Long-term declines in incidence and mortality of first major coronary events in Sweden 1997-2023
V Lak, M Lindgren, J G Smith, M Aberg, D Djekic, E Thunstrom, H Sjoland, A RosengrenAbstract
Background
Acute coronary syndromes remain a leading cause of premature mortality. Many fatal events occur before patients reach medical care. Understanding long-term trends in both non-fatal and fatal coronary events is essential for guiding prevention and emergency response strategies. Although declines in coronary events have been reported in many countries, contemporary reports on population-level trends that separately quantify out-of-hospital and in-hospital fatality are limited.
Purpose
To quantify contemporary population trends in incidence and fatal outcomes of a first major coronary event.
Methods
The Swedish population register, the cause of death register and the hospital discharge register were linked to identify all individuals aged 18 to 74 years residing in Sweden during 1997 – 2023 who experienced a first major coronary event. Events were defined as out-of-hospital death from coronary artery disease or hospital admission for acute myocardial infarction. In-hospital case fatality was defined as death occurring within 28 days of hospital admission. Annual incidences were age- and sex-standardized to the 2023 Swedish population.
Results
249,630 cases of a first major coronary event were identified. The standardised annual incidence of first major coronary events decreased by 42% from 198 to 105 per 100,000 population between 1997 and 2023 (figure 1). Over the same period, standardised annual incidence of case fatality decreased by 71% for out-of-hospital (from 58 to 17 per 100,000) and 67% for in-hospital events (12 to 4 per 100,000).
Conclusion
Over the past 27 years, Sweden experienced substantial reductions in both the occurrence and fatality of first major coronary events. These trends likely reflect sustained progress in cardiovascular prevention, early detection, and acute care. Despite these improvements, most fatal cases continue to occur out-of-hospital, highlighting the need for enhanced strategies to prevent sudden coronary death and improve early response.Figure 1