Article Text
Abstract
Background Both the incidence of myocardial infarction (MI) and short-term case fatality have declined in the UK. However, little is known about trends in longer-term survival following an MI. The aim of the study was to investigate trends in longer-term survival, alongside trends in medication prescribing in primary care.
Methods Data came from 218 general practices contributing to the Health Improvement Network, a UK-wide primary care database. 3-year survival and medication use were determined for 6586 men and 3766 women who had an MI between 1991 and 2002 and had already survived 3 months.
Results Adjusting for age and gender, the 3-year post-MI case-fatality rate among 3-month survivors fell by 28% (95% CI 13 to 40), from 83 deaths per 1000 person-years for MI occurring in 1991–2 to 61 deaths per 1000 person-years for MI in 2001–2. Relative declines in the case-fatality rate of 37% (20 to 50) and 14% (−11 to 34) were observed for men and women, respectively (p=0.06 for interaction). Prescribing in the 3 months following the MI of lipid-regulating drugs increased from 3% of patients in 1991 to 79% in 2002, prescribing of beta-blockers increased from 26% to 68%, prescribing of ACE inhibitors increased from 11% to 71% and prescribing of anti-platelet medication increased from 46% to 86%.
Conclusion There has been a moderate improvement in longer-term survival following an MI, distinct from improvements in short-term survival, although men may have benefited more than women. Increased medication prescribing in primary care may be a contributing factor.
- Coronary heart disease
- evidenced-based medicine
- longer-term survival
- myocardial infarction
- population
- primary care
- secondary prevention
- survival
- time trends
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Footnotes
Funding This work was supported by the Medical Research Council National Prevention Research Initiative (grant number G0501307). The funding partners for this award are: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office, Scottish Executive Health Department and Welsh Assembly government. The authors' work was independent of the funders (the funding source had no involvement).
Competing interests None.
Ethics approval This study was conducted with the approval of the South East Multi-Centre Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.