Key result
MI mortality in Singapore declines ~7% annually alongside falling incidence over a decade.
Why the study?
Many Asian countries lack nationwide systematically-collected and standardized data on myocardial infarction to accurately document coronary heart disease burden.
Observational (n=13,048)
Yes
Effect estimate: average decline of 6.5% per year (95% CI -3.9% to -9.1%)
Over a 10-year period in Singapore, MI mortality declined significantly more than MI incidence, suggesting a stronger immediate impact of therapeutic programs compared to primary prevention.
May indicate therapeutic gains outpacing prevention for MI in Singapore; leaves open generalizability and causal inference for prospective study.
INTRODUCTION AND METHODS: Cardiovascular diseases have progressively increased in importance as a major contributor of morbidity and mortality in Asia. However, many countries in Asia do not have nationwide systematically-collected and standardised data on myocardial infarction (MI). To accurately document the extent of atherosclerotic coronary heart disease in Singapore, a nationwide myocardial infarct registry was established in the mid-1986. Possible myocardial infarct events were identified through daily national lists of cardiac enzymes, hospital discharge codes, mortuary records and the national death registry. Data obtained from clinical history, cardiac enzymes and 12-lead electrocardiogram Minnesota codes were entered into an algorithm based on the WHO MONICA study. Cases identified as "definite" MI were included in the decade's review for this study. RESULTS: From 1988 to 1997, 13,048 myocardial infarct events were diagnosed with 3367 deaths. There was a 39.1% decline in mortality, with an average decline of 6.5% per year [95% confidence intervals (CI), -3.9% to -9.1%]. However, the decline in incidence was only 20.8% with an average decline of 2.4% per year (95% CI, -6.6% to -1.2%). The highest incidence and mortality rates for both genders were seen in the Indians, followed by the Malays and the Chinese. CONCLUSION: Over 10 years, from 1988 to 1997, we documented a significant fall in mortality from MI in Singapore. There was a smaller decline in the incidence of infarction. Singapore implemented a National Healthy Lifestyle Programme in 1992 as a 10-year effort. The disparity in the incidence and mortality may suggest that a more dramatic and immediate impact has taken place in mortality through therapeutic programmes; primary preventive programmes would be more difficult to evaluate and have a more gradual impact. Only with continual accurate data collection through the whole country, over a much longer period, can the relative value of preventive and therapeutic programmes in coronary heart disease be assessed.
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Tan et al. (2002) conducted an observational in Myocardial infarction (n=13,048). Time period (1988 to 1997) was evaluated on Mortality from myocardial infarction (average decline of 6.5% per year, 95% CI -3.9% to -9.1%). Over a 10-year period in Singapore, mortality from myocardial infarction declined by an average of 6.5% per year (95% CI, -3.9% to -9.1%), while incidence declined by 2.4% per year.
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