acute coronary syndrome (acs) - … coronary syndrome (acs) - epidemiology forecast to 2023 2 ......

REFERENCE CODE GDHCER053-14 | PUBLICAT ION DATE JULY 2014

ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023

Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 2 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.


Executive Summary

Acute coronary syndrome (ACS) is a serious

cardiovascular disease associated with high

healthcare costs, frequent recurrences and

hospitalizations, and high risks of sudden death

and short-term mortality. The ACS incidence

increases with age and will be a significant public

health problem as the elderly population increases

around the world. ACS is classified into three

disease entities based on evidence of heart muscle

damage inferred from a person’s symptoms,

changes in the ST-tracing of the electrocardiogram

(ECG), and levels of cardiac biomarkers that

signify heart muscle death: ST-elevation

myocardial infarction (STEMI), non-ST-elevation

myocardial infarction (NSTEMI), and unstable

angina (UA). These three disease entities differ in

their clinical characteristics, treatment approaches,

and survival probabilities.

This report provides an overview of the ACS risk

factors and comorbidities, a discussion of the ACS

global and historical trends, and a 10-year

epidemiological patient forecast for ACS from 2013

to 2023 in the seven major markets (7MM) (US,

France, Germany, Italy, Spain, UK, and Japan).

The epidemiological patient forecast includes:

Hospitalized incident cases of ACS,

segmented by STEMI, NSTEMI, and UA

ACS cases that survived until hospital

discharge, segmented by STEMI, NSTEMI,

and UA

ACS cases that survived for one year post-

hospital discharge, segmented by STEMI,

NSTEMI, and UA

Diagnosed prevalent cases of myocardial

infarction (MI) segmented by STEMI and

NSTEMI from 2013 to 2023 in the six major

markets (6MM) (US, France, Germany, Italy,

Spain, and UK)

Belo mentioned figure presents the forecast for the

hospitalized incident ACS cases in the 7MM for

men and women ages ≥25 years for 2013 and

2023. In the 7MM, the hospitalized incident cases

of ACS will increase from 1.29 million cases in

2013 to 1.47 million cases in 2023 at the rate of

1.40% per year. The US constitutes around 40% of

the total hospitalized incident ACS cases in the

7MM and will be the market with the highest

number of cases during the forecast period. The

majority of the cases occurred in men (58.15%)

and in those ages ≥65 years (69.34%). For the

7MM, about 33% of the ACS cases were STEMI,

44% were NSTEMI, and 23% were UA. The

proportions varied depending on the market.



Executive Summary

7MM, Hospitalized Incident Cases of ACS, Ages ≥25 Years, Both Sexes, N, 2013 and 2023

62,229

66,385

98,735

104,935

149,050

261,007

543,795

637,406

1,286,136

68,260

72,529

100,782

121,916

172,047

299,583

630,646

713,201

1,465,763

0 500,000 1,000,000 1,500,000 2,000,000

Spain

France

UKJapan

Italy

GermanyUS

5EU

7MM

Hospitalized Incident Cases of ACS (N)

Mar

kets

20232013

Sources: GlobalData; ASL Brescia, 2011; Cequier, 2008; Degano et al., 2013; Ferreira-Gonzalez et al., 2008; Floyd et al., 2009; ISS, 2010; Löwel et al., 2006; Marrugat et al., 2000; Marrugat et al., 2002; Marrugat et al., 2004; McManus et al., 2011b; Peretti et al., 2012; Smolina et al., 2012a; Smolina et al., 2012b


Table of Contents


1 Table of Contents

1 Table of Contents ....................................................................................................................... 4

1.1 List of Tables ...................................................................................................................... 7

1.2 List of Figures ..................................................................................................................... 8

2 Introduction ............................................................................................................................... 10

2.1 Catalyst ............................................................................................................................. 10

2.2 Related Reports ................................................................................................................ 10

2.3 Upcoming Reports ............................................................................................................ 11

3 Epidemiology ............................................................................................................................ 12

3.1 Disease Background ......................................................................................................... 12

3.2 Risk Factors and Comorbidities ........................................................................................ 13

3.2.1 Controlling hypertension can decrease the CHD incidence by 20–25%......................... 14

3.2.2 Every 1% decrease in cholesterol levels is associated with a 2% decrease in the CHD risk ............................................................................................................................... 15

3.2.3 Women who have diabetes have a higher risk of developing CHD than men with diabetes........................................................................................................................ 16

3.2.4 Cigarette smoking increases the risk of CHD and also increases the risk of developing other risk factors for CHD ............................................................................................. 17

