Heart attack mortality rate dependent on residence

Mortality rate for heart attack strongly dependent on place of residence

19/10/2013

The place of residence in Germany plays an important role in determining whether a heart attack is fatal. In some cases, the risk of dying after an infarction is twice as high in the eastern federal states as in the west. Experts try to explain the differences.

Heart disease patients live longer today
Generally, heart patients nowadays live longer and better. And more people survive a heart attack thanks to modern medicine often without permanent damage. But in 2011 acute myocardial infarction was the second leading cause of death in Germany. The mortality risk in the individual federal states varies greatly. This is clear from the 24th Heart Report of the German Heart Foundation, which was published in early 2013 and which regionally breaks down the statistical heart attack data from 2010.

Great regional differences
Nationwide, there were 212,914 cases of acute myocardial infarction. Today, significantly more patients survive such an infarct than ten years ago. Between 2000 and 2010, death rates fell by 15.8 percent in men and 14.8 percent in women. In 2010, a total of 55,541 people in this country died of a heart attack. There are large regional differences. Not only was the risk of heart attack in East Germany higher, as the German Society of Cardiology (DGK) recently announced, but also the number of those who die after an infarction is almost twice as high in Saxony-Anhalt, Brandenburg and Saxony in Schleswig-Holstein, Hesse, Berlin, Baden-Württemberg or Bavaria. In the East, only Mecklenburg-Western Pomerania stands out positively.

Better cardiological treatment in the West
Statistically, with 111 deaths per 100,000 inhabitants, most people in Saxony-Anhalt die from a heart attack. With 56 people in Berlin and 57 each in Schleswig-Holstein and Hesse, the figures are the lowest on 100,000 inhabitants. Cardiologists are wondering why this is so.Christian Hamm, President of the German Cardiac Society (DGK), says: „About the causes can only be speculated.“ Perhaps the better cardiological treatment in the West could be an explanation. Thomas Meinertz, CEO of the German Heart Foundation, criticizes: „The care for patients with heart disease is not equally good for the different regions.“

Defects in Brandenburg
According to the heart report, a lower density of physicians in the high-risk regions, a less effective emergency medical system and a resulting longer prehospital time, ie the time between infarction and treatment, are other possible causes for the uneven distribution of risk. In Brandenburg had recently become known that apparently every eighth call in the emergency number 110 went into emptiness. And as the Interior Ministry said, nearly one in four of the nearly 440,000 callers had to wait longer than 30 seconds to talk to whom. When emergency call in Brandenburg, the average waiting time was 13 seconds. But the time until an emergency call arrives at the scene seems to be getting longer and longer.

Heart emergency ambulances distributed differently
But just this time between infarction and the beginning of treatment is so important for the chance to survive. Many sufferers die before an ambulance arrives. However, if patients are taken to a clinic in a timely manner, the blood clot that clogs the coronary artery can usually be resolved quickly. However, special cardiac emergency ambulances, equipped with modern equipment and offering the best chances of survival, are distributed very differently across the federal states. They are not necessarily where they are most needed, such as where old people live. „This is unfortunately not the case, especially in some East German areas“, Meinertz reprimands.

More heart attacks in poor neighborhoods
In addition, the population, especially in areas that show high death rates, rather poorly informed about symptoms of heart attack. It was said by the DGK that many people would not call it an alarm when they felt chest pressure or cardiac arrhythmia. Such knowledge is so important for the chances of survival, because every second counts. According to studies, heart attacks in socially disadvantaged and poor neighborhoods would occur much more frequently. Patients from these neighborhoods are therefore also younger than those who come from more privileged districts and have a higher risk of dying within one year of infarction.

In Hamburg lower risk of myocardial infarction
According to the heart report, in Bremen and Saxony-Anhalt with 342 and 341 people per 100,000 inhabitants, statistically most patients were hospitalized because of a heart attack. In Hamburg (218), Bavaria (221) and Berlin (225) there were fewest hospital stays because of this. Similar results came from the Techniker Krankenkasse (TK), which relied on figures from the Federal Statistical Office and found a lower risk of myocardial infarction in Hamburg at the end of last month.

Most common causes of death in Germany
According to the Federal Statistical Office, three cardiological diseases are the leading causes of death in Germany: in 2011, coronary heart disease was the cause of death for 8.3 percent of people; 6.1 percent died in an acute infarct and 5.3 percent in heart failure , Taken together, this is about 170,000 people. However, mortality has fallen from over ten to under six percent in recent years thanks to advances in the treatment of cardiovascular disease. Thus, the number of deaths had almost halved compared to 1980 to about 55,000. And this against the background that the population on average getting older and thus also the heart risks would rise.

Trend towards unhealthy lifestyle
DGK President Christian Hamm says that this is probably also a reason for the rise in the number of other heart diseases such as valvular heart disease, cardiac arrhythmias and heart failure in recent years. He explains: „On the one hand, more and more people in Germany are reaching a higher age, and thus the risk of developing heart failure increases. On the other hand, thanks to the better treatment options and the care structure, more and more people are surviving a heart attack, which then suffers from heart failure at an advanced age.“ According to Hamm, the trend towards unhealthy lifestyles counteracts the advances in the early detection and treatment of heart disease. Obesity and diabetes are on the increase and the proportion of smokers is on the decline. This relativizes the success that medical professionals can achieve with medication. (Ad)