Päivi Kärjä-Koskenkari

Trends in coronary events in Finland during 1983–1997; The FINAMI study

AIMS To analyse the trends in incidence, recurrence, case fatality, and treatments of acute coronary events in Finland during the 15-year period 1983-97. METHODS AND RESULTS Population-based MI registration has been carried out in defined geographical areas, first as a part of the FINMONICA Project and then continued as the FINAMI register. During the study period, 6501 coronary heart disease (CHD) events were recorded among men and 1778 among women aged 35-64 years. The CHD mortality declined on average 6.4%/year (95% confidence interval -5.4, -7.4%) among men and 7.0%/year (-4.7, -9.3%) among women. The mortality from recurrent events declined even more steeply, 9.9%/year (-8.3, -11.4%) among men and 9.3%/year (-5.1, -13.4%) among women. The proportion of recurrent events of all CHD events also declined significantly in both sexes. Of all coronary deaths, 74% among men and 61% among women took place out-of-hospital. The decline in 28-day case fatality was 1.3%/year (-0.3, -2.3%) among men and 3.1%/year (-0.7, -5.5%) among women. CONCLUSIONS The study period was characterized by a marked reduction in the occurrence of recurrent CHD events and a relatively modest reduction in the 28-day case fatality. The findings suggest that primary and secondary prevention have played the main roles in the decline in CHD mortality in Finland.

Decline in Out-of-Hospital Coronary Heart Disease Deaths Has Contributed the Main Part to the Overall Decline in Coronary Heart Disease Mortality Rates Among Persons 35 to 64 Years of Age in Finland The FINAMI Study

Background—Out-of-hospital deaths constitute the majority of all coronary heart disease (CHD) deaths and are therefore of considerable public health significance. Methods and Results—We used population-based myocardial infarction register data to examine trends in out-of-hospital CHD deaths in Finland during 1983 to 1997. We included in out-of-hospital deaths also deaths in the emergency room and all deaths within 1 hour after the onset of symptoms. Altogether, 3494 such events were included in the analyses. The proportion of out-of-hospital deaths of all CHD deaths depended on age and gender. In the age group 35 to 64 years, it was 73% among men and 60% among women. These proportions did not change during the study. The annual average decline in the age-standardized out-of-hospital CHD death rate was 6.1% (95% CI, −7.3, −5.0%) among men and 7.0% (−10.0, −4.0%) among women. These declines contributed among men 70% and among women 58% to the overall decline in CHD mortality rate. In all, 58% of the male and 52% of the female victims of out-of-hospital CHD death had a history of symptomatic CHD. Among men with a prior history of myocardial infarction, the annual average decline in out-of-hospital CHD deaths was 5.3% (−7.2, −3.2%), and among men without such history the decline was 2.9% (−4.4, −1.5%). Among women, the corresponding changes were −7.8% (−14.2, −1.5%) and −4.5% (−8.0, −1.0%). Conclusions—The decline in out-of-hospital CHD deaths has contributed the main part to the overall decline in CHD mortality rates among persons 35 to 64 years of age in Finland.

Aging of the population may not lead to an increase in the numbers of acute coronary events: a community surveillance study and modelled forecast of the future

Objective To examine the incidence, mortality and case fatality of acute coronary syndrome (ACS) in Finland during 1993–2007 and to create forecasts of the absolute numbers of ACS cases in the future, taking into account the aging of the population. Design Community surveillance study and modelled forecasts of the future. Setting and methods Two sets of population-based coronary event register data from Finland (FINAMI and the National Cardiovascular Disease Register (CVDR)). Bayesian age–period–cohort (APC) modelling. Participants 24 905 observed ACS events in the FINAMI register and 364 137 in CVDR. Main outcome measures Observed trends of ACS events during 1993–2007, forecasted numbers of ACS cases, and the prevalence of ACS survivors until the year 2050. Results In the FINAMI register, the average annual declines in age-standardised incidence of ACS were 1.6% (p<0.001) in men and 1.8% (p<0.001) in women. For 28-day case fatality of incident ACS, the average annual declines were 4.1% (p<0.001) in men and 6.7% (p<0.001) in women. Findings in the country-wide CVDR data were consistent with the FINAMI register. The APC model, based on the CVDR data, suggested that both the absolute numbers of ACS events and the prevalence of ACS survivors reached their peak in Finland around 1990, have declined since then, and very likely will continue to decline until 2050. Conclusions The ACS event rates and absolute numbers of cases have declined steeply in Finland. The declining trends are likely to continue in the future despite the aging of the population.