3.2.5 Obese and physically inactive persons are more likely to develop CHD through an increased risk of developing the traditional risk factors ................................................. 17

3.2.6 Non-modifiable risk factors, such as family history, age, and sex, contribute to CHD development ................................................................................................................. 18

3.2.7 Comorbidities ................................................................................................................ 18

3.3 Global Trends – MI ........................................................................................................... 19

3.3.1 MI Incidence and Mortality Trends ................................................................................. 19

3.3.2 STEMI and NSTEMI Trends .......................................................................................... 29

3.3.3 Trends in MI Mortality and Case-Fatality Rates ............................................................. 31

3.3.4 MI Prevalence ............................................................................................................... 33


Table of Contents


3.4 Global Trends – UA........................................................................................................... 34

3.5 Forecast Methodology ....................................................................................................... 36

3.5.1 Forecast Case Flow Map............................................................................................... 38

3.5.2 Sources Used................................................................................................................ 44

3.5.3 Sources Not Used ......................................................................................................... 53

3.5.4 Forecast Assumptions and Methods, Hospitalized MI Incident Cases ........................... 54

3.5.5 Forecast Assumptions and Methods, STEMI and NSTEMI Cases that Survived until Hospital Discharge ....................................................................................................... 59

3.5.6 Forecast Assumptions and Methods, STEMI and NSTEMI Cases that Survived for One Year after Discharge..................................................................................................... 61

3.5.7 Forecast Assumptions and Methods, Diagnosed Prevalent Cases of MI ....................... 62

3.5.8 Forecast Assumptions and Methods, Hospitalized Cases of UA.................................... 64

3.5.9 Forecast Assumptions and Methods, UA Cases that Survived until Hospital Discharge and for One Year Post-Discharge ................................................................................. 66

3.6 Epidemiological Forecast for ACS (2013–2023) – Hospitalized Incident Cases ................ 66

3.6.1 Hospitalized Incident Cases of ACS .............................................................................. 66

3.6.2 Age-Specific Hospitalized Incident Cases of ACS ......................................................... 68

3.6.3 Sex-Specific Hospitalized Incident Cases of ACS ......................................................... 70

3.6.4 Hospitalized Incident Cases of ACS by STEMI, NSTEMI, and UA ................................. 72

3.6.5 ACS Cases that Survived until Hospital Discharge and for One Year ............................ 74

3.6.6 Age-Specific ACS Cases that Survived until Hospital Discharge ................................... 77

3.6.7 Age-Standardized Incidence of ACS ............................................................................. 78

3.7 Epidemiological Forecast for MI (2013–2023) – Prevalent Cases ..................................... 79

3.7.1 Diagnosed Prevalent Cases of MI ................................................................................. 79

3.7.2 Diagnosed Prevalent Cases of MI Segmented by STEMI and NSTEMI......................... 81

3.7.3 Age-Specific Diagnosed Prevalent Cases of MI ............................................................ 82

3.7.4 Sex-Specific Diagnosed Prevalent Cases of MI ............................................................. 84

3.7.5 Age-Standardized Diagnosed Prevalence of MI ............................................................ 85


Table of Contents


3.8 Discussion ........................................................................................................................ 86

3.8.1 Epidemiological Forecast Insight ................................................................................... 86

3.8.2 Limitations of the Analysis ............................................................................................. 87

3.8.3 Strengths of the Analysis ............................................................................................... 88

4 Appendix................................................................................................................................... 91

4.1 Bibliography ...................................................................................................................... 91

4.2 About the Authors ........................................................................................................... 102

4.2.1 Epidemiologists ........................................................................................................... 102

4.2.2 Reviewers ................................................................................................................... 102

4.2.3 Global Director of Epidemiology and Health Policy ...................................................... 104

4.2.4 Global Head of Healthcare .......................................................................................... 105

4.3 About GlobalData ............................................................................................................ 106

4.4 About EpiCast ................................................................................................................. 106

4.5 Disclaimer ....................................................................................................................... 107


Table of Contents


1.1 List of Tables

Table 1: Risk Factors and Comorbidities for CHD and ACS ....................................................................... 14

Table 2: Germany, MI Incidence and Re-Infarction Rates (Cases per 100,000 Population), 1985–1987 and

2001–2003 .................................................................................................................................. 23

Table 3: Spain, MI Incidence Rate (Cases per 100,000 Population) and Incidence Trends, 2000 and 2013

................................................................................................................................................... 25

