The MONICA project also investigated patterns and trends in case fatality. Case fatality is defined by the MONICA project as dying within 28 days of a coronary event. Case fatality rates are affected by many factors including the accuracy of diagnosis, the severity of the disease and the impact of treatment. The MONICA project shows that case fatality from CHD is higher in many populations in Central and Eastern Europe than in most populations in Northern, Southern and Western Europe. For example case fatality for men aged 35 to 64 living in Moscow (Russia) is 50% higher than in Belfast (United Kingdom) or in Catalonia (Spain).

The results of the MONICA project also show that case fatality is falling in most of the MONICA project populations in Southern, Northern and Western Europe but is not falling as fast in the populations in Central and Eastern Europe and in some cases is rising in these populations. For example case fatality for women aged 35 to 64 living in Toulouse (France) fell by 3.6% per year over the study period; over the same period the case fatality rate for women in Moscow increased by an average of 1.5% per year.

The MONICA project was partly established to investigate how much of reported declines in CHD mortality are attributable to improvements in case fatality and how much to declines in incidence. The project concludes that the ‘contribution to changing CHD mortality varied, but in populations in which mortality decreased, coronary-event rates contributed two thirds and case fatality one third’.

Patterns of CHD incidence and case fatality across Europe may have changed since the mid 1990s. Furthermore, the definition of myocardial infarction (heart attack) has changed following the introduction of troponin estimations which have increased the ability to detect myocardial infarction.