Introduction: Ischemic heart disease (IHD) has been the leading cause of mortality in the Republic of Croatia (RoC) for years. (1, 2) During the year 2017, 11,069 persons died of IHD. (3) Analyzing the time series of mortality of acute myocardial infarction (AMI), which is the leading manifestation of IHD, the aim of this paper is to show the trends of mortality and in-patient treatment of this disease in the RoC.

Methods: The analysis of the data of the Croatian Bureau of Statistics and the Croatian Public Health Institute on mortality of AMI (diagnosis I21 according to ICD-10 classification of the disease) during the period from 2001 to 2016 has been made at the level of the RoC and the counties. Age-standardized death rates (ASDR) were calculated based on population estimates for each year. In order to present the rates as realistic as possible, the standardization was performed on the 2011 Census of the RoC. The data on the frequency of in-patient treatment for the diagnosis I21 has been analyzed for the period from 2009 to 2016, when the hospital system used DTS (diagnostic and therapeutic system) as the only and official way of recording, accounting and invoicing medical services in hospital healthcare system.

Results: During the observed period, a continuous decline in ASDR of AMI (Figure 1) has been observed. In 2001, ASDR of AMI was 114.71 in the City of Zagreb, similar to that in region of ​​the RoC (117.69), while this rate was considerably higher in the County of Zagreb and was 171.28/100,000 inhabitants. In 2016, ASDR of AIM significantly decreased and accounted for 85.97 for the County of Zagreb, while ASDR was 75.79 for the RoC, and ASDR accounted for 50.90/100,000 inhabitants for the City of Zagreb (Table 1). In 2016, the lowest ASDR of AMI was recorded in the County of Dubrovnik and Neretva (37.85) and County of Split and Dalmatia (49.32), while ASDR of AMI was highest in Varaždin (119.98) and County of Osijek and Baranja (117.65/100,000 inhabitants). Analyzing the changes to ASDR of AMI for the year 2016 compared to those in 2001 by to the Croatian counties (Table 2), the highest decrease in ASDR by 55.62% was recorded in the City of Zagreb and by 49.81% in the County of Zagreb, while ASDR of AMI decreased by 35.60% during the same period in the Republic of Croatia. The frequency of in-patient treatment of AMI in the RoC during the period from 2009 to 2016 significantly increased (41.5%) in all Croatian counties (Figure 2).

Conclusion: The combined approach to adhering to prescribing the therapy according to the guidelines is an available and timely intervention in AMI in the Croatian Primary Percutaneous Coronary Intervention Network (4), that when accompanied by numerous scientific and professional activities and preventive and promotional programs has resulted in better AMI outcomes. The decline in mortality by 35% has been recorded in the observed period, while the number of hospitalizations rose.