• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of amjphAmerican Journal of Public Health Web SiteAmerican Public Health Association Web SiteSubmissionsSubscriptionsAbout Us
Am J Public Health. 1994 January; 84(1): 20–28.
PMCID: PMC1614906

Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure.


OBJECTIVES. Many developed countries have seen declining mortality rates for heart disease, together with an alleged decline in incidence and a seemingly paradoxical increase in health care demands. This paper presents a model for forecasting the plausible evolution of heart disease morbidity. METHODS. The simulation model combines data from different sources. It generates acute coronary event and mortality rates from published data on incidences, recurrences, and lethalities of different heart disease conditions and interventions. Forecasts are based on plausible scenarios for declining incidence and increasing survival. RESULTS. Mortality is postponed more than incidence. Prevalence rates of morbidity will decrease among the young and middle-aged but increase among the elderly. As the milder disease states act as risk factors for the more severe states, effects will culminate in the most severe disease states with a disproportionate increase in older people. CONCLUSIONS. Increasing health care needs in the face of declining mortality rates are no contradiction, but reflect a tradeoff of mortality for morbidity. The aging of the population will accentuate this morbidity increase.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (3.8M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Uemura K, Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q. 1988;41(3-4):155–178. [PubMed]
  • Sytkowski PA, Kannel WB, D'Agostino RB. Changes in risk factors and the decline in mortality from cardiovascular disease. The Framingham Heart Study. N Engl J Med. 1990 Jun 7;322(23):1635–1641. [PubMed]
  • Graboys TB, Biegelsen B, Lampert S, Blatt CM, Lown B. Results of a second-opinion trial among patients recommended for coronary angiography. JAMA. 1992 Nov 11;268(18):2537–2540. [PubMed]
  • Mackenbach JP, Looman CW, Kunst AE, Habbema JD, van der Maas PJ. Post-1950 mortality trends and medical care: gains in life expectancy due to declines in mortality from conditions amenable to medical intervention in The Netherlands. Soc Sci Med. 1988;27(9):889–894. [PubMed]
  • Goldman L, Cook EF. The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med. 1984 Dec;101(6):825–836. [PubMed]
  • Moss AJ, Benhorin J. Prognosis and management after a first myocardial infarction. N Engl J Med. 1990 Mar 15;322(11):743–753. [PubMed]
  • Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, Tristani F, Smith R, Dunkman WB, Loeb H, Wong M, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med. 1991 Aug 1;325(5):303–310. [PubMed]
  • Weinstein MC, Coxson PG, Williams LW, Pass TM, Stason WB, Goldman L. Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model. Am J Public Health. 1987 Nov;77(11):1417–1426. [PMC free article] [PubMed]
  • Kannel WB. Epidemiological aspects of heart failure. Cardiol Clin. 1989 Feb;7(1):1–9. [PubMed]
  • Hoogendoorn D. Atherosclerotische ziekten van het hart in het ziekenhuis en in de statistiek van doodsoorzaken. Ned Tijdschr Geneeskd. 1985 Sep 21;129(38):1827–1833. [PubMed]
  • Hoogendoorn D. Enkele opmerkingen over de stand van zaken betreffende de epidemie van het acute hartinfarct. Ned Tijdschr Geneeskd. 1990 Mar 24;134(12):592–595. [PubMed]
  • Hoogendoorn D. Frequenties van en operatieve sterfte bij operaties aan het hart en de intrathoracale grote vaten. I. Directe coronaria-revascularisaties. Ned Tijdschr Geneeskd. 1989 Dec 9;133(49):2445–2448. [PubMed]
  • Goldman L, Cook F, Hashimotso B, Stone P, Muller J, Loscalzo A. Evidence that hospital care for acute myocardial infarction has not contributed to the decline in coronary mortality between 1973-1974 and 1978-1979. Circulation. 1982 May;65(5):936–942. [PubMed]
  • Ericsson CG, Erhardt L, Rehnqvist N. Two-year survival after myocardial infarction. J Intern Med. 1990 Mar;227(3):195–199. [PubMed]
  • Marcus FI, Friday K, McCans J, Moon T, Hahn E, Cobb L, Edwards J, Kuller L. Age-related prognosis after acute myocardial infarction (the Multicenter Diltiazem Postinfarction Trial). Am J Cardiol. 1990 Mar 1;65(9):559–566. [PubMed]
