[Incidence and course of acute coronary events in the population of Ghent from 1983 to 1990]

G De Backer
Verhandelingen—Koninklijke Academie Voor Geneeskunde Van België 1996, 58 (1): 61-90; discussion 90-2
In the framework of the W.H.O.- MONICA project, a register for acute coronary events was established in the adult population aged 25-69 years of the city of Ghent. One of the objectives is to collect on an annual basis precise and valid information on the frequency of the disease. Fatal and non-fatal coronary events were monitored through the population-based register, using a standardized protocol and rigid diagnostic criteria. These criteria were evaluated by the research group on the basis of available information that was collected in collaboration with family doctors, hospital physicians, the city hall services and the district medical structure. Lethality was defined as deaths occurring within 28 days after initial symptoms. From 1993 to 1990, 2.626 events were registered. The age standardized annual event rates in men varied from 32.2 to 41.7/10.000; in women the corresponding values were 9.2 and 16.6/10.000. The attack rate declined over time at a rate of -13% over 5 years in men and -23% over 5 years in women. Attack rates of fatal coronary events declined even stronger. The incidence was calculated only in hospitalized cases in whom the antecedents of heart attacks were known in 93%. The age standardized annual incidence rates in hospitalized men varied from 15.5 to 22.4/10.000 and from 4.0 to 6.8/10.000 in hospitalized women. Over time no significant changes in incidence rates were observed. In both sexes there was a trend towards a decline in the incidence of fatal cases and towards an increase in the incidence of non-fatal cases. Lethality was dependent on age, sex and declined over time; the maximal case fatality rate was 57.9% and the minimal 42.3%. The lethality in hospitalized cases was 23.8% on average and declined significantly over time. In hospitalized cases with a first heart attack the lethality was 18.5%. All patients who entered the register from 1983 to 1985 for a non-fatal event (n = 465) were followed as to vital status until the end of 1991. The five years survival was 80.4 and 77.0% in respectively men and women. The long term prognosis was not different between sexes, strongly dependent on age and slightly different in the presence of antecedents of heart attacks. These results illustrate how precise and valid information on the frequency of acute coronary events can be collected through a population-based register. The results indicate high attack and incidence rates, a high case-fatality but favorable time trends from 1983 to 1990.

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