Determinants of prehospital coronary heart disease death
Ute Amann1, Margit Heier2,3, Christian Thilo4
1Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. ute.amann@lmu.de.
Insights
High coronary heart disease (CHD) death rates occur before hospital arrival and early in-hospital. Factors like smoking, angina, and living alone increase prehospital CHD death risk, especially in younger patients.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Limited data exists on prehospital and early in-hospital deaths from coronary heart disease (CHD).
- Understanding determinants of early CHD mortality is crucial for improving patient outcomes.
- Population-based registries provide valuable insights into acute cardiovascular events.
Purpose of the Study:
- To comprehensively describe coronary heart disease (CHD) cases.
- To analyze patient characteristics associated with prehospital death.
- To identify risk factors for early mortality in myocardial infarction (MI) patients.
Main Methods:
- Analysis of a population-based myocardial infarction (MI) registry in Augsburg, Germany.
- Inclusion of 12,572 CHD cases (25-74 years) and 4,754 CHD cases (75-84 years).
- Multivariable logistic regression to identify determinants of prehospital death versus 28-day survival.
Main Results:
- High rates of prehospital (13.6%-26.6%) and early in-hospital (7.5%-15.8%) CHD deaths were observed in both age groups.
- Increasing age, smoking, previous MI, angina pectoris, and stroke were associated with higher prehospital death risk.
- Living alone and diabetes were linked to prehospital death in younger patients (25-74 years), while COPD was a factor in older patients (75-84 years).
Conclusions:
- Prehospital and early in-hospital case fatality for CHD remains high.
- Classical cardiac risk factors significantly influence prehospital mortality.
- Social factors, such as living alone, and comorbidities like diabetes and COPD, play a notable role in early CHD deaths, particularly in specific age demographics.
Abstract:
Limited data on prehospital and early in-hospital coronary heart disease (CHD) deaths is available. Aims of this study were to provide a comprehensive description on CHD cases and to analyse determinants of prehospital death. From a population-based myocardial infarction (MI) registry in Augsburg, Germany we included 12,572 CHD cases aged 25-74 years between 2003-2017 and 4754 CHD cases aged 75-84 years between 2009-2017. Multivariable logistic regression models were conducted to identify patient characteristics associated with prehospital death compared to 28-day survival. In patients aged 25-74 years, 1713 (13.6%) died prehospital, 941 (7.5%) died within the first 24 h in-hospital and 560 (4.5%) died within the 2nd and 28th day after the acute event; in patients aged 75-84 years the numbers were 1263 (26.6%), 749 (15.8%) and 329 (6.9%), respectively. In both age groups increasing age, actual smoking or nicotine abuse, previous MI, angina pectoris and previous stroke were more likely and hypertension was less likely in cases, who died prehospital compared to 28-day survivors. For example, in the 25-74 years old we revealed an adjusted odds ratio (OR) of 4.53 (95% CI 3.84-5.34) for angina pectoris and an OR of 0.69 (95% CI 0.57-0.85) for hypertension. In cases aged 25-74 years, an association of living alone (OR 1.26, 95% CI 1.06-1.49) and diabetes (OR 1.20, 95% CI 1.03-1.41) with prehospital death was found. Whereas in cases aged 75-84 years, chronic obstructive pulmonary disease (OR 2.20, 95%CI 1.69-0.2.85) was associated with prehospital death. In summary, we observed high prehospital and early in-hospital case fatality. Besides classical cardiac risk factors, the impact of living alone on prehospital death was more important in patients aged 25-74 years than in older patients.
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