Shifts in the type and age distribution of coronary heart disease hospitalizations
METHODS: Using nationwide Dutch registers, we assessed time trends between 1998 and 2007 in hospitalization rates of 188,266 acute myocardial infarction (AMI, ICD-9 410), 294,374 unstable angina (ICD-9 411, 413) and 205,649 chronic forms of CHD (ICD-9 412, 414) admissions.
RESULTS: Between 1998 and 2007, the age-standardized CHD hospitalization rate declined from 688 to 545 per 100,000 in men and from 281 to 229 per 100,000 in women. Overall trends masked age differences, with increasing hospitalization rates in very old age (≥85 years). The annual percentage change in hospitalization rates was larger for AMI (men: -5.1%, women: -4.4%) than for unstable angina patients (men: -2.0%, women: -2.0%). For chronic CHD, the average annual percentage change was +0.5% in men and +2.1% in women. The proportion of chronic CHD in the total of CHD admissions increased between 1998 and 2007 from 29% to 36% in men and from 23% to 30% in women. The proportion of AMI decreased from 30% to 24% in men and from 27% to 22% in women.
CONCLUSIONS: An increasing proportion of CHD hospital admissions in the Netherlands was for chronic forms of CHD. The age at hospitalization was pushed towards older age, premature CHD admission declined over time and admission rates at very old age increased.