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Incidence, delay and survival in the Belfast MONICA Project coronary event register
A E Evans1, C C Patterson, Z Mathewson
1Belfast MONICA Project, Department of Community Medicine & Medical Statistics, Queen's University of Belfast, Northern Ireland.
Insights
The Belfast MONICA Project found that coronary event rates and mortality were age-dependent, with significant variations across electoral wards. Delays in receiving care impacted outcomes, especially for unmarried individuals and those with chronic ischemic heart disease.
Area of Science:
- Cardiovascular epidemiology
- Public health research
Background:
- The Belfast MONICA Project monitored coronary events between 1983-1985.
- The study included 2,512 individuals, with a focus on men and women.
Purpose of the Study:
- To analyze coronary event attack and mortality rates.
- To investigate factors influencing delay times for medical care.
- To assess survival rates and risk factors for pre-care death.
Main Methods:
- Population-based cohort study.
- Registration of coronary events and mortality data.
- Analysis of age- and sex-standardized rates across electoral wards.
- Assessment of delay times from symptom onset to care delivery.
Main Results:
- Coronary attack and mortality rates were significantly age-dependent, with higher rates in men.
- Median delay times to care were 2.5 hours for men and 3 hours for women.
- Shorter delays were observed in younger, married individuals, and those with prior infarctions.
- Unmarried individuals and those with chronic ischemic heart disease faced higher risks of pre-care death.
- 60% of 28-day deaths occurred before hospital admission.
- 28-day survival was 64% for males and 67% for females, with manual workers showing poorer survival.
Conclusions:
- Coronary event risk and outcomes are influenced by age, sex, and socioeconomic factors.
- Timely access to care is crucial for reducing mortality.
- Marital status and pre-existing conditions are significant predictors of survival.
Abstract:
During the 1983-85 period, the Belfast MONICA Project registered coronary events in 2,512 individuals (1,913 men and 599 women). The attack rates in men and women per 1,000 person years were 5.9 and 1.7 respectively, and the corresponding mortality rates were 2.4 and 0.61; both rates were heavily age-dependent. There were statistically significant differences in the age and sex-standardised rates for the 107 electoral wards of the Study. The median delay time from onset to delivery of care was 2 hours 30 minutes and 3 hours 2 minutes for men and women, respectively. Delays were shorter in younger and married individuals, and in those with previous infarctions. Unmarried individuals and those with chronic ischaemic heart disease were at significantly increased risk of pre-care death. Sixty per cent of deaths within 28 days of onset occurred before the patient could be admitted to hospital. Sixty-four per cent of males and 67% of females were alive at 28 days. Manual workers and their spouses had a poorer survival at 28 days. Married men and women were at lowest risk of death in the first 28 days, and this could not be attributed to the effects of age.