To estimate the trends in- and out-hospital coronary heart disease (CHD) mortality rates from 2000 to 2016 and their respective proportions in total mortality using data of the three French CHD registries (Strasbourg, Toulouse, Lille).

All fatal myocardial infarction (MI), coronary deaths (CD) and sudden deaths occurring between January 1st, 2000 and December 31st of 2016, were recorded for patients aged 35 to 74 years.

A total of 20,818 events were recorded in the three registers, of which 69.4% were out-of-hospital. Age- and region-adjusted CHD mortality rate decreased with an annual percentage change (APC) of -3.6% in men and -3.9% in women. This significant decrease was approximately twice as high for in-hospital deaths compared to out-of-hospital deaths (P<10⁻⁵ for both). While the out-of-hospital death rate represented 63.6% of the standardized total CHD mortality rate in 2000 for men, it was 70.1% in 2016. For women, these parts were respectively 63.9% and 70.5%. In men aged 35 to 54, the APC was twice higher for out-of-hospital deaths (-3.0%, P<10⁻³) than for in-hospital deaths (-1.5%, P=0.01) whereas the opposite was observed in men aged 55 to 74 (-1.4% P=0.01 vs -5.2% P<10⁻⁵, respectively) (Table 1).

More than two-thirds of the deaths from CHD occurred outside the hospital. The CHD mortality rates significantly decreased during the 2000-2016 period, for both genders. However, this decline was slighter for out-of-hospital deaths than for in-hospital deaths, pointing out the need to strengthen primary and secondary prevention of CHD.