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May 23, 1986, Vol 255, No. 20 >
ARTICLE | May 23, 1986

Recent Changes in Attack and Survival Rates of Acute Myocardial Infarction (1975 Through 1981): Title and subTitle BreakThe Worcester Heart Attack Study FREE

Robert J. Goldberg, PhD; Joel M. Gore, MD; Joseph S. Alpert, MD; James E. Dalen, MD, MPH
[+] Author Affiliations

Reprint requests to Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01605 (Dr Goldberg).


JAMA. 1986;255(20):2774-2779. doi:10.1001/jama.1986.03370200076031
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References

A communitywide study was conducted in all 16 acute general hospitals in the metropolitan Worcester, Mass, area during the calendar years 1975, 1978, and 1981 to examine time trends in the attack and case-fatality rates of patients hospitalized with validated acute myocardial infarction as well as of the occurrence of out-of-hospital coronary heart disease (CHD) deaths. Between 1975 and 1981, there was an increase in the age-adjusted attack rates of initial events of acute myocardial infarction (1975, 254/100,000; 1981, 280/100,000) as well as recurrent events (1975, 133/100,000; 1981, 156/100,000). These overall increases were due to an increase among those 65 years of age and older, with no significant changes observed in those less than 65 years old. The age-adjusted in-hospital case-fatality rates declined from 22.1% in 1975 to 20.3% in 1978 and 17.4% in 1981. In examining long-term prognosis, no significant differences were seen over an eight-year follow-up period between patients discharged in 1975, 1978, and 1981. The age-adjusted mortality rates of out-of-hospital CHD deaths significantly declined between 1975 (229/100,000) and 1981 (147/100,000). The results of this population-based survey suggest that recently observed declines in the mortality rates of CHD may reflect decreases in out-of-hospital coronary deaths and improving trends in the in-hospital survival of patients with acute myocardial infarction.

(JAMA 1986;255:2774-2779)

