[Increasing Mortality from Cardiac Arrhythmia in Germany?].

BACKGROUND

The 'Deutscher Herzbericht 2016' [German Heart Report] reported a strongly increasing mortality rate from cardiac arrhythmia in Germany from 1990 to 2014. The increase was higher in women than in men and was rated as 'paradoxical' in light of improved diagnostic and therapeutic procedures. The aim of this paper is to explore the mortality data for cardiac arrhythmias in detail and to generate an explanatory approach.

METHODS

We extracted the number of deaths from cardiac arrhythmia (ICD-10 codes I44-I49) for each sex, 5-year-age group and each federal state for 2000-2014 (www.gbe-bund.de). Crude as well as age-specific and age-standardized (standard: Germany census 2011) mortality rates were calculated.

RESULTS

While the crude mortality rates increased considerably between 2000 and 2014 (men: 18 to 26, women: 23 to 38 pro 100,000), the age-standardized mortality rates showed only a small increase (men: 31 to 32, women: 22 to 27 per 100,000 person years). This increase was attributable to an increasing mortality rate from atrial fibrillation and flutter (ICD-10: I48) in men and women aged 80 years and older. In younger age groups and in other subgroups of cardiac arrhythmia, no relevant increases were seen.

CONCLUSION

The increase of mortality rates from cardiac arrhythmia as reported in 'Deutscher Herzbericht 2016' is largely attributable to the demographic changes in the German population. After age-standardization, there still remains an increase in the mortality rates, but this is smaller. From an epidemiologic perspective, it is a common problem in the interpretation involving crude mortality data. Moreover, the validity of mortality rates for cardiac arrhythmia is limited due to several reasons.