Deaths Following Ischemic Heart Disease Events
What is the proportion of fatal ischemic heart disease (IHD) events, and where do they occur?
With the use of individual person linkage of national data sets, the authors identified all IHD hospitalizations and deaths in New Zealand from December 2008 to November 2010. Outcome measures were proportions of people: 1) hospitalized with IHD and alive at 28 days, 2) hospitalized with IHD and died within 28 days, 3) hospitalized for a non-IHD cause and died from IHD within 28 days, and 4) not hospitalized and died from IHD. Three event definitions were used (broad-balanced: IHD deaths and IHD hospitalizations, unbalanced: IHD deaths and myocardial infarction [MI] hospitalizations, and narrow-balanced: MI deaths and MI hospitalizations).
About 37,867 IHD hospitalizations and 9,409 IHD deaths were identified using the broad IHD definition. Approximately one-quarter of IHD events were fatal: 4% were deaths within 28 days of an IHD hospitalization, 6% were IHD deaths within 28 days of a non-IHD hospitalization, and 14% were nonhospitalized IHD deaths. Using different event definitions, overall case fatality varied from 24–25% (broad and narrow balanced) to 37–39% (unbalanced), whereas the proportion of all deaths that were nonhospitalized was approximately 60%. Forty percent of deaths were first-ever events that manifested as nonhospitalized IHD deaths.
About one-quarter of IHD events are fatal. About 60% of all IHD deaths occur out of the hospital, and of these, 60% are in people not previously hospitalized for IHD.
Most IHD deaths occur before a person seeks medical attention. In this study, 40% of IHD deaths were first-ever events that had manifested as nonhospitalized deaths. This underscores the importance of appropriate screening and efforts at primary prevention. There appear to be missed opportunities in proper identification of patients likely to die within 28 days due to IHD among patients admitted for non-IHD hospitalization.
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