REFERENCES

1 +
Havlik RJ, Feinleib M (eds): Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality , National Institutes of Health publication 79-1610. Dept of Health, Education, and Welfare, 1979;.
2 +
Gordon T, Thom T:  The recent decrease in CHD mortality . Prev Med 1975;;4:115-125.
3 +
Cooper R, Stamler J, Dyer A, et al:  The decline in mortality from coronary heart disease, U.S.A., 1968-1975 . J Chronic Dis 1978;; 31:709-720.
4 +
Patrick CH, Palesch YY, Feinleib M, et al:  Sex differences in declining cohort death rates from heart disease . Am J Public Health 1982;; 72:161-166.
5 +
Stallones RA:  The rise and fall of ischemic heart disease . Sci Am 1980;;243:53-59.
6 +
Stern MP:  The recent decline in ischemic heart disease mortality . Ann Intern Med 1979;; 91:630-640.
7 +
Dobson AJ, Gibberd RW, Wheeler DJ, et al:  Age-specific trends in mortality from ischemic heart disease and cerebrovascular disease in Australia . Am J Epidemiol 1981;;113:404-412.
8 +
Feinleib M, Thom T, Havlik RJ:  Decline in coronary heart disease mortality in the United States , Grotto AM Jr, Paoletti R (eds): in Atherosclerosis Reviews . New York, Raven Press, 1982;, vol 9, pp 29-42.
9 +
Nicholls ES, Jung J, Davies JW:  Cardiovascular disease mortality in Canada . Can Med Assoc J 1981;;125:981-992.
10 +
Marmot MG:  Lifestyle and national and international trends in coronary heart disease mortality . Postgrad Med J 1984;;60:3-8.
11 +
Kannel WB, Thom TJ:  Declining cardiovascular mortality . Circulation 1984;;70:331-336.
12 +
Levy RI:  The decline in cardiovascular mortality . Am Rev Public Health 1981;;2:45-52.
13 +
Walker WJ:  Changing U.S. lifestyle and declining vascular mortality: A retrospective . N Engl J Med 1983;;308:649-651.
14 +
Stamler J:  Primary prevention of coronary heart disease: The last 20 years . Am J Cardiol 1981;;47:722-735.
15 +
Thom TJ, Kannel WB:  Downward trend in cardiovascular mortality . Annu Rev Med 1981;; 32:427-434.
16 +
Gillum RF, Folsom AR, Blackburn H:  Decline in coronary heart disease mortality, old questions and new facts . Am J Med 1984;;76:1055-1065.
17 +
Goldman L, Cook EF:  The decline in ischemic heart disease mortality rates: An analysis of the comparative effects of medical interventions and changes in lifestyle . Ann Intern Med 1984;;101:825-836.
18 +
Gillum RF, Folsom A, Luepker RV, et al:  Sudden death and acute myocardial infarction in a metropolitan area 1970-1980: The Minnesota Heart Survey . N Engl J Med 1983;;309:1353-1358.
19 +
Connolly D, Oxman H, Nobrega FT, et al:  Coronary heart disease in residents of Rochester, Minnesota, 1950-1975: I. Background and study design . Mayo Clin Proc 1981;;56:661-664.
20 +
Elveback L, Connolly D, Kurland L:  Coronary heart disease in residents of Rochester, Minnesota, 1950-1975: II. Mortality, incidence and survivorship . Mayo Clin Proc 1981;;56:665-672.
21 +
Leeder SR, Dobson AJ, Gibberd RW, et al:  Attack and case fatality rates for acute myocardial infarction in the Hunter region of New South Wales, Australia, in 1979 . Am J Epidemiol 1983;;118:42-51.
22 +
Beaglehoe R, Bonita R, Jackson R, et al:  Trends in coronary heart disease event rates in New Zealand . Am J Epidemiol 1984;;120:225-235.
23 +
Pole DJ, McCall MG, Reader R, et al:  Incidence and mortality of acute myocardial infarction in Perth, Western Australia . J Chronic Dis 1977;;30:19-27.
24 +
World Health Organization:  Myocardial infarction community registers: Regional office for Europe, Copenhagen, 1976 . Public Health Eur 1976;;5:1-232.
25 +
Goldberg R, Szklo M, Tonascia J, et al:  Time trends in the prognosis of patients with myocardial infarction: A population-based study . Johns Hopkins Med J 1979;;144:73-80.
26 +
Szklo M, Goldberg R, Kennedy H, et al:  Survival of patients with nontransmural myocardial infarction: A population-based study . Am J Cardiol 1978;;42:648-652.
27 +
Walker SH, Duncan DB:  Estimation of the probability of an event as a function of several independent variables . Biometrika 1967;;54:167-179.
28 +