Table 4: England and Scotland, Temporal Trends in the MI Incidence (Cases per 100,000 Population),

2002–2010 .................................................................................................................................. 25

Table 5: 7MM, Summary of STEMI and NSTEMI In-Hospital and One-Year Case-Fatality Rates ............... 32

Table 6: Global, Crude Total Population Prevalence Percentages of Angina Pectoris and Mean Age of

Study Participants ....................................................................................................................... 35

Table 7: 7MM, Sources of MI and UA Incidence Data................................................................................ 40

Table 8: 7MM, Sources of Diagnosed Prevalence Data for MI ................................................................... 42

Table 9: 7MM, Data Sources of STEMI and NSTEMI Proportions Among Hospitalized Cases of MI .......... 43

Table 10: 7MM, Hospitalized Incident Cases of ACS, Ages ≥25 Years, Both Sexes, N (Col %), Selected

Years, 2013–2023 ....................................................................................................................... 67

Table 11: 7MM, Age-Specific Hospitalized Incident Cases of ACS, Both Sexes, N (Row %). 2013 .............. 69

Table 12: 7MM, Sex-Specific Hospitalized Incident Cases of ACS, Ages ≥25 Years, N (Row %), 2013 ........ 71

Table 13: 7MM, Hospitalized Incident Cases of ACS Segmented by STEMI, NSTEMI, and UA (N, Row %),

Ages ≥25 Years, Both Sexes, 2013 ............................................................................................. 73

Table 14: 7MM, ACS Cases that Survived until Hospital Discharge, Ages ≥25 Years, Both Sexes, N, 2013 . 76

Table 15: 7MM, ACS Cases that Survived for One Year Post-Discharge, Ages≥25 Years, Both Sexes, N,

2013............................................................................................................................................ 76

Table 16: 7MM, Age-Specific ACS Cases that Survived until Hospital Discharge and for One Year, Post-

Discharge Both Sexes, N, 2013 ................................................................................................... 78


Table of Contents


Table 17: 6MM, Diagnosed Prevalent Cases of MI, Ages ≥25 Years, Both Sexes, N (Col %), Select Years,

2013–2023 .................................................................................................................................. 80

Table 18: 6MM, Diagnosed Prevalent Cases of MI Segmented by STEMI and NSTEMI, Ages ≥25 Years,

Both Sexes, N (Row %), 2013 ..................................................................................................... 81

Table 19: 6MM, Age-Specific Diagnosed Prevalent Cases of MI, Both Sexes, N (Row %), 2013 ................. 83

Table 20: 6MM, Sex-Specific Diagnosed Prevalent Cases of MI, Ages ≥25 Years, N (Row %), 2013 ........... 84

Table 21: 7MM, Historical Data Validation ................................................................................................... 90

1.2 List of Figures

Figure 1: US, Temporal Trend in the Hospitalized MI Incidence from the Worcester Heart Attack Study, All

Ages, 1975–2005 ........................................................................................................................ 21

Figure 2: UK, Age-Adjusted MI Incidence and Hospitalized Incidence (Cases per 100,000 Population), Men,

2002–2010 .................................................................................................................................. 26

Figure 3: UK, Age-Adjusted MI Incidence and Hospitalized Incidence (Cases per 100,000 Population),

Women, 2002–2010 .................................................................................................................... 27

Figure 4: England and Scotland, Age-Adjusted Temporal Trends in MI Mortality, Deaths per 100,000

Population, Men and Women, 2002–2010 ................................................................................... 28

Figure 5: US, Germany, and UK, Crude Diagnosed MI Prevalence in Men and Women, 1990–2008 .......... 33

Figure 6: Global, Crude Total Population Prevalence Percentages of Angina Pectoris (%).......................... 36

Figure 7: MI Forecast Case Flow Map ........................................................................................................ 39

Figure 8: 7MM, Hospitalized Incident Cases of ACS, Ages ≥25 Years, Both Sexes, N, Select Years, 2013–

2023............................................................................................................................................ 68

Figure 9: 7MM, Age-Specific Hospitalized Incident Cases of ACS, Both Sexes, N, 2013 ............................. 70

Figure 10: 7MM, Sex-Specific Hospitalized Incident Cases of ACS, Ages ≥25 Years, N, 2013 ...................... 72

Figure 11: 7MM, Hospitalized Incident Cases of ACS Segmented by STEMI, NSTEMI, and UA, Ages ≥25

Years, Both Sexes, N, 2013 ........................................................................................................ 74


