Research Article: Hospital burden of coronary artery disease: Trends of myocardial infarction and/or percutaneous coronary interventions in France 2009–2014

Date Published: May 2, 2019

Publisher: Public Library of Science

Author(s): Jessica Pinaire, Jérôme Azé, Sandra Bringay, Guillaume Cayla, Paul Landais, Chiara Lazzeri.


Currently, cardiovascular disease (CVD) is widely acknowledged to be the first leading cause of fatality in the world with 31% of all deaths worldwide and is predicted to remain as such in 2030. Furthermore, CVD is also a major cause of morbidity in adults worldwide. Among these diseases, the coronary artery disease (CAD) is the most common cause, accounting for over 40% of CVD deaths. Despite a decline in mortality rates, the consequences of more effective preventive and management programs, the burden of CAD remains significant. Indeed, the rise in the prevalence of modifiable risk factors due to changes in lifestyle and health behaviors has further increased the burden of this epidemic. Our objective was to evaluate the hospital burden of CAD via MI trends and Percutaneous Coronary Intervention (PCI) in the French Prospective Payment System (PPS).

MI/PCI were identified in the national PPS database from 2009 to 2014 for patients aged 20 to 99, living in metropolitan France. We examined hospitalisation, readmission and mortality trends using standardised rates.

Over the six-year period, we identified 678,021 patients, representing 900,121 stays of which, 215,224 had a MI and a PCI. Admission trends increased by nearly 25%. Acute MI cases increased every year, with an alarming increase in women, and more specifically in young women. Men were 3 times more hospitalised than women, who were older. A North-South divide was noted. Twenty seven percent of patients experienced readmission within 1 month. Trajectories of care were significantly different by sex and age. Overall in-hospital death was 3.3%, decreasing by 15% during the period. The highest adjusted mortality rates were observed for inpatients aged <40 or >80.

We outlined the public health burden of this condition and the importance of improving the trajectories of care as an aid for better care.

Partial Text

Around the world, cardiovascular disease (CVD) is recognized as the leading cause of death (accounting for approximately 31% of all deaths worldwide) and is predicted to remain as such in 2030 [1]. Moreover, this is reinforced with by the World Health Organization (WHO), which forecasts an 11% increase in the burden of CVD by 2030, bringing the worldwide number of myocardial infarctions (MI) and stroke to approximately 36.2 million [2]. In addition, CVD was also a major cause of morbidity in adults worldwide during the 20th century. Today, people with MI have a risk of recurrence and/or development of coronary heart disease-related conditions six times higher than those with no history of MI [3]. Among these diseases, the coronary artery disease (CAD) is the most common cause, accounting for more than 40% of CVD deaths (Source WHO). Despite improvements in care, CAD remain among the top causes of disease, disability and death worldwide leading to a high consumption of health resources [4].

We identified 900,121 stays representing 678,021 patients with MI during the study period. Nearly 45% of patients presented with AMI and 7% were OIHD. The remaining 48% of patients, they had a PCI (S1 Fig). Angioplasty was performed in 72% of AMI and 60% OIHD patients, respectively.

We quantified the burden of CAD, as opposed to other studies estimating changing trends, this requires taking into account the entire consumption of hospital care. Our findings, based on 900,121 stays representing 678,021 patients with MI/PCI during the study period, showed that the burden of CAD is persisting making it a major public health issue exerting heavy economic costs. Indeed, we underscored a constant increase in AMI and PCI burden meaning rising hospitalisation rates with rising health care costs. In contrast, we observed a decline in OIHD burden. However, mortality rates were decreasing illustrating the medical progress in reducing CVD fatality in recent decades, but also the positive impact of health campaigns to address risk factors such as smoking bans in work and public places [46] and reducing salt intake [47].