CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

June 9th, 2010

• Decline in MIs Observed Over Past Decade
• Smoke-Free Legislation Reduces MI Admissions in England

Decline in MIs Observed Over Past Decade: Yeh and colleagues reviewed data from 46,000 hospitalizations for MI among more than 3 million people enrolled in the Kaiser Permanente Northern California system. In their paper in the New England Journal of Medicine, they report that from 1999 to 2008 the rate of MI decreased by 24%, resulting in a reduction from 274 cases to 208 cases per 100,000 person-years. The reduction in STEMI cases was even more marked, from 133 cases to 50 cases per 100,000 person-years. Thirty-day mortality was also reduced, which the authors say might have been driven by the drop in STEMI and the lower rate of death from non-STEMI.

In an accompanying perspective, JR Brown and GT O’Connor write that the reduction in MI may be due, in part, to greater use of statins, beta-blockers, ACE inhibitors, and angiotensin-receptor blockers. Because of adverse lifestyles and nutrition, however, the “rate of improvement has slowed down or stopped.” And, they observe, “as a nation, we are not making prevention a priority in our hospitals, clinics, schools, or communities.”

Smoke-Free Legislation Reduces MI Admissions in England: Michelle Sims and colleagues analyzed data on hospital admissions in England to examine the effect of smoke-free legislation on MI. Following implementation of the legislation in July 2007, emergency admissions for MI dropped significantly (by 2.4%) in the next year, resulting in 1,200 fewer admissions, according to the retrospective analysis appearing in the British Medical Journal. The authors conclude: “Given the large number of myocardial infarction events per year, even the relatively small reduction seen in England has important public health benefits.”

Categories: General


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One Response to “• Decline in MIs Observed Over Past Decade
• Smoke-Free Legislation Reduces MI Admissions in England”

  1. William L Blanchet, MD says:
    June 9, 2010 at 10:27 pm

    Reason for decline in MI

    It is almost certain that the reduction in MI was due to a reduction in smoking and an improvement in secondary prevention after the first MI. It is most likely that only a small percentage is due to improved primary prevention. Some of the reduction might be due to underwriting criteria of Kaiser of Northern CA. There is very little that can be attributed to improved primary prevention as Framingham and NCEP-III has been shown to be inadequate in identifying who should be treated prior to the initial MI and I doubt that Kaiser of Northern CA has adopted atherosclerosis imaging in their prevention protocols.

    Competing Interests: I use EBT calcium imaging and carotid ultrasound to help determine who needs to be treated and serial EBT calcium imaging to determine adequacy of medical intervention.