Table of Contents


Figure 12: 7MM, Survival of Hospitalized Incident Cases of ACS, Ages ≥25 Years, Both Sexes, %, 2013 ..... 75

Figure 13: 7MM, Age-Specific Survival of Hospitalized Incident Cases of ACS, Both Sexes, %, 2013 ........... 77

Figure 14: 7MM, Age-Standardized Incidence of ACS (Cases per 100,000 Population), Ages ≥25 Years, 2013

................................................................................................................................................... 79

Figure 15: 6MM, Diagnosed Prevalent Cases of MI, Ages ≥25 Years, Both Sexes, N, 2013–2023 ................ 80

Figure 16: 6MM, Diagnosed Prevalent Cases of MI Segmented by STEMI and NSTEMI, Ages ≥25 Years,

Both Sexes, N, 2013 ................................................................................................................... 82

Figure 17: 6MM, Age-Specific Diagnosed Prevalent Cases of MI, Both Sexes, N, 2013 ................................ 83

Figure 18: 6MM, Sex-Specific Diagnosed Prevalent Cases of MI, Ages ≥25 Years, N, 2013 ......................... 85

Figure 19: 6MM, Age-Standardized Diagnosed Prevalence of MI, Ages ≥25 Years, %, 2013 ........................ 86



Introduction

2 Introduction

2.1 Catalyst

Acute coronary syndrome (ACS) is a serious cardiovascular disease associated with high

healthcare costs, frequent recurrences and hospitalizations, and high risks of sudden death and

short-term mortality. The ACS incidence increases with age and will be a significant public health

problem as the elderly population increases around the world. ACS is classified into three disease

entities based on evidence of heart muscle damage inferred from a person’s symptoms, changes in

the ST-tracing of the electrocardiogram (ECG), and levels of cardiac biomarkers that signify heart

muscle death: ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction

(NSTEMI), and unstable angina (UA). These three disease entities differ in their clinical

characteristics, treatment approaches, and survival probabilities.

The epidemiology of ACS in the 7MM has changed significantly during the past two decades and

varies between the western and Japanese markets. In order to capture the country-specific trends

and provide detailed patient population segmentation, GlobalData epidemiologists built separate

forecasts for (myocardial infarction) (MI) and UA in the 7MM and used a case-flow methodology to

determine the number of cases that survived until hospital discharge and for one year after hospital

discharge. Key results of the forecast are the following:

In the 7MM, the hospitalized incident cases of ACS will increase from 1.29 million cases in

2013 to 1.47 million cases in 2023 at the rate of 1.40% per year.

More ACS cases in the 7MM occurred in men (58.15%) than in women (41.85%).

For the 7MM, about 33% of the ACS cases were STEMI, 44% were NSTEMI, and 23% were

UA. The proportions varied depending on the market.



Introduction

2.3 Upcoming Reports

GlobalData (2014). PharmaPoint: Acute Coronary Syndrome Global Drug Forecast and Market

Analysis to 2023


Appendix


4.3 About GlobalData

GlobalData is a leading global provider of business intelligence in the healthcare industry.

GlobalData provides its clients with up-to-date information and analysis on the latest developments

in drug research, disease analysis, and clinical research and development. Our integrated business

intelligence solutions include a range of interactive online databases, analytical tools, reports, and

forecasts. Our analysis is supported by a 24/7 client support and analyst team.

GlobalData has offices in New York, San Francisco, Boston, London, India, Korea, Japan,

Singapore, and Australia.

4.4 About EpiCast

EpiCast is a series of premier epidemiology reports written and developed by Master’s-

and PhD-level epidemiologists.

EpiCast Reports are in-depth, high-quality, transparent, and market-driven, providing expert

analysis of epidemiological trends and forecasting of patient populations for major markets.

Specifically, the reports identify disease trends over a 10-year forecast period in six to seven major

markets (US, France, Germany, Italy, Spain, UK, and Japan). Additional countries, such as

Canada, Brazil, China, and India, are covered in these reports if their markets are highly relevant.


Appendix


4.5 Disclaimer

All Rights Reserved.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any

form by any means, electronic, mechanical, photocopying, recording or otherwise without the prior

permission of the publisher, GlobalData. The facts of this report are believed to be correct at the

time of publication, but cannot be guaranteed. Please note that the findings, conclusions, and

recommendations that GlobalData delivers will be based on information gathered in good faith from

both primary and secondary sources, whose accuracy we are not always in a position to

guarantee. As such, GlobalData can accept no liability whatever for actions taken based on any

information that may subsequently prove to be incorrect.

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