Trends in cardiovascular mortality and hospitalisations, and potential contribution of inhospital case-fatality rates to changes in national mortality in the Czech Republic 1994-2009

Objectives To analyse trends in cardiovascular disease (CVD) mortality and hospitalisations in the Czech Republic in 1994-2009 and to assess the contribution of inhospital case-fatality rates (CFR) to changes in national CVD mortality. Design National hospitalisation and mortality registers were used to estimate rates of hospital admissions and mortality for hypertension, angina pectoris, acute myocardial infarction (AMI), chronic ischaemic heart disease chronic (IHD), heart failure and stroke. Patients All hospitalisations and deaths from CVD during 1994-2009. Main Outcome Measures Average annual relative changes in age-standardised mortality, hospital admission and inhospital CFR. Results Between 1994 and 2009, 5 409 407 hospital admissions and 930 659 deaths from CVD were recorded. The age-standardised CVD mortality rate fell from 561 to 357 per 100 000 population (mean annual decline 3.1%) but hospitalisation rates remained relatively stable, with 2800 admissions per 100 000 per year (annual decline 0.7%). Inhospital CFR decreased significantly in all examined diagnoses but most rapidly for AMI (by 5.5% per year) and stroke (4.2% per year). The improvements were larger in the younger population than in elderly persons. Calculations based on unlinked mortality and hospitalisation data suggest that a decline in inhospital CFR may explain approximately 24%, 41% and 61% of the decline in national deaths from IHD, AMI and stroke, respectively. Conclusions During the study period, the overall CVD hospitalisation rates remained high but inhospital CFR declined considerably. The improved case-fatality seems to have made a substantial contribution to the decline in the national CVD mortality, particularly for AMI and stroke.