Trends of in-hospital and out-of-hospital coronary heart disease mortality in French registries during the period 2000 to 2016

Purpose: To estimate trends of in- and out-of-hospital Acute Coronary Events (ACE) mortality rates from 20 0 0 to 2016 and their respective contributions to total ACE mortality in France. Methods: All fatal coronary events occurring between January 20 0 0 and December 2016 were recorded for patients age 35-74 in the French MONICA registries. Trends in age-standardized and crude mortality rates were expressed as annual percentage changes (APC). Results: Between 20 0 0 and 2016, 20,822 fatal events were recorded, of which 69.4% were out-of-hospital. Almost 90% of out-of-hospital deaths occurred at home. Decreases in ACE mortality were greater inside than outside the hospital (APC: -4.3% vs. -2.9% in men; -5.0% vs. -3.2% in women), resulting in a higher contribution of out-of-hospital mortality to overall ACE mortality, from 65.3% in 20 0 0 to 71.4% in 2016. This trend was more pronounced for elderly than younger patients. Conclusions: Between 20 0 0 and 2016, ACE mortality declined in France. This trend was more pronounced for in- than for out-of-hospital. These results underline the importance of out-of-hospital mortality in driving ACE mortality rates and the need to further investigate ways to reduce it. (c) 2022 Elsevier Inc. All rights reserved.

Automated summary

Between 2000 and 2016, both in-hospital and out-of-hospital mortality rates for acute coronary events (ACE) declined in France, with a greater decrease observed in out-of-hospital deaths. The contribution of out-of-hospital mortality to total ACE mortality increased over time, especially among elderly patients. These findings highlight the importance of reducing out-of-hospital mortality.