Trends and inequalities in short-term acute myocardial infarction case fatality in Scotland, 1988-2004

We used linked hospital discharge and death records covering the Scottish population (5.1 million). Between 1988 and 2004, 178,781 of 372,349 patients with a first AMI died on the day of the event (Day0 CF) and 34,198 died within 28 days after surviving the day of their AMI (Day1-27 CF).Age-standardized Day0 CF at 30+ years decreased from 51% in 1988-90 to 41% in 2003-04. Day1-27 CF decreased from 29% to 18% over that period. Socioeconomic inequalities in Day0 CF existed for both sexes and persisted over time. The odds of case fatality for men aged 30-59 living in the most deprived areas in 2000-04 were 1.7 (95%CI: 1.3-2.2) times as high as in the least deprived areas and 1.9 (1.1-3.2) times as high for women. There was little evidence of socioeconomic inequality in Day1-27 CF in men or women. After adjustment for socioeconomic deprivation, significant geographic variation still remained for both CF definitions.A high proportion of AMI incidents in Scotland result in death on the day of the first event; many of these are sudden cardiac deaths. Short-term CF has improved, perhaps reflecting treatment advances and reductions in first AMI severity. However, persistent socioeconomic and geographic inequalities suggest these improvements are not uniform across all population groups, emphasizing the need for population-wide primary prevention.Declining ischemic heart disease (IHD) mortality in the world's developed regions can be partly explained by decreasing incidence of the disease, suggesting effective primary prevention measures, and partly by reduced case fatality rates, reflecting improved primary and secondary care [1]. Downward trends in IHD mortality have been seen in Scotland [2], but to a lesser extent than in other Western European countries, resulting in Scotland having one of the worst IHD mortality rates in the region [3]. Incidence [2] and case fatality [4-7] from the disease have also been declining rapidly in Scotland, but its fatal and nonfatal event r