In Finland since the 1980s, coronary heart disease mortality has declined more than might be predicted by risk factor reductions alone. The aim of this study was to assess how much of the decline could be attributed to improved treatments and risk factor reductions. The authors used the cell-based IMPACT mortality model to synthesize effectiveness of treatments and risk factor reductions with data on treatments administered to patients and trends in cardiovascular risk factors in the population. Cardiovascular risk factors were measured in random samples of patients in 1982 (n=8,501) and 1997 (n=4,500). Mortality and treatment data were obtained from the National Causes of Death Register, Hospital Discharge Register, social insurance data, and medical records. Estimated and observed changes in coronary heart disease mortality were used as main outcome measures. Between 1982 and 1997, coronary heart disease mortality rates declined by 63%, with 373 fewer deaths in 1997 than expected from baseline mortality rates in 1982. Improved treatments explained approximately 23% of the mortality reduction, and risk factors explained some 53-72% of the reduction. These findings highlight the value of a comprehensive strategy that promotes primary prevention programs and actively supports secondary prevention. It also emphasizes the importance of maximizing population coverage of effective treatments.
"Studies from England and Wales , Scotland , Australia , Ireland  and Canada  have attributed 40-44 per cent of the decline to treatment effects and 48-58 per cent to population risk factor reductions. In Finland, a similar estimation attributed 23 per cent of the reduction to treatment effects and 53-72 per cent to risk factor reduction between 1982 and 1997 . In international comparison the proportion attributed to risk factor reduction is unusually large. "
[Show abstract][Hide abstract] ABSTRACT: Growing mortality differences between socioeconomic groups have been reported in both Finland and elsewhere. While health behaviours and other lifestyle factors are important in contributing to health differences, some researchers have suggested that some of the mortality differences attributable to lifestyle factors could be preventable by health policy measures and that health care may play a role. It has also been suggested that its role is increasing due to better results in disease prevention, improved diagnostic tools and treatment methods. This study aimed to assess the impact of mortality amenable to health policy and health care on increasing income disparities in life expectancy in 1996-2007 in Finland.
The study data were based on an 11% random sample of Finnish residents in 1988--2007 obtained from individually linked cause of death and population registries and an oversample of deaths. We examined differences in life expectancy at age 35 (e35) in Finland. We calculated e35 for periods 1996-97 and 2006-07 by income decile and gender. Differences in life expectancies and change in them between the richest and the poorest deciles were decomposed by cause of death group.
Overall, the difference in e35 between the extreme income deciles was 11.6 years among men and 4.2 years among women in 2006-07. Together, mortality amenable to health policy and care and ischaemic heart disease mortality contributed up to two thirds to socioeconomic differences. Socioeconomic differences increased from 1996-97 by 3.4 years among men and 1.7 years among women. The main contributor to changes was mortality amenable through health policy measures, mainly alcohol related mortality, but also conditions amenable through health care, ischaemic heart disease among men and other diseases contributed to the increase of the differences.
The results underline the importance of active health policy and health care measures in tackling socioeconomic health inequalities.
BMC Public Health 09/2013; 13(1):812. DOI:10.1186/1471-2458-13-812 · 2.26 Impact Factor
"The biggest contributions came from treatments delivered in the community for secondary prevention, hypertension and heart failure plus therapies for acute coronary syndromes. The effect of treatment on CHD mortality reduction are thus broadly similar to that reported for Iceland, Sweden and Finland  but lower than that reported for North America  and Europe ,  in studies using the same methodology. "
[Show abstract][Hide abstract] ABSTRACT: In Tunisia, Cardiovascular Diseases are the leading causes of death (30%), 70% of those are coronary heart disease (CHD) deaths and population studies have demonstrated that major risk factor levels are increasing.
To explain recent CHD trends in Tunisia between 1997 and 2009.
Published and unpublished data were identified by extensive searches, complemented with specifically designed surveys.
Data were integrated and analyzed using the previously validated IMPACT CHD policy model. Data items included: (i)number of CHD patients in specific groups (including acute coronary syndromes, congestive heart failure and chronic angina)(ii) uptake of specific medical and surgical treatments, and(iii) population trends in major cardiovascular risk factors (smoking, total cholesterol, systolic blood pressure (SBP), body mass index (BMI), diabetes and physical inactivity).
CHD mortality rates increased by 11.8% for men and 23.8% for women, resulting in 680 additional CHD deaths in 2009 compared with the 1997 baseline, after adjusting for population change. Almost all (98%) of this rise was explained by risk factor increases, though men and women differed. A large rise in total cholesterol level in men (0.73 mmol/L) generated 440 additional deaths. In women, a fall (-0.43 mmol/L), apparently avoided about 95 deaths. For SBP a rise in men (4 mmHg) generated 270 additional deaths. In women, a 2 mmHg fall avoided 65 deaths. BMI and diabetes increased substantially resulting respectively in 105 and 75 additional deaths. Increased treatment uptake prevented about 450 deaths in 2009. The most important contributions came from secondary prevention following Acute Myocardial Infarction (AMI) (95 fewer deaths), initial AMI treatments (90), antihypertensive medications (80) and unstable angina (75).
Recent trends in CHD mortality mainly reflected increases in major modifiable risk factors, notably SBP and cholesterol, BMI and diabetes. Current prevention strategies are mainly focused on treatments but should become more comprehensive.
PLoS ONE 05/2013; 8(5):e63202. DOI:10.1371/journal.pone.0063202 · 3.23 Impact Factor
"Although this seems reasonable, further development work is clearly needed . Overall, it is also reassuring that a diverse range of countries have demonstrated similar results when the IMPACT CHD model was applied     . "
[Show abstract][Hide abstract] ABSTRACT: Background:
Consistent declines in coronary heart disease (CHD) death rates have been previously observed in Ireland since 1985.
Aims & methods:
To use the previously validated Irish IMPACT CHD mortality model to further examine the subsequent CHD mortality falls from 1985 through to 2006, and to determine the contribution of risk factor changes and "evidence based" treatments to this decline by age and gender.
CHD mortality rates fell by 68% in men (63% in 65-84 years) and by 69% in women (66% in 65-84 years). This resulted in approximately 6450 fewer CHD deaths than if mortality rates had not changed. Overall, approximately 40% (38% in men; 45% in women) of the CHD mortality decline could be attributed to improvements in treatment uptake, particularly secondary prevention (12%), angina (9%), and heart failure therapies (8%). Approximately 48% of the CHD mortality decline was attributable to risk factor improvements (54% in men; 37% in women); the biggest contributions came from falls in population systolic pressure (28%), cholesterol (24%), and physical inactivity levels (10%). Negative trends in diabetes and obesity levels generated an estimated 17% additional CHD deaths. The largest benefits from improvements in risk factors were seen in men aged 25-64 years, while the greatest treatment benefits occurred in women aged 65-84 years. The model explained approximately 88% of the observed mortality declines.
Falls in CHD mortality have continued in both sexes in Ireland, but with notable gender and age differences. The continued increase in diabetes and obesity levels is particularly worrying.
International journal of cardiology 03/2013; 168(3). DOI:10.1016/j.ijcard.2013.03.007 · 4.04 Impact Factor
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