Summary
This report highlights the considerable progress that has been made in addressing the epidemic of coronary heart disease (CHD) in Australia among 40–90 year-olds.
Some major gains include:
- falling death rates for CHD: by over 30% between 1993–94 and 1999–00;
- falling onset of major coronary events: 20% decline in incidence rates between 1993–94 and 1999–00;
- better overall survival from major coronary events: 12–16% decline in case-fatality rates between 1993–94 and 1999–00;
- fewer hospital admissions for heart attack (a major component of CHD): 12% decline in acute myocardial infarction (AMI) admission rates between 1993–94 and 1999–00;
- better in-hospital survival for AMI: 17–19% decline in in-hospital case-fatality rates for
- AMI between 1993–94 and 1999–00;
- some lower risk factor levels: large declines in tobacco smoking and blood pressure levels since 1980.
Associated large trends:
- large increases in the prescription of lipid lowering drugs, ACE inhibitors and calcium channel blockers between 1990 and 1998;
- rapid increase in revascularisation procedures, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), for the treatment of AMI during acute admissions between 1993–94 and 1999–00.
Some unwelcome statistics:
- rapid increase in prevalence of overweight and obesity and diabetes since 1980;
- increase in physical inactivity levels since 1997;
- no change in high blood cholesterol levels since 1980.
Current patterns (in 1999–00):
- four in ten adult Australians have two or more major modifiable risk factors for CHD;
- 48,313 major coronary events, or 132 per day;
- 50% of these coronary events are fatal; and one in eight AMI patients die in hospital
- (3,258 patients);
- 28,002 hospital admissions for AMI. Of these:
- one in four have cardiac catheterisation;
- at least one in eight have PCI;
- one in twenty have CABG;
- in-hospital case-fatality rates for AMI patients undergoing PCI is 3.5% and CABG 5.4% during acute admissions. This contrasts with overall PCI mortality of 0.8% and overall CABG mortality of 2.1%.
Men and the elderly are most affected (in 1999–00):
- compared with women, men are:
- more likely to have multiple risk factors, such as tobacco smoking, physical inactivity, overweight and diabetes;
- twice as likely to have CHD and die from it;
- twice as likely to be hospitalised for heart attack;
- more likely to receive cardiac catheterisation and revascularisation procedures;
- on the other hand, women are more likely to die during acute hospital admissions for AMI and following CABG and cardiac catheterisation;
- compared with younger age groups (40–64 year-olds), the elderly (75–90 year-olds) have:
- worse risk factor levels;
- substantially higher death rates and incidence rates from CHD;
- higher admission rates for AMI, but lower rates of revascularisation procedures and cardiac catheterisations;
- poorer survival after a coronary event.
Preliminary material (157K PDF): List of tables; List of figures; Preface; Acknowledgments
Introduction (42K PDF)
- Background
- What is coronary heart disease?
- Risk factors and prevention
- Medical treatment and cardiac procedures
- Greater risk among the elderly
- Purpose and structure of this report
Methods (118K PDF)
- Overview
- Incidence of acute coronary events
- Hospital admissions
- Mortality
- Prevalence of heart disease
- Risk factor prevalence
- Drug treatment
- Cardiac procedures
- Expenditure
- Classifications
Incidence, prevalence and mortality of coronary heart disease (233K PDF)
- Introduction
- Incidence
- Mortality
- Case-fatality
- Prevalence
- Discussion
Risk factors and drug treatment for coronary heart disease (144K PDF)
- Introduction
- Risk factors for coronary heart disease
- Drug treatment
- Discussion
Admissions and in-hospital treatment for acute myocardial infarction (272K PDF)
- Introduction
- Hospital admissions for acute myocardial infarction
- Acute cardiac procedures
- Outcomes of acute care interventions
- Discussion
Expenditure (116K PDF)
- Introduction
- Aggregate expenditure on coronary heart disease
- Length of stay in hospital for acute myocardial infarction
- Average expenditure for hospital treatment
- Conclusion
End matter (145K PDF): Appendix; References