title: Potential reductions in United States coronary heart disease mortality by treating more patients.
abstract: Approximately one half of the recent decline observed in age-adjusted coronary heart disease (CHD) mortality rates can be attributed to the use of modern medical and surgical interventions. In 2000, however, only about 30% to 60% of eligible patients actually received the appropriate treatment. To examine the reduction in CHD mortality potentially achievable by increasing the provision of specific medical and surgical treatment to eligible patients with CHD in the United States, we integrated the data on CHD patient numbers, medical and surgical treatment uptake levels, and treatment effectiveness using a previously validated CHD policy model. We estimated the number of deaths prevented or postponed for 2000 (baseline) and for an alternative scenario (60% of eligible patients). In 2000, the treatment levels in the United States were generally poor; only 30% to 60% of eligible patients received the appropriate therapy. These treatments resulted in approximately 159,330 fewer deaths. By treating 60% of eligible patients, 297,470 fewer deaths would have been obtained (minimum 118,360; maximum 628,120), representing 134,635 less than in 2000, with approximately 32% from heart failure therapy, 30% from secondary prevention therapy, 19% from acute coronary syndrome treatment, 15% from primary prevention with statins, 0.5% from hypertension treatment, and 1% from coronary bypass surgery for chronic angina. These findings remained stable in the sensitivity analysis. In conclusion, increasing the proportion of eligible patients with CHD who received the appropriate treatment could have achieved approximately 135,000 fewer deaths in 2000, almost doubling the benefit actually achieved. Future strategies should maximize the delivery of appropriate therapies to all eligible patients with CHD and prioritize medical therapies for secondary prevention and heart failure.
authors.affiliation: Division of Public Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.forename: Martin
authors.initials: M
authors.lastname: O'Flaherty
authors.forename: Earl S
authors.initials: ES
authors.lastname: Ford
authors.forename: Julia A
authors.initials: JA
authors.lastname: Critchley
mesh_terms: D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents