research Team

CCORT• CCORT is a group of over 30 outcomes researchers from

5 provinces (NS, QC, ON, AB, BC) who are working together on projects to measure and improve the quality of cardiac care in Canada

• Funded by a CIHR Team Grant in Cardiovascular Outcomes Research

• Institute for Clinical Evaluative Sciences (ICES) in Toronto is the national coordinating centre for CCORT

• www.ccort.ca


Purpose of Study• To examine national trends between 1994 and

2004, in hospitalizations and death rates for acute myocardial infarction, heart failure and stroke

• To see whether the rate of change for these three conditions has been similar or different


Methods• We analyzed mortality data from Statistic Canada’s

Canadian Mortality Database and data on hospital admissions from the Canadian Institute for Health Information’s Hospital Morbidity Database for the period 1994-2004

• We determined age- and sex-standardized rates of death and hospital admissions per 100,000 population aged 20 years and over as well as in-hospital case-fatality rates


Overview• The following is a set of slides that highlight key findings

from the original manuscript including the following:– Decrease in mortality rates– Decrease in hospital admission rates– Decrease in in-hospital case-fatality rates– Differences between men and women in relation to mortality

and hospitalization rates• Please feel free to use these slides to disseminate this

information


Trends in the rates of death, hospital admissions and in-hospital case fatality associated with acute myocardial infarction, heart failure and stroke in Canada, 1994-2004

Age- and sex-specific rates of death by cardiovascular disease per 100,000 population aged 20 and over in Canada, 1994-2004

Age- and sex-standardized rates of death from acute myocardial infarction, heart failure and stroke per 100,000 population aged 20 and over in Canada, 1994-2004. Rates are standardized to the Canadian 1991 census population

Decline in age- and sex-standardized mortality rates for acute myocardial infarction, heart failure and

stroke in Canada, 1994-2004

19.6

102.5

70.2

15

63.450.4

0

10

20

30

40

50

60

70

80

90

100

110

Acute myocardial infarction Heart failure Stroke

Rat

e pe

r 10

0,00

0

1994

2004

38.1%

23.5%

28.2%

Age-standardized mortality rates for cardiovascular disease in women and men in Canada, 1994-2004

0

50

100

150

200

250

300

350

400

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Rat

e p

er 1

00,0

00

women

men

32.3% 27.5%

Decline in age-standardized mortality rates for cardiovascular disease in women and men in Canada, 1994-2004

346.4375.4

251 254.1

0

50

100

150

200

250

300

350

400

women men

Rate

per

100

,000 1994

2004

27.5% 32.3%

Percentage of female and male deaths for acute myocardial infarction, heart failure, stroke and cardiovascular disease in

Canada, 1994-2004

50.549.3

59.357.9

60.159.2

43.641.9

49.5

50.7

40.742.139.940.7

56.458.1

0

10

20

30

40

50

60

1994 2004 1994 2004 1994 2004 1994 2004

Acute myocardial infarction Heart failure Stroke CVD

% women

men

Age- and sex-standardized rates of hospital admissions because of acute myocardial infarction, heart failure and stroke per 100,000 population aged 20 and over in Canada, 1994-2004. Rates are standardized to the Canadian 1991

census population.

Decline in age-and sex-standardized rate of hospital admissions for acute myocardial infarction, heart

failure and stroke in Canada, 1994-2004

227

260.1 266.9

206.2 189.3 193.3

0

100

200

300


Rat

e pe

r 10

0,00

0

1994

2004

9.2%27.2% 27.6%

Percentage of women and men hospitalized for acute myocardial infarction, heart failure and stroke in Canada, 1994-

2004

49.749.150.650.4

3735.4

50.450.849.449.7

63.164.6

0

10

20

30

40

50

60

70

1994 2004 1994 2004 1994 2004


Hos

pita

l adm

issi

ons,

%

women

men

Age- and sex-adjusted in-hospital case-fatality rates among patients with acute myocardial infarction, heart failure and stroke in Canada, 1994-2004. Rates are

standardized to the Canadian 1991 census population.

Decline in age- and sex-adjusted in-hospital case-fatality rates for acute myocardial infarction, heart failure and

stroke in Canada, 1994-2004

15.8

11.1

14.5 14.4

10.29.7

0

2

4

6

8

10

12

14

16

18


In-h

ospi

tal c

ase-

fata

lity

rate

, %

1994

2004

33.1% 8.1%

8.9%

Age- and sex-specific rates of hospital admissions by cardiovascular disease per 100,000 population aged 20 and over in Canada, 1994-2004

Increase in average age of patients being hospitalized for acute mycardial infarction, heart failure and stroke in Canada,

1994-2004

68

71

7779

74 75

62

64

66

68

70

72

74

76

78

80

1994 2004 1994 2004 1994 2004


Ave

rage

age

Average age

Conclusions• Mortality, hospitalization and in-hospital case-fatality rates

for heart disease decreased significantly between 1994-2004• For the first time in Canada, more women than men died from

cardiovascular disease in 2000• Efforts to prevent cardiovascular disease have been

successful but may have delayed the onset of disease until people are older

• Further prevention, treatment and national surveillance of cardiovascular disease is continuously required as it is still the leading cause of death in Canada

Reasons for mortality decline• Better heart disease prevention

– Decreasing smoking rates– Greater awareness and control of hypertension– Decreasing cholesterol levels (i.e. statins)

• Better heart disease treatment– Aspirin, beta-blockers, ACE inhibitors, statins, etc.– Fibrinolytics (clot-busting drugs), – Primary angioplasty, CABG surgery

Funding• This study was supported by a Team Grant in

Cardiovascular Outcomes Research to the Canadian Cardiovascular Outcomes Research Team from the Canadian Institutes of Health Research


Thank You

For more information please visitwww.ccort.ca


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