Trends in event rates of first and recurrent, fatal and non-fatal acute myocardial infarction, and 28-day case fatality in the Northern Sweden MONICA area 1985-98

Aims: This study looks at trends in event rates of first and recurrent fatal and non-fatal acute myocardial infarction (AMI), and 28-day case fatality in AMI within the Northern Sweden MONICA area. Methods: The AMI event rate and 28-day case fatality in acute myocardial infarction were registered between 1985 and 1998 in the two northernmost counties in Sweden in men and women in the age groups 25-64 years. Results: Statistically significant mean annual decreases were found in fatal and non-fatal combined event rates (4% for men and 2.3%, for women), fatal event rate (7.1% for men and 5% for women), fatal first acute myocardial infarction (7.1% for men and 4.4% for women), and both non-fatal and fatal recurrent AMI for both sexes (5.5% for both men and women for non-fatal and, for fatal AMI, 7.1% for men and 5.7% for women). In addition, there were significant decreases for men in non-fatal event rate (2.4%), and non-fatal first AMI (1.4%). The decreases in case fatality were small, especially so for women. Conclusions: There is a trend of decreasing event rates in both fatal and non-fatal AMI, and first and recurrent AMI, most pronounced for men. The case fatality also decreased although to a lesser degree, suggesting that the decreasing mortality in ischaemic heart disease mainly is caused by reduced disease incidence.