  • Benhorin J, Moss AJ, Oakes D. Prognostic significance of nonfatal myocardial reinfarction. Multicenter Diltiazem Postinfarction Trial Research Group. J Am Coll Cardiol. 1990 Feb;15(2):253–258. [PubMed]
  • DeBusk RF, Kraemer HC, Nash E, Berger WE, 3rd, Lew H. Stepwise risk stratification soon after acute myocardial infarction. Am J Cardiol. 1983 Dec 1;52(10):1161–1166. [PubMed]
  • Kannel WB, Feinleib M. Natural history of angina pectoris in the Framingham study. Prognosis and survival. Am J Cardiol. 1972 Feb;29(2):154–163. [PubMed]
  • DeBusk RF, Blomqvist CG, Kouchoukos NT, Luepker RV, Miller HS, Moss AJ, Pollock ML, Reeves TJ, Selvester RH, Stason WB, et al. Identification and treatment of low-risk patients after acute myocardial infarction and coronary-artery bypass graft surgery. N Engl J Med. 1986 Jan 16;314(3):161–166. [PubMed]
  • Ahnve S, Gilpin E, Dittrich H, Nicod P, Henning H, Carlisle J, Ross J., Jr First myocardial infarction: age and ejection fraction identify a low-risk group. Am Heart J. 1988 Oct;116(4):925–932. [PubMed]
  • Sanz G, Castañer A, Betriu A, Magriña J, Roig E, Coll S, Paré JC, Navarro-López F. Determinants of prognosis in survivors of myocardial infarction: a prospective clinical angiographic study. N Engl J Med. 1982 May 6;306(18):1065–1070. [PubMed]
  • Brook RH, Kosecoff JB, Park RE, Chassin MR, Winslow CM, Hampton JR. Diagnosis and treatment of coronary disease: comparison of doctors' attitudes in the USA and the UK. Lancet. 1988 Apr 2;1(8588):750–753. [PubMed]
  • Winslow CM, Kosecoff JB, Chassin M, Kanouse DE, Brook RH. The appropriateness of performing coronary artery bypass surgery. JAMA. 1988 Jul 22;260(4):505–509. [PubMed]
  • Weintraub WS, Jones EL, King SB, 3rd, Craver J, Douglas JS, Jr, Guyton R, Liberman H, Morris D. Changing use of coronary angioplasty and coronary bypass surgery in the treatment of chronic coronary artery disease. Am J Cardiol. 1990 Jan 15;65(3):183–188. [PubMed]
  • Kaul S, Lilly DR, Gascho JA, Watson DD, Gibson RS, Oliner CA, Ryan JM, Beller GA. Prognostic utility of the exercise thallium-201 test in ambulatory patients with chest pain: comparison with cardiac catheterization. Circulation. 1988 Apr;77(4):745–758. [PubMed]
  • Parisi AF, Peduzzi P, Detre K, Shugoll G, Hultgren HN, Takaro T. Characteristics and outcome of medical nonadherers in the Veterans Administration Cooperative Study of Coronary Artery Surgery. Am J Cardiol. 1984 Jan 1;53(1):23–28. [PubMed]
  • Veldkamp RF, Baartman GJ, van Domburg R, Tijssen JG, Bos E, Meeter K. Overleving 11 jaar na een aorto-coronaire bypass-operatie. Ned Tijdschr Geneeskd. 1991 Jul 6;135(27):1229–1233. [PubMed]
  • Glazier JJ, Varricchione TR, Ryan TJ, Ruocco NA, Jacobs AK, Faxon DP. Outcome in patients with recurrent restenosis after percutaneous transluminal balloon angioplasty. Br Heart J. 1989 Jun;61(6):485–488. [PMC free article] [PubMed]
  • Fioretti P, Tijssen JG, Azar AJ, Lazzeroni E, Brower RW, ten Katen HJ, Lubsen J, Hugenholtz PG. Prognostic value of predischarge 12 lead electrocardiogram after myocardial infarction compared with other routine clinical variables. Br Heart J. 1987 Apr;57(4):306–312. [PMC free article] [PubMed]
  • Laird-Meeter K, van Domburg R, van den Brand MJ, Lubsen J, Bos E, Hugenholtz PG. Frequentie en resultaten van heringrepen na kransvatoperaties. Ned Tijdschr Geneeskd. 1988 Dec 17;132(51):2316–2320. [PubMed]
  • Detre K, Holubkov R, Kelsey S, Bourassa M, Williams D, Holmes D, Jr, Dorros G, Faxon D, Myler R, Kent K, et al. One-year follow-up results of the 1985-1986 National Heart, Lung, and Blood Institute's Percutaneous Transluminal Coronary Angioplasty Registry. Circulation. 1989 Sep;80(3):421–428. [PubMed]
  • Epstein SE, Palmeri ST, Patterson RE. Current concepts: evaluation of patients after acute myocardial infarction: indications for cardiac catheterization and surgical intervention. N Engl J Med. 1982 Dec 9;307(24):1487–1492. [PubMed]
  • Reunanen A, Aromaa A, Pyörälä K, Punsar S, Maatela J, Knekt P. The Social Insurance Institution's coronary heart disease study. Baseline data and 5-year mortality experience. Acta Med Scand Suppl. 1983;673:1–120. [PubMed]
  • Uemura K. International trends in cardiovascular diseases in the elderly. Eur Heart J. 1988 Mar;9 (Suppl 500):1–8. [PubMed]
  • Fries JF. Aging, natural death, and the compression of morbidity. N Engl J Med. 1980 Jul 17;303(3):130–135. [PubMed]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...