Abstract
Limited data on prehospital and early in-hospital coronary heart disease (CHD) deaths is available. Aims of this study were to provide a comprehensive description on CHD cases and to analyse determinants of prehospital death. From a population-based myocardial infarction (MI) registry in Augsburg, Germany we included 12,572 CHD cases aged 25–74 years between 2003–2017 and 4754 CHD cases aged 75–84 years between 2009–2017. Multivariable logistic regression models were conducted to identify patient characteristics associated with prehospital death compared to 28-day survival. In patients aged 25–74 years, 1713 (13.6%) died prehospital, 941 (7.5%) died within the first 24 h in-hospital and 560 (4.5%) died within the 2nd and 28th day after the acute event; in patients aged 75–84 years the numbers were 1263 (26.6%), 749 (15.8%) and 329 (6.9%), respectively. In both age groups increasing age, actual smoking or nicotine abuse, previous MI, angina pectoris and previous stroke were more likely and hypertension was less likely in cases, who died prehospital compared to 28-day survivors. For example, in the 25–74 years old we revealed an adjusted odds ratio (OR) of 4.53 (95% CI 3.84–5.34) for angina pectoris and an OR of 0.69 (95% CI 0.57–0.85) for hypertension. In cases aged 25–74 years, an association of living alone (OR 1.26, 95% CI 1.06–1.49) and diabetes (OR 1.20, 95% CI 1.03–1.41) with prehospital death was found. Whereas in cases aged 75–84 years, chronic obstructive pulmonary disease (OR 2.20, 95%CI 1.69–0.2.85) was associated with prehospital death. In summary, we observed high prehospital and early in-hospital case fatality. Besides classical cardiac risk factors, the impact of living alone on prehospital death was more important in patients aged 25–74 years than in older patients.
Highlights
Limited data on prehospital and early in-hospital coronary heart disease (CHD) deaths is available
The World Health Organization (WHO) multinational MONICA (MONItoring Trends and Determinants in CArdiovascular disease) project found that over the 10 years studied from the early 1980s, the fall in coronary heart disease (CHD) mortality rates in the population aged [35–64] years was two thirds determined by decline in coronary-event rates and one third by decline in case fatality[2]
The authors found that the relative contribution of out-of-hospital death to overall case fatality increased with time, especially among younger persons aged [35–54] years with 15.7% of all events dying outside the hospital and 1.9% dying in hospital within 28 days after hospital a dmission[5]
Summary
Limited data on prehospital and early in-hospital coronary heart disease (CHD) deaths is available. Even among persons above 74 years the CHD event rates and the 28-day case fatality, defined as ‘as number of deaths within 28 days (mortality) divided by fatal plus non-fatal coronary events (morbidity) by 100’, has decreased in western countries such as Finland[3] and Germany[4] Besides this success, recent data of the population-based MI registry in Germany showed a prehospital case fatality of 27.8% in 25 to 84 years old men and 36.5% in women of the same age-range in 2016/2018. Aims of this study were firstly, to provide information on sociodemographic characteristics, medical history and CV risk factors among persons registered in a population-based MI registry from 2003 to 2017 by survival status with a special focus on prehospital deaths and early in-hospital deaths. To analyse potential determinants associated with prehospital death compared to 28-day survival after the acute coronary event
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