Merrell M, Shulman LE:  Determination of prognosis in chronic disease illustrated by systemic lupus erythematosus . J Chronic Dis 1955;; 1:12-32.
29 +
Peto R, Pike MC, Armitage P, et al:  Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II. Analysis and examples . Br J Cancer 1977;;35:1-39.
30 +
Cox DR:  Regression models and life tables . J R Stat Soc 1972;;34:187-202.
31 +
Mantel N, Haenzsel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-742.
32 +
Friedman GD:  Decline in hospitalizations for coronary heart disease and stroke: The Kaiser-Permanente experience in Northern California, 1971-1977 , in Havlik RJ, Feinleib M (eds): Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality , publication 79-1610. National Institutes of Health, 1979;, pp 116-118.
33 +
Pell S, Fayerweather WE:  Trends in the incidence of myocardial infarction and in associated mortality and morbidity in a large employed population, 1957-1983 . N Engl J Med 1985;;312:1005-1011.
34 +
 Report of the Surgeon General : The Health Consequences of Smoking: Cardiovascular Diseases . Public Health Service, 1983;, pp 344-347.
35 +
Stamler J:  Coronary heart disease: Doing the 'right things .' N Engl J Med 1985;;312:1053-1055.
36 +
Goldberg RJ, Kennedy HL, Gore JM:  Absence of secular changes in the prognosis of patients with an initial myocardial infarction . Clin Cardiol 1982;;5:469-475.
37 +
Weinblatt E, Goldberg JD, Ruberman W, et al:  Mortality after first myocardial infarction: Search for a secular trend . JAMA 1982;;247:1576-1581.
38 +
May GS, Eberlein KA, Furberg CD, et al:  Secondary prevention after myocardial infarction: A review of long-term trials . Prog Cardiovasc Dis 1982;;24:331-352.
39 +
Passamani ER (ed):  Limitation of infarct size with thrombolytic agents . Circulation 1983;; 68( (suppl 1) ):I-1.
40 +
Rude RE, Muller J, Braunwald E:  Efforts to limit the size of myocardial infarcts . Ann Intern Med 1981;;95:736-761.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Havlik RJ, Feinleib M (eds): Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality , National Institutes of Health publication 79-1610. Dept of Health, Education, and Welfare, 1979;.
2 +
Gordon T, Thom T:  The recent decrease in CHD mortality . Prev Med 1975;;4:115-125.
3 +
Cooper R, Stamler J, Dyer A, et al:  The decline in mortality from coronary heart disease, U.S.A., 1968-1975 . J Chronic Dis 1978;; 31:709-720.
4 +
Patrick CH, Palesch YY, Feinleib M, et al:  Sex differences in declining cohort death rates from heart disease . Am J Public Health 1982;; 72:161-166.
5 +
Stallones RA:  The rise and fall of ischemic heart disease . Sci Am 1980;;243:53-59.
6 +
Stern MP:  The recent decline in ischemic heart disease mortality . Ann Intern Med 1979;; 91:630-640.
7 +
Dobson AJ, Gibberd RW, Wheeler DJ, et al:  Age-specific trends in mortality from ischemic heart disease and cerebrovascular disease in Australia . Am J Epidemiol 1981;;113:404-412.
8 +
Feinleib M, Thom T, Havlik RJ:  Decline in coronary heart disease mortality in the United States , Grotto AM Jr, Paoletti R (eds): in Atherosclerosis Reviews . New York, Raven Press, 1982;, vol 9, pp 29-42.
9 +
Nicholls ES, Jung J, Davies JW:  Cardiovascular disease mortality in Canada . Can Med Assoc J 1981;;125:981-992.
10 +
Marmot MG:  Lifestyle and national and international trends in coronary heart disease mortality . Postgrad Med J 1984;;60:3-8.
11 +
Kannel WB, Thom TJ:  Declining cardiovascular mortality . Circulation 1984;;70:331-336.
12 +
Levy RI:  The decline in cardiovascular mortality . Am Rev Public Health 1981;;2:45-52.
13 +
Walker WJ:  Changing U.S. lifestyle and declining vascular mortality: A retrospective . N Engl J Med 1983;;308:649-651.
14 +
Stamler J:  Primary prevention of coronary heart disease: The last 20 years . Am J Cardiol 1981;;47:722-735.
15 +
Thom TJ, Kannel WB:  Downward trend in cardiovascular mortality . Annu Rev Med 1981;; 32:427-434.
16 +
Gillum RF, Folsom AR, Blackburn H:  Decline in coronary heart disease mortality, old questions and new facts . Am J Med 1984;;76:1055-1065.
