Background: Trends in cardiovascular risk factors among UK adults present a complex picture. Ominous increases in obesity and diabetes among young adults raise concerns about subsequent coronary heart disease (CHD) mortality rates in this group. Objective: To examine recent trends in age-specific mortality rates from CHD, particularly those among younger adults. Methods and results: Mortality data from 1984 to 2004 were used to calculate age-specific mortality rates for British adults aged 35+ years, and joinpoint regression was used to assess changes in trends. Overall, the ageadjusted mortality rate decreased by 54.7% in men and by 48.3% in women. However, among men aged 35– 44 years, CHD mortality rates in 2002 increased for the first time in over two decades. Furthermore, the recent declines in CHD mortality rates seem to be slowing in both men and women aged 45–54. Among older adults, however, mortality rates continued to decrease steadily throughout the period. Conclusions: The flattening mortality rates for CHD among younger adults may represent a sentinel event. Deteriorations in medical management of CHD appear implausible. Thus, unfavourable trends in risk factors for CHD, specifically obesity and diabetes, provide the most likely explanation for the observed trends.

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Coronary heart disease trends in England and Wales from 1984 to 2004: concealed levelling of mortality rates among young adults

Objective To measure the short term impact on hospital admissions for myocardial infarction of the introduction of smoke-free legislation in England on 1 July 2007. Design An interrupted time series design with routinely collected hospital episode statistics data. Analysis of admissions from July 2002 to September 2008 (providing five years’ data from before the legislation and 15 months’ data from after) using segmented Poisson regression. Setting England. Population All patients aged 18 or older living in England with an emergency admission coded with a primary diagnosis of myocardial infarction. Main outcome measures Weekly number of completed hospital admissions. Results After adjustment for secular and seasonal trends and variation in population size, there was a small but significant reduction in the number of emergency admissions for myocardial infarction after the implementation of smoke-free legislation (−2.4%, 95% confidence interval −4.06% to −0.66%, P=0.007). This equates to 1200 fewer emergency admissions for myocardial infarction (1600 including readmissions) in the first year after legislation. The reduction in admissions was significant in men (3.1%, P=0.001) and women (3.8%, P=0.007) aged 60 and over, and men (3.5%, P Conclusion This study adds to a growing body of evidence that smoke-free legislation leads to reductions in myocardial infarctions. It builds on previous work by showing that such declines are observed even when underlying reductions in admissions and potential confounders are controlled for. The considerably smaller decline in admissions observed in England compared with many other jurisdictions probably reflects aspects of the study design and the relatively low levels of exposure to secondhand smoke in England before the legislation.

https://www.bmj.com/content/bmj/340/bmj.c2161.full.pdf

Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction

Background. Chest pain is a common symptom that presents the primary care physician with a complex diagnostic and therapeutic challenge. Aims. To evaluate the natural history and management of patients diagnosed with chest pain of unspecified type or origin in primary care. Design. Population-based case-control study. Methods. The study included 13 740 patients with a first diagnosis of unspecified chest pain and 20 000 age- and sex-matched controls identified from the UK General Practice Research Database. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using unconditional logistic regression. Risk estimates were adjusted for age, sex and number of physician visits. Results. The incidence of a new diagnosis of chest pain was 15.5 per 1000 person-years and increased with age, particularly in men. The risk of a chest pain diagnosis was greatest in patients with prior diagnoses of coronary heart disease (OR: 7.1; 95% CI: 6.1-8.2) and gastroesophageal reflux disease (OR: 2.0; 95% CI: 1.7-2.3). In the year after diagnosis, chest pain patients were more likely than controls to be newly diagnosed with coronary heart disease (OR: 14.9; 95% CI: 12.7-17.4) and heart failure (OR: 4.7; 95% CI: 3.6-6.1). A new diagnosis of chest pain was associated with an increased risk of death in the following year (RR: 2.3; 95% CI: 1.9-2.8). Conclusions. Some causes of chest pain are underdiagnosed in primary care. This is of particular consequence for the minority of chest pain patients with cardiac disease.

