Time-Trends in Case-Fatality After Acute Myocardial Infarction Among Middle-Aged Lithuanian Adults, 2000-2023: Data from the Population-Based Kaunas Ischemic Heart Disease Register

Background and Objectives. During the past two decades, the 28-day fatality rates from acute myocardial infarction (AMI) for both middle-aged and older persons have decreased significantly due to increased access to modern treatment and advances in secondary prevention. Study aim – to determine and evaluate case fatality rates from AMI and trends among the Kaunas 25-64 years population from 2000 to 2023. Materials and Methods. During the study period, data from the population-based Kaunas (Lithuania) Ischemic Heart Disease Registry, which was implemented in accordance with the WHO MONICA project recommendations, were used. All cases of AMI and coronary deaths within 28 days occurring in the 25-64-year-old population of Kaunas city have been registered from 2000 to 2023. The 28-day case-fatality from AMI rates was calculated as a proportion of deaths to all AMI events multiplied by 100. To assess trends and their changes, JoinPoint regression was used. Results. Between 2000 and 2023, 28-day case-fatality rates from AMI for males remained essentially unchanged, while in females increased significantly (on average, 2.5%/year, p=0.002). The in-hospital case-fatality rates from AMI for both males and females did not change substantially during this period. The average case-fatality rates for both males aged 25-54 and 55-64 were significantly higher than for females. Only the 28-day case-fatality rates in Kaunas females aged 55-64 increased significantly (on average 3.0%/year, p=0.002). The average in-hospital case-fatality rates from AMI for both males aged 25-54 and 55-64 were without significant changes as compared with females. When assessing the trend for males 2006 point was established, and no significant trend was observed. For females, 2010 was an important year, as the AMI case-fatality rate increased significantly from 2010 to 2023. When assessing changes in the in-hospital AMI case-fatality rate among males over one year (2015), it was found that significant changes occurred during the 2015-2023 period, with the rate decreasing on average by 14.7%/year. Conclusions. During the past two decades, 28-day case-fatality rates from AMI for males showed no significant changes, while for females increased. The in-hospital case-fatality rates from AMI for both males and females did not change substantially. The average case-fatality rates for males with age were significantly higher than for females. The 28-day case-fatality rates for Kaunas males in aging groups showed no significant changes, but in females, the rates increased significantly with age.