17 +
Goldman L, Cook EF:  The decline in ischemic heart disease mortality rates: An analysis of the comparative effects of medical interventions and changes in lifestyle . Ann Intern Med 1984;;101:825-836.
18 +
Gillum RF, Folsom A, Luepker RV, et al:  Sudden death and acute myocardial infarction in a metropolitan area 1970-1980: The Minnesota Heart Survey . N Engl J Med 1983;;309:1353-1358.
19 +
Connolly D, Oxman H, Nobrega FT, et al:  Coronary heart disease in residents of Rochester, Minnesota, 1950-1975: I. Background and study design . Mayo Clin Proc 1981;;56:661-664.
20 +
Elveback L, Connolly D, Kurland L:  Coronary heart disease in residents of Rochester, Minnesota, 1950-1975: II. Mortality, incidence and survivorship . Mayo Clin Proc 1981;;56:665-672.
21 +
Leeder SR, Dobson AJ, Gibberd RW, et al:  Attack and case fatality rates for acute myocardial infarction in the Hunter region of New South Wales, Australia, in 1979 . Am J Epidemiol 1983;;118:42-51.
22 +
Beaglehoe R, Bonita R, Jackson R, et al:  Trends in coronary heart disease event rates in New Zealand . Am J Epidemiol 1984;;120:225-235.
23 +
Pole DJ, McCall MG, Reader R, et al:  Incidence and mortality of acute myocardial infarction in Perth, Western Australia . J Chronic Dis 1977;;30:19-27.
24 +
World Health Organization:  Myocardial infarction community registers: Regional office for Europe, Copenhagen, 1976 . Public Health Eur 1976;;5:1-232.
25 +
Goldberg R, Szklo M, Tonascia J, et al:  Time trends in the prognosis of patients with myocardial infarction: A population-based study . Johns Hopkins Med J 1979;;144:73-80.
26 +
Szklo M, Goldberg R, Kennedy H, et al:  Survival of patients with nontransmural myocardial infarction: A population-based study . Am J Cardiol 1978;;42:648-652.
27 +
Walker SH, Duncan DB:  Estimation of the probability of an event as a function of several independent variables . Biometrika 1967;;54:167-179.
28 +
Merrell M, Shulman LE:  Determination of prognosis in chronic disease illustrated by systemic lupus erythematosus . J Chronic Dis 1955;; 1:12-32.
29 +
Peto R, Pike MC, Armitage P, et al:  Design and analysis of randomized clinical trials requiring prolonged observation of each patient: II. Analysis and examples . Br J Cancer 1977;;35:1-39.
30 +
Cox DR:  Regression models and life tables . J R Stat Soc 1972;;34:187-202.
31 +
Mantel N, Haenzsel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-742.
32 +
Friedman GD:  Decline in hospitalizations for coronary heart disease and stroke: The Kaiser-Permanente experience in Northern California, 1971-1977 , in Havlik RJ, Feinleib M (eds): Proceedings of the Conference on the Decline in Coronary Heart Disease Mortality , publication 79-1610. National Institutes of Health, 1979;, pp 116-118.
33 +
Pell S, Fayerweather WE:  Trends in the incidence of myocardial infarction and in associated mortality and morbidity in a large employed population, 1957-1983 . N Engl J Med 1985;;312:1005-1011.
34 +
 Report of the Surgeon General : The Health Consequences of Smoking: Cardiovascular Diseases . Public Health Service, 1983;, pp 344-347.
35 +
Stamler J:  Coronary heart disease: Doing the 'right things .' N Engl J Med 1985;;312:1053-1055.
36 +
Goldberg RJ, Kennedy HL, Gore JM:  Absence of secular changes in the prognosis of patients with an initial myocardial infarction . Clin Cardiol 1982;;5:469-475.
37 +
Weinblatt E, Goldberg JD, Ruberman W, et al:  Mortality after first myocardial infarction: Search for a secular trend . JAMA 1982;;247:1576-1581.
38 +
May GS, Eberlein KA, Furberg CD, et al:  Secondary prevention after myocardial infarction: A review of long-term trials . Prog Cardiovasc Dis 1982;;24:331-352.
39 +
Passamani ER (ed):  Limitation of infarct size with thrombolytic agents . Circulation 1983;; 68( (suppl 1) ):I-1.
40 +
Rude RE, Muller J, Braunwald E:  Efforts to limit the size of myocardial infarcts . Ann Intern Med 1981;;95:736-761.

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