Decline in out-of-hospital coronary heart disease deaths has contributed the main part to the overall decline in coronary heart disease mortality rates among persons 35 to 64 years of age in Finland: the FINAMI study.
BACKGROUND
Out-of-hospital deaths constitute the majority of all coronary heart disease (CHD) deaths and are therefore of considerable public health significance.


RESULTS
We used population-based myocardial infarction register data to examine trends in out-of-hospital CHD deaths in Finland during 1983 to 1997. We included in out-of-hospital deaths also deaths in the emergency room and all deaths within 1 hour after the onset of symptoms. Altogether, 3494 such events were included in the analyses. The proportion of out-of-hospital deaths of all CHD deaths depended on age and gender. In the age group 35 to 64 years, it was 73% among men and 60% among women. These proportions did not change during the study. The annual average decline in the age-standardized out-of-hospital CHD death rate was 6.1% (95% CI, -7.3, -5.0%) among men and 7.0% (-10.0, -4.0%) among women. These declines contributed among men 70% and among women 58% to the overall decline in CHD mortality rate. In all, 58% of the male and 52% of the female victims of out-of-hospital CHD death had a history of symptomatic CHD. Among men with a prior history of myocardial infarction, the annual average decline in out-of-hospital CHD deaths was 5.3% (-7.2, -3.2%), and among men without such history the decline was 2.9% (-4.4, -1.5%). Among women, the corresponding changes were -7.8% (-14.2, -1.5%) and -4.5% (-8.0, -1.0%).


CONCLUSIONS
The decline in out-of-hospital CHD deaths has contributed the main part to the overall decline in CHD mortality rates among persons 35 to 64 years of age in Finland.
Salomaa
V
V
KTL-National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, FIN-00300 Helsinki, Finland. veikko.salomaa@ktl.fi
Ketonen
M
M
Koukkunen
H
H
Immonen-Räihä
P
P
Jerkkola
T
T
Kärjä-Koskenkari
P
P
Mähönen
M
M
Niemelä
M
M
Kuulasmaa
K
K
Palomäki
P
P
Mustonen
J
J
Arstila
M
M
Vuorenmaa
T
T
Lehtonen
A
A
Lehto
S
S
Miettinen
H
H
Torppa
J
J
Tuomilehto
J
J
Kesäniemi
Y A
YA
Pyörälä
K
K
D000328:Adult; D017677:Age Distribution; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012042:Registries / Q000706:statistics & numerical data; D017678:Sex Distribution