Declines in in- and out-of-hospital coronary mortality from 2000 to 2016: results from the French MONICA registries

Abstract Background In the past decades, improvements in the management of acute coronary events (ACE) have dramatically reduced in-hospital Coronary Heart Disease (CHD) mortality. Little is known on recent evolutions in out-of-hospital mortality and its contribution to overall ACE mortality. Purpose To estimate trends of in- and out-of-hospital ACE mortality rates from 2000 to 2016 and their respective contribution to total CHD mortality. Methods Using data from the three CHD MONICA registries, all fatal myocardial infarctions, coronary deaths and sudden deaths occurring between January 1st, 2000 and December 31st, 2016 in patients age 35 to 74 were recorded. Age-standardized mortality rates (SMRs) were estimated by gender and calendar year. Crude mortality rates (CMRs) were estimated by 20-years age group. Trends were expressed as annual percentage changes (APCs). Results During the study period, 20,822 fatal events were recorded, of which 69.4% took place out-of hospital (Figure 1). Almost 90% of out-of-hospital deaths occurred at home. Standardized ACE mortality rates decreased more steeply in women as compared to men, with an APC of −4.4%, versus −3.5% in men. Decreases in ACE mortality were more pronounced inside than outside the hospital (APC: −4.6% versus −3.1% in men; −5.9% versus −3.7% in women), with an increase in the contribution of out-of-hospital mortality to overall ACE mortality from 64.7% to 71.1% in men, and from 64.4% to 71.4% in women. Decreases in CMRs were more pronounced for people age 55–74 compared to those age 35–54. In the 55–74 age group, in-hospital SMRs decreased more steeply inside than outside the hospital (APC −5.2% versus −3.6% in men; −6.3% versus −3.9% in women, Figure 2). This was not observed among the youngest subjects, in whom the decreases for in- and out-of-hospital CMRs were similar (APC −1.5% versus −1.6% in men; −3.6% versus −3.1% in women). Conclusions Over the study period, out-of-hospital mortality accounted for more than two-thirds of overall ACE mortality. Declines were more pronounced for in-hospital mortality than for out-of hospital, except in the youngest subjects, in whom they were similar. These results highlight the need to strengthen primary prevention. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): - Santé Publique France (SPF) - Institut national de la santé et de la recherche médicale (Inserm)