Chest pain in general practice: incidence, comorbidity and mortality

Objective:To describe long-term temporal trends in patient characteristics, processes of care, and in-hospital outcomes among unselected admissions within the contemporary coronary care unit.Design:Hospital administrative database that records both payment and operation data.Setting:Coronary care un

Evolution of the coronary care unit: Clinical characteristics and temporal trends in healthcare delivery and outcomes*

Background—Given the recent declines in heart attack and stroke incidence, it is unclear how women and men differ in first lifetime presentations of cardiovascular diseases (CVDs). We compared the incidence of 12 cardiac, cerebrovascular, and peripheral vascular diseases in women and men at different ages. Methods and Results—We studied 1 937 360 people, aged ≥30 years and free from diagnosed CVD at baseline (51% women), using linked electronic health records covering primary care, hospital admissions, acute coronary syndrome registry, and mortality (Cardiovascular Research Using LInked Bespoke Studies and Electronic Records [CALIBER] research platform). During 6 years median follow-up between 1997 and 2010, 114 859 people experienced an incident cardiovascular diagnosis, the majority (66%) of which were neither myocardial infarction nor ischemic stroke. Associations of male sex with initial diagnoses of CVD, however, varied from strong (age-adjusted hazard ratios, 3.6–5.0) for abdominal aortic aneurysm, ...

How Does Cardiovascular Disease First Present in Women and Men? Incidence of 12 Cardiovascular Diseases in a Contemporary Cohort of 1,937,360 People.

Although hospital discharge rates for acute myocardial infarction are falling,1–4 no contemporary studies compare temporal trends in these rates for angina and other types of chest pain. We examined recent trends in population discharge rates for myocardial infarction, angina, and chest pain (“suspected acute coronary syndromes”) between 1990 and 2000.

We got data from the Scottish morbidity record for Scottish residents aged at least 18 years with a “first” emergency hospitalisation for myocardial infarction (codes ICD-9 (international classification of diseases, ninth revision) 410, ICD-10 I21 or I22), angina (ICD-9 411 or 413; ICD-10 I20 or I24.9) or “other chest pain” (ICD-9 786.5; ICD-10 R07), between 1990 and 2000.5 We analysed discharges coded only in the principal position. A “first” hospitalisation was one with no discharge diagnosis of coronary heart disease or chest pain in the previous 10 years.

We calculated rates using annual official age and sex specific population estimates for 1990-2000 and tested the significance of …

https://www.bmj.com/content/bmj/early/2003/12/31/bmj.38111.650741.F7.full.pdf

Hospital discharge rates for suspected acute coronary syndromes between 1990 and 2000: population based analysis

No study has described the burden to a health service of the complete spectrum of possible acute coronary syndromes (ACS). The objective of this study was to describe the changing burden of suspected ACS on the hospital sector of the National Health Service in Scotland over the period 1990–2000.

The record linkage system for discharges from Scottish hospitals and deaths has been described previously.1 We identified all emergency hospitalisations of patients ⩾ 18 years old in Scotland between January 1990 and December 2000 where acute myocardial infarction (AMI; International classification of diseases , (ICD), ninth revision, code 410, ICD-10 I21, 22), angina (ICD-9 411, 413, ICD-10 I20, I249), or chest pain (ICD-9 786.5, ICD-10 R07) was coded as the principal diagnosis on discharge. Numbers and age and sex specific rates of discharges (and patients discharged), length of stay, revascularisation procedures, and deaths were studied. We used linear regression to examine trends in population hospitalisation rates, hospitalisation numbers, and …

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Papers

Hospital discharge rates for suspected acute coronary syndromes between 1990 and 2000: population based analysis

Hospital burden of suspected acute coronary syndromes: recent trends