Falling hospital mortality for acute myocardial infarction in Quebec hospitals.
OBJECTIVE
To present in-hospital mortality trends for acute myocardial infarction (AMI).


METHODS
Observational study using the Quebec administrative hospital database, which records all hospitalizations for AMI, for the period 1986 to 1996.


RESULTS
From 1986 to 1996, the case fatality rate for AMI decreased from 18.4% to 12.7% despite an increase in the total number of admissions, due to an ageing population. Men and women have had similar yearly mortality reductions--7.6% versus 7.4%, respectively--although the absolute case fatality rate remains significantly higher for women. The mortality reduction for men was constant over the decade, while the decline for women was more pronounced over the last five years. Improving case fatality rates were also observed in the elderly and again were most evident from 1991 to 1996.


CONCLUSIONS
These data show a sharp decline in case fatality rates for AMI patients treated in Quebec hospitals from 1986 to 1996, suggesting that treatment advances observed in clinical trials are being applied at a population level. While improved survival has been observed in all patient groups, the data suggest that the part of the decline in mortality may be due to increased penetration of proven treatment strategies in women and the elderly.
Brophy
J
J
Department of Medicine, Centre Hospitalier, l'Université de Montréal, Québec. jbroph@po-box.mcgill.ca
D017677:Age Distribution; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D011792:Quebec / Q000453:epidemiology; D017678:Sex Distribution; D017741:Survivors / Q000706:statistics & numerical data