Inpatient deaths from acute myocardial infarction, 1982-92: analysis of data in the Nottingham heart attack register

BMJ. 1997 Jul 19;315(7101):159-64. doi: 10.1136/bmj.315.7101.159.

Abstract

Objective: To assess longitudinal trends in admissions, management, and inpatient mortality from acute myocardial infarction over 10 years.

Design: Retrospective analysis based on the Nottingham heart attack register.

Setting: Two district general hospitals serving a defined urban and rural population.

Subjects: All patients admitted with a confirmed acute myocardial infarction during 1982-4 and 1989-92 (excluding 1991, when data were not collected).

Main outcome measures: Numbers of patients, background characteristics, time from onset of symptoms to admission, ward of admission, treatment, and inpatient mortality.

Results: Admissions with acute myocardial infarction increased from 719 cases in 1982 to 960 in 1992. The mean age increased from 62.1 years to 66.6 years (P < 0.001), the duration of stay fell from 8.7 days to 7.2 days (P < 0.001), and the proportion of patients aged 75 years and over admitted to a coronary care unit increased significantly from 29.1% to 61.2%. A higher proportion of patients were admitted to hospital within 6 hours of onset of their symptoms in 1989-92 than in 1982-4, but 15% were still admitted after the time window for thrombolysis. Use of beta blockers increased threefold between 1982 and 1992, aspirin was used in over 70% of patients after 1989, and thrombolytic use increased 1.3-fold between 1989 and 1992. Age and sex adjusted odds ratios for inpatient mortality remained unchanged over the study period.

Conclusions: Despite an increasing uptake of the "proved" treatments, inpatient mortality from myocardial infarction did not change between 1982 and 1992.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Coronary Care Units / statistics & numerical data
  • England / epidemiology
  • Female
  • Hospital Mortality*
  • Hospitals, District / statistics & numerical data
  • Humans
  • Length of Stay
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality*
  • Odds Ratio
  • Prospective Studies
  • Rural Health
  • Urban Health