Prognosis of acute coronary events is worse in patients living alone: the FINAMI myocardial infarction register

Background Single living has been associated with a worse prognosis of acute coronary syndrome (ACS). We aimed to study the relation of sociodemographic characteristics to the morbidity, mortality, and case fatality (CF) of ACS in a large population-based ACS register. Methods The population-based FINAMI myocardial infarction register recorded 15,330 cases of ACS among persons aged 35–99 years in Finland in 1993–2002. Record linkage with the files of Statistics Finland provided information on sociodemographic characteristics (marital status, household size). Results ACS incidence and 28-day mortality rate were higher in unmarried men and women in all age groups. The prehospital CF of incident ACS was higher in single living and/or unmarried 35–64-year-old people. The 28-day CF was 26% (95% confidence interval, CI, 24–29%) in married men, 42% (95% CI 37–47%) in men who had previously been married, and 51% (95% CI 46–57%) in never-married men. Among women, the corresponding figures were 20% (95% CI 15–24%), 32% (95% CI 25–39%), and 43% (95% CI 31–56%). Most of these CF differences were apparent already at the prehospital phase. The only difference in treatment was that middle-aged men living alone or unmarried received thrombolysis less often. The disparities in ACS morbidity and mortality by marital status tended to widen during the study period. Conclusions Single living and/or being unmarried increases the risk of having a heart attack and worsens its prognosis both in men and women regardless of age. Most of the excess mortality appears already before the hospital admission and seems not to be related to differences in treatment of ACS.

A method to determine diastolic blood pressure based on pressure pulse propagation in the electronic palpation method

Evaluates the accuracy of the pulse transit time method for determining diastolic blood pressure using intra-arterial blood pressure as a reference. First, the paper describes the method. Then it discusses two sets of measurements which were carried out to determine the accuracy of the method with cardiac operated patients and healthy young volunteers. The thus obtained accuracies were +0.7 mmHg /spl plusmn/ 10.7 mmHg for the cardiac patients and -6.6 mmHg /spl plusmn/ 10.5 mmHg for the young volunteers, respectively.

Systolic blood pressure accuracy enhancement in the electronic palpation method using pulse waveform

This paper presents and evaluates some methods to improve the accuracy of systolic blood pressure measurements based on the pulse waveform. A set of measurement was carried out with elderly cardiac surgery patients. The experiments comprised two to five measurements per patient, each including a one-minute follow-up, after which the cuff was slowly inflated over the systolic blood pressure. Systolic pressure errors were defined and correlations with other specific values, like pressure rise time, pulse wave velocity, systolic pressure, augmentation, arm circumference and body mass index were calculated. These indices may he affected by arterial stiffness, a common source of errors in blood pressure measurements. With a value of -0.52, the character which correlated best with systolic error was found to be the peak level of the first derivative of the pressure signal. Also rise time (10%...90%) exhibits a moderate correlation, +0.49. On the other hand, pulse wave velocity, body mass index, cardiac output, peripheral and intra-arterial temperature do not seem to correlate with systolic blood pressure error. It is also noteworthy that indices describing the rising edge of the pressure pulse correlated better with systolic pressure error than those describing the failing part. Using the first derivative peak level method, the accuracy improved slightly.

The effect of the venous pressure to the blood pressure signals measured by the electronic palpation method

It was shown, that in 52 percent of blood pressure measurements made with an inflating cuff, the linear increase in venous blood pressure was also increasing with palpated signals amplitude linearly. It was found that the strong increase in venous pressure was not the reason for increased blood pressure amplitudes. The method for determining venous pressure by an electronic method was considered. The electronic palpation method can be used for venous pressure measurement if it is made with an inflating cuff and secondly with a deflating cuff. At the start of the measurements, blood pressure should be monitored in the absence of cuff pressure for determining the venous pressure at rest.