Since the late 1970s there has been a decline in cardiovascular mortality in the Netherlands. In recent years, the number of hospital admissions due to cardiovascular disease has decreased, whereas short-stay admissions and outpatients' visits are increasing. One explanation for this phenomenon, suggested by Koek et al. in this issue, is the limited availability and closure of hospital beds in recent years. However, there are other possible reasons for the decrease in cardiovascular mortality. First of all, there has been a substantial improvement in survival following acute myocardial infarction, mainly as a result of advances in the treatment. As all patients with an acute myocardial infarction are admitted anyway, the observed decrease in hospital admissions due to acute myocardial infarction reflects a decrease in the incidence as opposed to a decrease in the availability of hospital beds. Secondly, primary preventive measures aimed at modifying risk factors have been shown to result in a clear decrease in cardiovascular mortality. Lastly, mortality and morbidity due to chronic cardiovascular disease, such as heart failure, have decreased significantly. The range of options to adequately treat this category of patients has expanded considerably with, for example, the introduction of new drugs and biventricular pacemakers. There are many factors, other than the closure of hospital beds, which could explain the observed decline in the number of admissions due to cardiovascular disease.