Heart attacks and strokes still leading causes of death

Barbados continues to record an increase in heart attacks and strokes, according to the Barbados National Registry (BNR) 2019 cardiovascular disease report.

The document pointed out that studies have shown that the prevalence of cardiovascular disease was increasing, and rates in the Caribbean were higher than other countries in the Americas, and continued to be the largest contributor to deaths in the region.

In 2019, Barbados registered 547 people with myocardial infarction (MI or heart attack). This included confirmed hospital diagnoses and cases identified after death, using death certification records.

Of the 547 cases, 342 were hospitalised. Of those with full information, the case fatality rate was approximately 32 per cent, compared to the between three and 12 per cent internationally in-hospital case fatality rates.

“The three-year average for 2014 to 2016 is 391 cases versus 499 cases for 2017 to 2019. This implies a 28 per cent increase in new cases over a three-year period. This increase was driven by an increase in events in older women (ages 74-85 years), the absolute number surpassing cases in men for the first time recorded by the BNR,” the report said.

“The in-hospital case fatality rate (CFR) was similar over the past three years 2017, 2018 and 2019 at 21 per cent, 25 per cent and 25 per cent respectively. This remains high in comparison to other countries. For example, the CFR in Scotland between 2005 and 2015 was 10 per cent,” it added.

The report indicated that men continued to have a higher age-standardised rate of heart attacks compared to women, while the median length of stay for stroke had increased from seven days to eight days in 2019, compared to 2017.

The report said the trend of younger men having heart attacks continued in 2019, with the peak age range for events falling from 75-84 years in 2018 to 65-74 years in 2019.

In relation to strokes, the report indicated that there were some 758 stroke cases registered in Barbados in 2019, which included confirmed hospital diagnoses and cases only identified after death, using death certification records.

“There continues to be a rise in strokes in younger men, with increases in the 34 – 45 and the 55- 64 age groups. This trend is in line with a global shift towards strokes in younger men in low to middle-income countries,” said the report.

“The three-year average rose from 631 to 697 in 2014 to 2016 to an average of 697 for 2017 to 2019. In-hospital case fatality for all stroke cases was 37 per cent in 2019, up from 28 per cent in 2018. In comparison, the UK has maintained an in-hospital case fatality rate of 15 per cent between 2014 and 2019,” it added.

The report also indicated that there was an increased number of cases among women in the 45 to 64 age group and the 85 years and over age group.

It said ischaemic stroke remains the largest category with 266 women and 247 men experiencing this type of event (82 per cent of cases).

“Less than five per cent of strokes were classified as subarachnoid haemorrhages or unclassified. These numbers are in keeping with the percentages of patients with these conditions in other countries in 2016 – 2017 (85 per cent – 87 per cent Ischemic strokes and 11 per cent Intracerebral strokes),” said the report.

The 39-page document noted that non-communicable disease (NCD) remains the leading cause of death in Barbados, representing eight of the top ten causes of death in 2017, with cerebrovascular disease, diabetes mellitus and cancer of the prostate representing the top three.

“Further, hypertensive diseases, ischemic heart disease, pulmonary heart disease, cerebrovascular disease, atherosclerosis and other diseases of the circulatory system accounted for 28.8 per cent of deaths in 2017,” said the report.

“The incidence of cardiovascular disease increases with age and a high proportion of the Barbadian population (17 per cent) is over 65 years old. The 2015 Health of the Nation study revealed a high prevalence of common risk factors for cardiovascular disease including hypertension, diabetes, alcohol and tobacco use in individuals in this age-group,” it said.
marlonmadden@barbadostoday.bb