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

https://doi.org/10.1016/j.rec.2013.01.018Get rights and content

Abstract

Acute coronary syndromes are a leading cause of mortality, morbidity, and health care cost in Spain. The aims of this report are to estimate the number of acute coronary syndromes cases in the Spanish population in 2013 and 2021, and the trend from 2005 to 2049. We estimated the number of acute coronary syndromes cases by sex and Spanish autonomous community using data from the most updated population and hospital registries. We present the estimated number of cases with an exact 95% confidence interval, assuming that the number of cases followed a Poisson distribution. There will be 115 752 acute coronary syndromes cases in Spain in 2013 (95% confidence interval, 114 822-116 687). Within 28 days, 39 086 of these patients will die and 85 326 will be hospitalized. Non-ST segment elevation acute coronary syndromes (56%) and acute myocardial infarction (81%) will be the most common admission and discharge diagnoses, respectively. We estimate approximately 109 772 acute coronary syndromes cases in 2021 (95% confidence interval, 108 868-110 635). The trend of acute coronary syndromes cases from 2005 to 2049 will stabilize in the population aged 25 to 74 years, but increase in those older than 74 years. Due to population aging, the number of acute coronary syndrome cases will increase overall until 2049, it may stabilize in the population aged <75 years. The acute coronary syndromes case-fatality has decreased in hospitalized patients but the proportion of sudden deaths remains unchanged.

Resumen

El síndrome coronario agudo es una de las principales causas de mortalidad, morbilidad y coste sanitario en España. Los objetivos del presente estudio son estimar el número de casos de síndrome coronario agudo en España en 2013 y 2021, así como la tendencia en el periodo 2005–2049. Se estimó el número de casos de síndrome coronario agudo según el sexo y la comunidad autónoma utilizando datos de los registros más actualizados. Se presenta el número de casos estimado y el intervalo de confianza exacto del 95% asumiendo una distribución de Poisson. En 2013 habrá unos 115.752 (intervalo de confianza del 95%, 114.822-116.687) casos de síndrome coronario agudo en España. De estos, 39.086 morirán durante los primeros 28 días y 85.326 serán hospitalizados. Los diagnósticos más comunes al ingreso y al alta serán síndrome coronario agudo sin elevación del ST (56%) e infarto agudo de miocardio (81%) respectivamente. En 2021 el número de casos de síndrome coronario agudo se situará en 109.772 (intervalo de confianza del 95%, 108.868-110.635). La tendencia en el número de casos de síndrome coronario agudo entre 2005 y 2049 tenderá a estabilizarse en la población de 25 a 74 años y aumentar significativamente en la población mayor de 74 años. Los casos de síndrome coronario agudo aumentarán hasta el año 2049 debido al envejecimiento de la población, aunque parece estabilizarse en la población menor de 75 años. La letalidad del síndrome coronario agudo entre los pacientes hospitalizados se ha reducido, pero la proporción de muertes súbitas se mantiene sin cambios.

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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