Intended for healthcare professionals


Hypothesis that people with coronary heart disease are living longer is supported

BMJ 1997; 314 doi: (Published 21 June 1997) Cite this as: BMJ 1997;314:1828
  1. P S Watson, Director of acute servicesa,
  2. D C Bensley, Section head, economics and operational research divisionb
  1. a Cambridge and Huntingdon Health Authority, Fulbourn Hospital, Cambridge CBI 5EF
  2. b NHS Executive, Leeds LS2 7UE

    Editor—Luc Bonneux and colleagues argue that the fall in mortality from coronary heart disease in the Netherlands is at least partly due to increasing numbers of survivors of coronary heart disease dying of other disorders.1 Several commentators have estimated that 30-40% of the recent fall in coronary heart disease can be attributed to improved treatment rather than a reduction in the incidence of the disease.2 3

    A similar effect to that reported by Bonneux and colleagues can be seen within the overall category of coronary heart disease in England. In work that was carried out in the former Yorkshire Regional Health Authority we analysed deaths in England within the category coronary heart disease between the years 1975 and 1992. Death rates were standardised, with the European standard population being taken as the reference population. Coronary heart disease is covered in the ninth revision of the International Classification of Diseases by categories 410 (acute myocardial infarction), 411 (other acute and sub-acute forms of coronary heart disease), 412 (old myocardial infarction), 413 (angina pectoris), and 414 (other forms of chronic coronary heart disease). In our analysis we distinguished deaths due to acute disease (410, 411) from deaths due to chronic disease (412, 413, 414).

    Total mortality from coronary heart disease fell by an average of 2.05% a year between 1975 and 1992 (equivalent to a fall of 30% over the whole period). The fall was, however, confined to acute disease. Mortality from chronic disease rose by an average of 1.5% a year over the same period (or 29% overall from 1975 to 1992). In 1975, 21% of all deaths from coronary heart disease were attributed to chronic disease, whereas in 1992 the proportion was 39%.

    These results support the hypothesis that people with coronary heart disease are living longer. This will have important implications for national health policy; the need for treatment services may paradoxically rise despite falls in overall mortality. This is because people will require treatment over a longer time before death eventually occurs; the very success of modern treatments for coronary heart disease will thus fuel the demand for their greater use.


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