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Comparative trends in coronary heart disease subgroup hospitalisation rates in England and Australia
Lee Nedkoff1, Raphael Goldacre2, Melanie Greenland1
1School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
Insights
Hospitalization rates for coronary heart disease (CHD) decreased overall since 2004, with acute coronary syndromes (ACS) declining faster than chronic CHD. Chronic CHD admissions, particularly those undergoing procedures, warrant further attention.
Area of Science:
- Cardiovascular epidemiology
- Public health research
- Clinical outcomes analysis
Background:
- Coronary heart disease (CHD) studies often focus on myocardial infarction (MI), with limited insight into broader CHD trends.
- Investigating hospitalization rates across the full spectrum of CHD is crucial for understanding population health.
- This study examines trends in acute and chronic CHD hospitalizations in England and Australia.
Purpose of the Study:
- To analyze hospitalization trends for various coronary heart disease (CHD) subgroups.
- To compare trends in acute coronary syndromes (ACS) versus chronic CHD hospitalizations.
- To identify changes in CHD hospitalization rates in England and Australia between 1996 and 2013.
Main Methods:
- Utilized electronic hospital data for CHD hospitalizations in individuals aged 35-84 years.
- Identified and categorized CHD subgroups: acute coronary syndromes (ACS) and chronic CHD.
- Calculated age-standardized rates and estimated annual changes using age-adjusted Poisson regression.
Main Results:
- From 1996-2013, millions of CHD hospitalizations occurred in England and Australia, predominantly in men.
- During 2004-2013, ACS hospitalization rates declined more steeply than chronic CHD rates in both countries.
- Unstable angina showed the largest subgroup declines, while 'other CHD' rates increased in older adults (75-84 years).
Conclusions:
- Since 2004, all CHD subgroups have seen reduced hospitalization rates, with acute presentations declining faster than chronic ones.
- Chronic CHD constitutes a significant portion of admissions, often involving invasive procedures like angiography or PCI.
- Further focus is needed on managing chronic CHD and optimizing interventions, given slower decline rates and high procedural rates.
Background:
Population-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013.
Methods:
CHD hospitalisations for individuals aged 35-84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and 'other CHD'). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression.
Results:
From 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004-2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: -7.1 %/year, 95% CI -7.2 to -7.0; women: -7.5 %/year, 95% CI -7.7 to -7.3; Australia: men: -8.5 %/year, 95% CI -8.6 to -8.4; women: -8.6 %/year, 95% CI -8.8 to -8.4). Other CHD rates increased in individuals aged 75-84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention.
Conclusions:
Since 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus.
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