Analysis Of The Trend Of Changes In Comparative Incidence Of Heart Diseases And Status Of Treatment Among Hospitalized Patients In Tianjin Over Past 30 Years

Objective To investigate the trend in the changes of etiological types of cardiovascular diseases ; to find out the trend in the use of cardiovascular agents and evaluate its rationality among inpatients in our hospital over past 30 years; to provide continuous epidemiological information for normative diagnosis and treatment of heart diseases; to provide objective evidence for reasonable allocation of medical and health resources. Methods The retrospective survey was carried out based on the data of 3 different periods: 1981 — 1983, 1991¹993 , 2001 ²003 in our hospital. Altogether there were 6212 cases included. Descriptive statistics wereprovided for all patients meeting the inclusion criteria. Trend of percentage change was compared using linear regression. Diagnosis was categorized according to the International Classification of Diseases, 10th revision. Cardiovascular agents consumption status was analyzed by calculating utilization rates. Results (1)The percentage of heart disease among hospitalized patients in medical wards was significantly increased during the last three periods of time, being 29.32%n 38.83% and 46.44% respectively (P<0.001) and reaching a peak in 2001-2003. (2)Patterns of different etiological types of heart diseases changed markedly in the three periods. The percentage of coronary heart disease increased from 25.44% in 1981-1983 to 45.24% in 2001-2003 (6=9.90, P=0.041), meanwhile its sequence elevated from 2nd to 1^st; arrthymias of unknown reason from 2.22% to 8.09% (b=2.94, P=0.038), and its sequence from 7^th to 4^th; whereas the percentage of rheumatic heart disease decreased from 36.52% in 1981-1983 to 17.20% in 2001-2003(b=-9.66, P=0.146), and its sequence dropped from 1st to 2nd; congenital heart disease also showed a falling trend with its percentage changing from 6.56% to 2.40%(b=-2.08, P=0.002) and its sequence from 4^th to 7^th; pericarditis from 8^th(1.86%) to 11^th (0.85%); the percentage of other heart diseases , including primary hypertension, pulmonary heart disease, primary cardiomyopathy, myocarditis, infective endocarditis, anemic heart disease and thyroid heart disease, remained unchanged or only slightly changed. (3)The average age of inhospitalized patients increased from 53.46±14.24 in the early 1980s to 53.86±13.61 in the early 1990s and to 62.45±13.46 in the early 2000s (P<0.001). (4)The percentage of male patients increased from 51.60% to 54.82%, then to 57.37% (P<0.01) ,(5)In-hospital mortality of heart diseases decreased significantly. In each period, it was 10.73%, 9.40% and 5.45% (P<0.001).(6)Median onset-admission time delay gradually decreased from 4 days in the period of 1981-1983 to 2 days in the period of 2001-2003 (P<0.001); median clinical course also experienced a decline from 6¹0 years to 1⁵ years (P<0.001); meaninhospital days dropped from 30.47±25.07 days to 14.49±14.17days (PO.001). (7)Most heart diseases still occurred in winter and spring. The trend appeared to be similar in the three periods. (8)The percentage of inpatients with diabetes mellitus , stroke or smoking history on admission increased to 8.35 times, 6.26 times and 3.74 times in 2001-2003 compared with 1981-1983. (9)The percentage of chronic renal failure and water-electrolytes disturbance appeared to be on the rise gradually in the three periods (6=0.370, P=0.020 fa 6=6.715, P=0.014). (10) The percentage of abnormal natremia among patients with chronic heart failure was 28.94%, 26.52% and 27.26% in the three periods respectively; the percentage of abnormal kalemia was 20.94%,18.78% and 16.14%. (11) Hypertriglyceridemia was more common among patients with coronary heart disease, the percentage of which was 19.16%,33.39% and 28.50% in the three periods respectively (PO.001); the percentage of hypercholesterolemia and hypertriglyceridemia decreased from 30.77% and 33.39% in the early 1990s to 25.00% (PO.001) and 28.50% (P<0.05) in the early 2000s respectively. (12) Diuretics, nitrites and digitalis we re the main agents for the treatment of chronic heart failure in the three periods, the total utilization rate of which was 61.33%,68.61% and 66.58% respectively; the utilization rate of ACEI and P-adrenergic receptor blocker had increased from 48.43% and 15.95% in the early 1990s to 76.03% (PO.001) and 25.73% (PO.001) in the early 2000s. (13)The utilization rate of anti-platelet, anticoagulant, P-adrenergic receptor blocker and ACEI in acute myocardial infarction increased from 75.97%, 24.35%, 31.49% and 55.84% in the early 1990s to 96.26%, 93.16%* 68.13% and 89.29% in the early 2000s (.PO.001 in all the four agents). (14) Among anti-hypertensive agents, the utilization rate of compound agent, diuretics and short-effect calcium channel blocker decreased from 69.01%, 61.99% and 82.46% in the early 1990s to 32.49% (PO.001), 55.91% (P>0.05) and 46.20% (PO.001) in the early 2000s, while the utilization rate of ACEI and P-adrenergic receptor blocker...