Focus on: Epidemiology of Cardiovascular Disease in Spain Over the Past 20 Years (I)Epidemiology of Acute Coronary Syndromes in Spain: Estimation of the Number of Cases and Trends From 2005 to 2049Epidemiología del síndrome coronario agudo en España: estimación del número de casos y la tendencia de 2005 a 2049
Section snippets
INTRODUCTION
ACS are the most common and deleterious clinical manifestation of CAD,1, 2 which continues to be the leading cause of death and morbidity in Europe, although the disease burden varies with latitude.3 ACS results in two main discharge diagnoses: unstable angina (UA) and acute myocardial infarction (AMI).
In Spain, CAD mortality rates have steadily decreased in the past 40 years (Fig. 1A). However, the absolute number of CAD deaths increased from 1980 to 2000 and steadily declined thereafter (Fig.
METHODS
Most of the data sources for our estimations and analyses are based on descriptive studies of the ACS burden published in peer-reviewed journals in the past decade. We also used unpublished data from the REGICOR (REgistre GIroní del COR, which stands for Girona Heart Registry) study when no other source was available.13 The study projects the number of AMI and UA cases likely to occur in the population older than 24 years.
RESULTS
Basic Spanish data on incidence, case-fatality, 6-month mortality and readmissions for AMI and UA by sex and age groups are summarized in Table 1. AMI incidence rate was higher in men than in women in all age groups. However, population 28-day case-fatality and 6-month mortality in hospitalized AMI was higher in women than in men for both age groups. The readmission rate in the first 6 months after discharge was around 8% for all sex and age groups except women older than 74 years, in whom it
DISCUSSION
We estimate that the number of population and hospitalized ACS cases in Spain in 2013 will be 115 752 and 85 326, respectively. In a previously published estimate8 these figures were 102 023 and 74 518, respectively, and AMI diagnoses constituted 67% and 55% of these cases, respectively. In the current estimation the AMI figures have increased to 87% of population cases and 82% of hospitalized ACS patients. This change is mostly related to the increasing use and sensitivity of troponins since
CONCLUSIONS
Our results show that ACS cases will increase in Spain in the coming decades. The most significant cause of this increase will be the expansion of the elderly population, which will account for up to 60% of all ACS cases by 2049. The main reduction of 28-day case-fatality has been achieved in hospitalized patients: ACS sudden death remains an unsolved public health problem.
FUNDING
This study has been funded in part by Instituto de Salud Carlos III- RETIC RD12/0042/0061; RD12/0042/0013-FEDER-ERDF (Red de Investigación Cardiovascular-Programa Heracles), FEDER-FIS (PI081327, PI1101801) and Agència de Gestió d’Ajuts Universitaris i de Recerca-Generalitat de Catalunya (2009 SGR 1195).
CONFLICTS OF INTEREST
None declared.
Acknowledgements
The authors are grateful to Susanna Tello, Marta Cabañero, Leny Franco, and Isabel Ramió for project and data management. We appreciate the contribution of Anna Puigdefábregas and Rosa Gispert for providing the cross-linkage of our databases with the Mortality Registry from the Catalan Government. We also appreciate the revision of the English text by Elaine Lilly, Ph.D., of Writer's First Aid.
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