Declines have been observed in population based mortality rates from coronary heart disease and acute myocardial infarction (AMI) in many developed countries, including England, since the 1970s. Since 1998 it has been possible to link routinely collected hospital and mortality data for England. Using such a linked dataset, the authors of this paper in the BMJ report trends in event rate and case fatality for AMI and examine the relative contributions of changes in these rates to changes in mortality from AMI by sex and age between 2002 and 2010 in England.

Routine hospital and mortality data were analysed for 840,175 people of all ages, admitted to hospital for AMI or who died suddenly from AMI. The main outcome measures were AMI event, 30 day case fatality, and total mortality rates.

The following findings were reported for 2002 to 2010:

• The age standardised total mortality rate fell by about half, whereas the age standardised event and case fatality rates both declined by about one third.

• In men, the AMI event, case fatality, and total mortality rates declined at an average annual rate of, respectively, 4.8%, 3.6% and 8.6%.

• In women, the corresponding figures were 4.5%, 4.2% and 9.1%,

• Overall, the relative contributions of the reductions in event and case fatality rates to the decline in AMI mortality rate were, respectively, 57% and 43% in men and 52% and 48% in women; however, the relative contributions differed by age, sex, and geographical region.

The researchers conclude “Just over half of the decline in deaths from AMI during the 2000s in England can be attributed to a decline in event rate and just less than half to improved survival at 30 days. Both prevention of AMI and acute medical treatment have contributed to the decline in deaths from acute myocardial infarction over the past decade.”