Background Shifts in the burden of coronary heart disease (CHD) from an acute to chronic illness may have important public health consequences. The objective of this study was to assess age-gender-specific time trends in rates and characteristics of acute and chronic forms of CHD hospital admissions in the Netherlands.
Methods Using nationwide Dutch registers, we assessed time trends between 1998 and 2007 in hospitalisation rates of 188,266 acute myocardial infarction (AMI, ICD-9 410), 294,374 unstable angina (ICD-9 411, 413) and 203,881 chronic forms of CHD (ICD-9 412, 414) admissions.
Results Between 1998 and 2007, the age-standardised CHD hospitalisation rate declined from 688 to 545 per 100,000 in men and from 281 to 229 per 100,000 in women. Overall trends masked age differences, with increasing hospitalisation rates in very old age (≥85 years). The annual percentage change in hospitalisation rates was larger for AMI (men: -5.1%, women: -4.4%) than for unstable angina patients (men: -2.0%, women: -2.0%). For chronic CHD, the average annual percentage change was +0.5% in men and +2.1% in women. The proportion of chronic CHD in the total of CHD admissions increased between 1998 and 2007 from 29% to 36% in men and from 23% to 30% in women. The proportion of AMI decreased from 30% to 24% in men and from 27% to 22% in women.
Conclusion An increasing proportion of CHD hospital admissions in the Netherlands were for chronic forms of CHD. This may in part be accounted for by the increased use of revascularization procedures, especially among the elderly.