A “significantly” lower percentage of patients have died from heart attacks and other cardiovascular diseases in Malta over the last decade – even though it remains the leading cause of death in the country and worldwide.
The drop in fatalities may be due to increased early interventions, according to a recent study that analysed coronary procedures at Mater Dei Hospital over the last five years.
In 2013, 40 per cent of all deaths in Malta were attributed to cardiovascular causes. By 2023, this had dropped to 29 per cent. Heart attacks, which accounted for 21.7 per cent of total deaths 12 years ago, declined to 13.9 per cent in 2023, according to the hospital’s Cardiology Department.
The department’s chairman, consultant cardiologist Andrew Cassar Maempel, revealed the figures to Times of Malta after data presented in parliament last month confirmed cardiovascular diseases remained the leading cause of death in Malta in 2023.
Heart-related illnesses resulted in 1,168 fatalities out of 4,033 patients. Cancer ranked as the second major cause.
Picking up illness earlier
An analysis of coronary interventions at Mater Dei Hospital between 2019 and 2024 found an increase in preventative interventions like elective angiograms and stents, but a slight decline in emergency procedures known as primary percutaneous interventions.
During the five-year study period, a median of 1,394 coronary angiograms were performed each year, mostly on male patients (70.3%) with an average age of 65.6. A median of 559 stent procedures were conducted each year, again predominantly on male patients (80.1%) with a median age of 66.
But for primary percutaneous interventions – emergency procedures such as artery unblocking – a median of 365 operations were carried out annually, with a male predominance of 78.4% and a median age of 63. This suggests that patients suffering from acute chest pain are being diagnosed and treated earlier.
Consultant cardiologists Caroline Magri and Bernard Borg led the study, which suggested that patients suffering from angina (severe chest pain) are being identified at an earlier stage.
The fact that the number of urgent interventions to unblock arteries in potential fatal heart attacks has not continued to rise also meant a lower incidence of heart failure, said Magri, the research lead in the Office of the Medical Director. She attributed this to greater awareness about cardiac problems, with early referrals from GPs and decisions about the need for angiograms taken at outpatient stage, Magri said.
While the average patient age (around 65) and male predominance remained unchanged, the study found a significant change in the number of procedures performed. The study accounted for population growth over time.
I am seeing more younger patients with heart disease- Consultant cardiologist Caroline Magri
Coronary angiograms and stent procedures dropped in 2020 due to COVID-19 but gradually increased, with stent use peaking in 2024. Emergency heart attack interventions also declined during the pandemic, rebounded in 2021, but have since fallen below pre-COVID levels. Further follow-up is needed to see if this trend continues, Magri said.
“But what is happening is that we are doing many more interventions, including many more angiograms, whereby the arteries are looked into to decide whether to take action, such as putting in stents to open up artery paths and keep them open,” Magri explained. “More interventions mean more people are being treated, and not necessarily more illness.”
Living longer through interventions
Cardiovascular diseases account for about a third of all global deaths. However, life expectancy in Malta is higher than the rest of Europe, estimated at 81.8 years as opposed to 76.3.
“The findings could explain the higher longevity of the Maltese compared to the rest of Europe,” Magri said. “They are being kept alive longer through interventions. But of course, prevention is still necessary.”
Asked whether cancer might overtake heart disease as the leading cause of death, Magri pointed out that both illnesses share common risk factors, including unhealthy lifestyles. Oncology treatment can also contribute to cardiovascular disease, meaning both will likely remain the leading causes of death.
“The population is not the healthiest,” she continued, listing weight gain, diabetes and hypertension among the increasing prevalence of risk factors, leading to the slow occlusion of arteries. Other major risk factors include smoking, lack of exercise, poor diet and stress.
Substance abuse is another growing cause for concern. Magri said she is seeing more cases of patients in their 30s, with a link between drugs and heart disease. Drugs do not only obstruct the vessels, but they could also cause spasms that could lead to a heart attack, she said.
“These cases may still be rare, but I am seeing more younger patients with heart disease than before. It is an eye-opener when you see a 36-year-old with heart problems,” she said. “We need to be aware that it is not just about smoking. Drug abuse can also lead to an increase in cardiovascular disease in younger generations.”
New consultants and a split in specialisations
Last year, two new consultants joined Mater Dei’s Cardiology Department, bringing the total to 16. The first consultant specialising in heart failure is in the process of being recruited, Cassar Maempel said.
Cardiology consultants have expanded their services into primary care, serving at the Mosta health centre and St Vincent de Paul residence.
Magri highlighted a recent division in specialisations between interventional, electrophysiology and clinical cardiologists, allowing for more efficient operations. Six interventional cardiology consultants now focus fully on angiograms, stents and valves, while the clinical team manages outpatients and echocardiograms.