WWW-publications from the WHO MONICA Project
December 2001
Markku Mähönen1, Zygimantas Cepaitis1and Kari Kuulasmaa1 for the WHO MONICA Project2
1 MONICA Data Centre, National Public Health Institute, Helsinki, Finland
2 Annex: Sites and key personnel of the WHO MONICA
Project
This document updates the unpublished reports: :
Thanks are due to Hugh Tunstall-Pedoe for thoughtful comments.
The MONICA Centres are funded predominantly by regional and national governments, research councils, and research charities. Coordination is the responsibility of the World Health Organization (WHO), assisted by local fund raising for congresses and workshops. WHO also supports the MONICA Data Centre (MDC) in Helsinki. Not covered by this general description is the ongoing generous support of the MDC by the National Public Health Institute of Finland, and a contribution to WHO from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA for support of the MDC and the Quality Control Centre for Event Registration in Dundee. The completion of the MONICA Project is generously assisted through a Concerted Action Grant from the European Community. Likewise appreciated are grants from ASTRA Hässle AB, Sweden, Hoechst AG, Germany, Hoffmann-La Roche AG, Switzerland, the Institut de Recherches Internationales Servier (IRIS), France, and Merck & Co. Inc., New Jersey, USA, to support data analysis and preparation of publications.
This data book provides detailed descriptive statistics for each MONICA population on the acute coronary care (ACC) data of the MONICA coronary event registers for the years 1981-1995. The data book consists of summary tables of the most important items for age group 35-64. The data are tabulated in three-year time periods.
The report is based on the data which the MONICA Data Centre (MDC) has received from the MONICA Collaborating Centres (MCCs) on acute coronary care (Form 02) and on coronary events (Form 01).
In the specifications of the calculations for this report the names of the data items in the Core Data Transfer Format - Coronary Events (1) and Core Data Transfer Format - Acute Coronary Care (1) have been used. The terminology used is this report follows that developed for MONICA event registration in the MONICA manual (1), with later refinements in the collaborative publications (2).
The report considers the Reporting Unit Aggregates (RUAs) which are seen as potential candidates for units of analysis of the MONICA ACC data. The RUAs, their abbreviations and Reporting Units (RUs) are listed in Table 1. In ACC data analyses, all RUs within each MCC are grouped together except in GER-EGE, where ACC data were collected in RU19 only. This report considers altogether 32 RUAs.
Time periods considered in this report from each population are shown in Table 1.
Individual records have been excluded from the analysis if:
Table 2 presents the number of events included in or excluded from the other tables of the data book.
Non-fatal DIACAT 2 events have been excluded from the tables since this category is very heterogeneous and varies between the RUAs. DIACAT 3 events were included in Table 5 only.
Standardized methods for data collection were defined for the MONICA Project, and particular attention was paid on training of the personnel involved in data collection and on processing and on quality control. The quality of the registered data is reported in the separate quality assessment reports for acute coronary care data (3) and for coronary event registration data (4). No data were excluded from this data book because of problems in the quality. Therefore, the quality assessment reports should be consulted before using the data presented.
The following notation was used:
Diagnostic categories:
Events were also categorized by previous MI or CHD using the variables PREMI and HISIHD:
In many tables the events in several diagnostic categories were combined using the following definition for a coronary event:
Men and women were tabulated separately, and the variables were tabulated separately by previous MI or previous CHD when feasible. The data were not adjusted for age, since acute coronary care and other medical care of CHD in this age group is not dependent on age.
Table 1 presents the RUAs and time periods considered in this report. Table 2 presents the number of events included in and excluded from the tables and the exclusion criteria.
Table 3a and 3b present the time between the onset of symptoms and medical presence in fatal (F1+F2+F9) events, and in nonfatal definite MI (NF1) events, respectively. Overall, the time lag from the onset of symptoms to medical presence did not diminish notably.
Tables 4a and 4b present the proportions of the different categories of initial care in fatal (F1+F2+F9) events, and in nonfatal definite MI (NF1) events, respectively. The proportion of events with initial care given by a mobile team with a defibrillator increased notably during the study period in several RUAs. Nonfatal definite MIs (NF1) were treated first in hospital in most RUAs.
Table 5 presents the numbers and respective proportions of severe acute coronary events (NF1+NF3+F1+F2+F9) with cardiac arrest which were resuscitated, and the numbers and respective proportions surviving at 28 days. The proportion of surviving 28 days after out-of-hospital cardiac arrest and resuscitation was below 10% in almost all RUAs but the proportion was increasing in several RUAs. About one third of patients with in-hospital cardiac arrest survived at least 28 days but there were notable differences between the RUAs. The proportion was very low in CHN-BEI, RUS-MOS, RUS-NOV and high 50% in AUS-PER (1982-1987), GER-RHN, SWE-GOT (1991-1992) and SWI-SWI.
