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Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: linked national database study

BMJ 2012; 344 doi: (Published 25 January 2012) Cite this as: BMJ 2012;344:d8059
  1. Kate Smolina, DPhil candidate1,
  2. F Lucy Wright, cardiovascular epidemiologist2,
  3. Mike Rayner, director3,
  4. Michael J Goldacre, professor of public health1
  1. 1Unit of Health-Care Epidemiology, Department of Public Health, Headington, Oxford OX3 7LF, UK
  2. 2Cancer Epidemiology Unit, Department of Public Health, Oxford
  3. 3British Heart Foundation Health Promotion Research Group, Department of Public Health, Oxford
  1. Correspondence to: K Smolina kate.smolina{at}
  • Accepted 3 November 2011


Objective To report trends in event and case fatality rates for acute myocardial infarction and examine the relative contributions of changes in these rates to changes in total mortality from acute myocardial infarction by sex, age, and geographical region between 2002 and 2010.

Design Population based study using person linked routine hospital and mortality data.

Setting England.

Participants 840 175 people of all ages who were admitted to hospital for acute myocardial infarction or died suddenly from acute myocardial infarction.

Main outcome measures Acute myocardial infarction event, 30 day case fatality, and total mortality rates.

Results From 2002 to 2010 in England, the age standardised total mortality rate fell by about half, whereas the age standardised event and case fatality rates both declined by about one third. In men, the acute myocardial infarction event, case fatality, and total mortality rates declined at an average annual rate of, respectively, 4.8% (95% confidence interval 3.0% to 6.5%), 3.6% (3.4% to 3.7%), and 8.6% (5.4% to 11.6%). In women, the corresponding figures were 4.5% (1.7% to 7.1%), 4.2% (4.0% to 4.3%), and 9.1% (4.5% to 13.6%). Overall, the relative contributions of the reductions in event and case fatality rates to the decline in acute myocardial infarction mortality rate were, respectively, 57% and 43% in men and 52% and 48% in women; however, the relative contributions differed by age, sex, and geographical region.

Conclusions Just over half of the decline in deaths from acute myocardial infarction during the 2000s in England can be attributed to a decline in event rate and just less than half to improved survival at 30 days. Both prevention of acute myocardial infarction and acute medical treatment have contributed to the decline in deaths from acute myocardial infarction over the past decade.


  • Leicester Gill and Matt Davidson from the Unit of Health-Care Epidemiology and the Oxford Record Linkage Study built the linked file and extracted the data for analysis.

  • Contributors: KS conceived the study and is guarantor. KS, MJG, FLW, and MR developed the study design. KS undertook the data analysis and drafted the paper. All authors contributed to the interpretation of the data and revision of the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding: KS is funded by the Rhodes Trust. FLW is funded by the Medical Research Council. MR is funded by the British Heart Foundation. MJG is partly funded by the National Institute for Health Research; the institute funded the work to build the English national linked dataset of hospital episode statistics and Office for National Statistics records. The funding bodies had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed in this paper are those of the authors and not necessarily those of the funding bodies.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no spouses, partners, or children have financial relationships that may be relevant to the submitted work; and no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: The building and analysis of the linked dataset were approved by Central and South Bristol research ethics committee (No 04/Q2006/176).

  • Data sharing: Data from hospital episodes statistics and the Office for National Statistics can be obtained from the NHS Information Centre at

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