Resumen de Evolución de las tasas de hospitalización y mortalidad hospitalaria por enfermedades cardiovasculares agudas en Castilla y León, 2001-2015

Juan B. López Messa, Jesús María Andrés de Llano, Laura López Fernández, Jesús García Cruces, Julio García Crespo, Miryam Prieto González

• español

  Introducción y objetivos Explorar las tasas de hospitalización y mortalidad por enfermedades cardiovasculares agudas (ECVA).

  Métodos Estudio de asociación cruzada sobre altas hospitalarias de Castilla y León en 2001-2015 de infarto de miocardio (IAM), angina inestable, insuficiencia cardiaca o accidente cerebrovascular agudo (ACVA). Mediante regresión joinpoint, se estudiaron las tendencias de las tasas de hospitalización/100.000 habitantes/año y de mortalidad hospitalaria/1.000 hospitalizaciones/año, en general y por sexo.

  Resultados Se estudiaron 239.586 ECVA (IAM, 55.004; angina inestable, 15.406; insuficiencia cardiaca, 111.647; ACVA, 57.529). Se observaron cambios estadísticamente significativos: hospitalización y ECVA, ascendentes en 2001-2007 (5,14; IC95%, 3,5-6,8; p < 0,005) y descendentes en 2011-2015 (3,7; IC95%, 1,0-6,4; p < 0,05); angina inestable, descendente en 2001-2010 (–12,73; IC95%, –14,8 a –10,6; p < 0,05); IAM, ascendente en 2001-2003 (15,6; IC95%, 3,8-28,9; p < 0,05) y descendente en 2003-2015 (–1,20; IC95%, –1,8 a –0,6; p < 0,05); insuficiencia cardiaca, ascendente en 2001-2007 (10,70; IC95%, 8,7-12,8; p < 0,05) y en 2007-2015 (1,10; IC95%, 0,1-2,1; p < 0,05); ACVA, ascendente en 2001-2007 (4,44; IC95%, 2,9-6,0; p < 0,05); mortalidad, descendente en 2001-2015 por ECVA (–1,16; IC95%, –2,1 a –0,2; p < 0,05), IAM (–3,37; IC95%, –4,4 a –2,3; p < 0,05), insuficiencia cardiaca (–1,25; IC95%, –2,3 a –0,1; p < 0,05) y ACVA (–1,78; IC95%, –2,9 a –0,6; p < 0,05), y angina inestable, ascendente en 2001-2007 (24,73; IC95%, 14,2-36,2; p < 0,05).

  Conclusiones Las ECVA presentaron una tendencia a tasas de hospitalización crecientes, marcada por la insuficiencia cardiaca, y tasas de mortalidad hospitalaria descendentes, que fueron similares en ambos sexos. Estos datos apuntan a una estabilización y un descenso en la mortalidad hospitalaria atribuibles a medidas establecidas contra ellas.

• English

  Introduction and objectives To analyze hospitalization and mortality rates due to acute cardiovascular disease (ACVD).

  Methods We conducted a cross-sectional study of the hospital discharge database of Castile and León from 2001 to 2015, selecting patients with a principal discharge diagnosis of acute myocardial infarction (AMI), unstable angina, heart failure, or acute ischemic stroke (AIS). Trends in the rates of hospitalization/100 000 inhabitants/y and hospital mortality/1000 hospitalizations/y, overall and by sex, were studied by joinpoint regression analysis.

  Results A total of 239 586 ACVD cases (AMI 55 004; unstable angina 15 406; heart failure 111 647; AIS 57 529) were studied. The following statistically significant trends were observed: hospitalization: ACVD, upward from 2001 to 2007 (5.14; 95%CI, 3.5-6.8; P < .005), downward from 2011 to 2015 (3.7; 95%CI, 1.0-6.4; P < .05); unstable angina, downward from 2001 to 2010 (–12.73; 95%CI, –14.8 to –10.6; P < .05); AMI, upward from 2001 to 2003 (15.6; 95%CI, 3.8-28.9; P < .05), downward from 2003 to 2015 (–1.20; 95%CI, –1.8 to –0.6; P < .05); heart failure, upward from 2001 to 2007 (10.70; 95%CI, 8.7-12.8; P < .05), upward from 2007 to 2015 (1.10; 95%CI, 0.1-2.1; P < .05); AIS, upward from 2001 to 2007 (4.44; 95%CI, 2.9-6.0; P < .05). Mortality rates: downward from 2001 to 2015 in ACVD (–1.16; 95%CI, –2.1 to –0.2; P < .05), AMI (–3.37, 95%CI, –4.4 to –2, 3, P < .05), heart failure (–1.25; 95%CI, –2.3 to –0.1; P < .05) and AIS (–1.78; 95%CI, –2.9 to –0.6; P < .05); unstable angina, upward from 2001 to 2007 (24.73; 95%CI, 14.2-36.2; P < .05).

  Conclusions The ACVD analyzed showed a rising trend in hospitalization rates from 2001 to 2015, which was especially marked for heart failure, and a decreasing trend in hospital mortality rates, which were similar in men and women. These data point to a stabilization and a decline in hospital mortality, attributable to established prevention measures.