Tables 6a and 6b present the ECG findings in nonfatal definite MI events (NF1) in men and women by previous MI.
Table 7a presents the proportions of normal, equivocal and abnormal enzyme levels in nonfatal definite MI events (NF1) in men and women, and 7b presents the means and medians of the enzyme levels (expressed as percentages of the upper limit of normal), respectively.
Table 8 presents the prevalence of smoking in men and in women in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events, and in events belonging to the MONICA Definition 1 category. In men the prevalence of smoking is quite similar (40-50%) in different RUAs in Definition 1 events.
Table 9 presents the duration of treatment in CCU, and the duration of hospitalization (in days) in nonfatal definite MI (NF1) events. The duration is shown by 20th, 50th and 80th percentiles. There is a large variation in the duration of hospitalization, and in the duration of treatment in CCU. In CHN-BEI the duration of hospitalization is coded as 28 days for almost all events.
Table 10 presents the proportions of the different categories of place of death in (F1+F2+F9) events. In most RUAs the majority of deaths occur outside hospital before the arrival of the ambulance. In CAN-HAL a clearly lower proportion of deaths than in the other RUAs were coded as out-of-hospital deaths.
Tables 11a-11j present drug treatment prevalences before the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category (11a: antiarrythmics; 11b: anticoagulants; 11c: antiplatelets; 11d: beta blockers; 11e: calcium channel blockers; 11f: diuretics; 11g: other antihypertensives; 11h: inotropic drugs; 11i: nitrates; 11j: thrombolytics). Tables 11k-11n present corresponding proportions with different procedures (11k: coronary angiography; 11l: CABG; 11m: angioplasty; 11n: pacing). Tables 11o-11p present the corresponding prevalences of treatment with drugs for which data collection began later (11o: lipid lowering drugs; 11p: ACE inhibitors). In many RUAs the proportion of missing data on fatal events is quite high but low on nonfatal events.
Tables 12a-12j present drug treatment prevalences during the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category (12a: antiarrythmics; 12b: anticoagulants; 12c: antiplatelets; 12d: beta blockers; 12e: calcium channel blockers; 12f: diuretics; 12g: other antihypertensives; 12h: inotropic drugs; 12i: nitrates; 12j: thrombolytics). Tables 12k-12n present corresponding proportions with different procedures (12k: coronary angiography; 12l: CABG; 12m: angioplasty; 12n: pacing). Tables 12o-12p present the corresponding prevalences of treatment with drugs for which data collection began later (12o: lipid lowering drugs; 12p: ACE inhibitors).
Tables 13a-13j present drug treatment prevalences post-event (on discharge from hospital) in nonfatal definite MI (NF1) events (13a: antiarrythmics; 13b: anticoagulants; 13c: antiplatelets; 13d: beta blockers; 13e: calcium channel blockers; 13f: diuretics; 13g: other antihypertensives; 13h: inotropic drugs; 13i: nitrates). Tables 13o-13p present the corresponding prevalences of treatment with drugs for which data collection began later (13o: hypolipidaemic drugs; 13p: ACE inhibitors).
The treatment prevalences with antiplatelet drugs before the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category are presented in Table 11c. The prevalences of treatment are stratified by previous MI and previous CHD for nonfatal definite MI (NF1) events in Table 14.
The treatment prevalences with beta blockers before the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category are presented in Table 11d. The prevalences of treatment are stratified by previous MI and previous CHD for nonfatal definite MI (NF1) events in Table 15.
The proportions of events treated with thrombolytic agents during the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category are presented in Table 12j. The proportions are stratified by previous MI for nonfatal definite MI (NF1) events in Table 16.
The proportions of events with coronary artery bypass surgery (CABG) before the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category are presented in Table 11l.The proportions are stratified by previous MI and previous CHD for nonfatal definite (NF1) events in Table 17.
The proportions of events with CABG during the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category are presented in Table 12l. The proportions are stratified by previous MI and previous CHD for nonfatal definite (NF1) events in Table 18.
The proportions of events with coronary angioplasty before the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category are presented in Table 11m. The proportions are stratified by previous MI and previous CHD for nonfatal definite (NF1) events in Table 19.
The proportions of events with coronary angioplasty during the event in nonfatal definite MI (NF1) events, in fatal (F1+F2+F9) events and in events belonging to the MONICA Definition 1 category are presented in Table 12m. The proportions are stratified by previous MI and previous CHD for nonfatal definite (NF1) events in Table 20.