Summary

This report highlights the considerable progress that has been made in addressing the epidemic of coronary heart disease (CHD) in Australia among 40–90 year-olds.

Some major gains include:

  • falling death rates for CHD: by over 30% between 1993–94 and 1999–00;
  • falling onset of major coronary events: 20% decline in incidence rates between 1993–94 and 1999–00;
  • better overall survival from major coronary events: 12–16% decline in case-fatality rates between 1993–94 and 1999–00;
  • fewer hospital admissions for heart attack (a major component of CHD): 12% decline in acute myocardial infarction (AMI) admission rates between 1993–94 and 1999–00;
  • better in-hospital survival for AMI: 17–19% decline in in-hospital case-fatality rates for
  • AMI between 1993–94 and 1999–00;
  • some lower risk factor levels: large declines in tobacco smoking and blood pressure levels since 1980.

Associated large trends:

  • large increases in the prescription of lipid lowering drugs, ACE inhibitors and calcium channel blockers between 1990 and 1998;
  • rapid increase in revascularisation procedures, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), for the treatment of AMI during acute admissions between 1993–94 and 1999–00.

Some unwelcome statistics:

  • rapid increase in prevalence of overweight and obesity and diabetes since 1980;
  • increase in physical inactivity levels since 1997;
  • no change in high blood cholesterol levels since 1980.

Current patterns  (in 1999–00):

  • four in ten adult Australians have two or more major modifiable risk factors for CHD;
  • 48,313 major coronary events, or 132 per day;
  • 50% of these coronary events are fatal; and one in eight AMI patients die in hospital
  • (3,258 patients);
  • 28,002 hospital admissions for AMI. Of these:
    • one in four have cardiac catheterisation;
    • at least one in eight have PCI;
    • one in twenty have CABG;
  • in-hospital case-fatality rates for AMI patients undergoing PCI is 3.5% and CABG 5.4% during acute admissions. This contrasts with overall PCI mortality of 0.8% and overall CABG mortality of 2.1%.

Men and the elderly are most affected (in 1999–00):

  • compared with women, men are:
    • more likely to have multiple risk factors, such as tobacco smoking, physical inactivity, overweight and diabetes;
    • twice as likely to have CHD and die from it;
    • twice as likely to be hospitalised for heart attack;
    • more likely to receive cardiac catheterisation and revascularisation procedures;
  • on the other hand, women are more likely to die during acute hospital admissions for AMI and following CABG and cardiac catheterisation;
  • compared with younger age groups (40–64 year-olds), the elderly (75–90 year-olds) have:
    • worse risk factor levels;
    • substantially higher death rates and incidence rates from CHD;
    • higher admission rates for AMI, but lower rates of revascularisation procedures and cardiac catheterisations;
    • poorer survival after a coronary event.