Shifts in the age distribution and from acute to chronic coronary heart disease hospitalizations

Eur J Prev Cardiol. 2016 Jan;23(2):170-7. doi: 10.1177/2047487314544975. Epub 2014 Jul 30.


Background: Shifts in the burden of coronary heart disease (CHD) from an acute to chronic illness have important public health consequences.

Objective: To assess age-sex-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 hospitalization rates of 188,266 acute myocardial infarction (AMI, ICD-9 410), 294,374 unstable angina (ICD-9 411, 413) and 205,649 chronic forms of CHD (ICD-9 412, 414) admissions.

Results: Between 1998 and 2007, the age-standardized CHD hospitalization rate declined from 688 to 545 per 100,000 in men and from 281 to 229 per 100,000 in women. Overall, hospitalization rates decreased at younger age (<75 years) but increased in very old age (≥85 years). The annual percentage change in hospitalization 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 +0.7% 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.

Conclusions: An increasing proportion of Dutch CHD hospital admissions was for chronic forms of CHD. The age at hospitalization was pushed towards older age: premature CHD admission declined over time and admission rates at very old age increased.

Keywords: Coronary disease; Netherlands; age distribution; chronic disease; hospitalization; myocardial infarction; trends; unstable angina.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Angina, Unstable / epidemiology
  • Coronary Artery Disease / epidemiology*
  • Female
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Netherlands / epidemiology
  • Registries