Public Health Briefs The New Old Epidemic of Coronary Heart

Coronary heart disease (CHD) is the leading cause of death in the Netherlands, as in the rest of the world. ' The costs for CHD are increasing rapidly, faster than medical costs for other causes in the Netherlands.2 Part of this increase seems to be the result of expanding health care needs. Mortality rates are declining steeply, but hospital admission rates are increasing.3 As more patients sur-vive acute myocardial infarction, more are eligible for intervention or remain at risk for recurrent infarction or congestive heart failure.4 In this study we estimated the changing prevalence of CHD as a consequence of the changing disease history. An incidence-prevalence-mortality model describes a sim-plified CHD history: flows of incidence and mortality determine pools of surviving patients.5 We will show that the decreasing CHD mortality is causing hospital admission rates to rise and quantify the resulting marked increase in the prevalence of sur-vivors