Having it both ways: Prevention and treatment

Each week, we select an article from an influential journal that has broad implications for healthcare and has just become available for free online.

People who follow healthcare, even casually, are probably aware that fewer people die from heart attacks now than in earlier times. If that’s all you need to know, then you can skip this week’s article.

However, would you be amazed to know that the death rate from heart attack in England decreased by half in only 8 years (2002 to 2010)? I was, and I wanted to know how they did it.

They did it using both prevention and treatment. Just over half of the decrease is attributable on statistical grounds to fewer people having heart attacks; the balance (not quite half) is attributable to a higher proportion of people surviving their heart attacks. Because this a statistical study, the authors can’t say exactly which preventive methods or treatment methods had the most effect. Presumably, less smoking, better diets, more exercise, and statins all helped reduce the number of heart attacks. And more effective first responders, anticlotting treatments, stents, and better CCUs all contributed to the reduced death rate once the heart attacks happened.

However you choose to tell the story, the outcome in less than half a generation is remarkable. Heart attack is still a justly feared event, but it’s not the monster it used to be.

Check out the abstract below or go right to the free full text.

PubMed Citation

BMJ. 2012 Jan 25;344:d8059. doi: 10.1136/bmj.d8059.

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

Smolina K, Wright FL, Rayner M, Goldacre MJ.


Unit of Health-Care Epidemiology, Department of Public Health, Headington, Oxford, UK. kate.smolina@spc.ox.ac.uk



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.


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




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


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


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.


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.

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