Epidemiological trends in mortality, event rates and case fatality of acute myocardial infarction from 2004 to 2015: results from the KORA MI registry

Christina Krämer,Ute Amann,Bernhard Kuch,Margit Heier,Christa Meisinger,Christian Thilo,Inge Kirchberger,Jakob Linseisen

doi:10.1080/07853890.2021.2002926

Abstract

Aim This study examines epidemiological trends of acute myocardial infarction (AMI) in Germany from 2004–2015 across different age groups, using data of the population-based KORA myocardial infarction registry. Methods Annual age-standardised, age-group- and sex-specific mortality and event rates (incident and recurrent) per 100,000 population as well as 28-day case fatality were calculated from all registered cases of AMI and coronary heart disease deaths in 25–74-year-olds from 2004–2015 and 75–84-year-olds from 2009–2015. Average annual percentage changes (AAPC) were calculated by joinpoint regression. Results Mortality rates declined considerably among the elderly (75–84 years), in men by –6.0% annually, due to declines of case fatality by –3.0% and incidence rate by 3.4% and in women by –10.0%, driven by declines in incidence (–9.1%) and recurrence rate (–4.9%). Significant mortality declines also occurred in males, 65–74 years of age (AAPC –3.8%). Among the age groups 25–54 years and 55–64 years, there was no substantial decline in mortality, event rates or case fatality except for a decline of incidence rate in 55–64-year-old men (AAPC –1.8%). Conclusion Inhomogeneous AMI trends across age-groups indicate progress in prevention and treatment for the population >64 years, while among <55-year-olds, we found no significant trend in AMI morbidity and mortality. KEY MESSAGES Age standardised AMI mortality continued to decline from 2009 to 2015 in the study region. Declines in AMI mortality were driven by declines in event rates (both incidence and recurrence rates) and case fatality. AMI trends were inconsistent across different age groups with the strongest declines in mortality and event rates among the elderly population (75–84 years of age).

Highlights

Coronary heart disease (CHD) is still one of the leading causes of death in most high-income countries within and outside Europe, mortality rates have already decreased substantially since the early 1980s [1,2]
We found the current trends to be inhomogeneous across age groups, especially when including the population up to 85 years of age since 2009, who showed the steepest declines in mortality
Trends in event rates We found a similar pattern of trends in incidence rates across age groups, which points in the same direction as previous studies from Denmark (1998–2007) [12], Norway (2001–2014) [11], the Netherlands (1998–2007) [14], France (2006–2014) [23], Western Australia (1993–2012 and 1995–2010) [10,15] and Australia (2000–2007) [24]

Summary

Introduction

Coronary heart disease (CHD) is still one of the leading causes of death in most high-income countries within and outside Europe, mortality rates have already decreased substantially since the early 1980s [1,2]. This decline in CHD mortality has largely been attributed to primary prevention measures like improved treatment and modification of cardiovascular risk factors such as arterial hypertension, hyperlipidaemia, diabetes mellitus and tobacco smoking, as well as to improvements in diagnostics and medical treatment of CHD, including secondary prevention [2,3]

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