Incidence of Emergency Department Visits for ST-Elevation Myocardial Infarction in a Recent Six-Year Period in the United States

Abstract

The incidence and longitudinal trends of patients with ST-elevation myocardial infarction (STEMI) presenting to U.S. emergency departments (EDs) are currently unknown. Efforts to use effective treatments for cardiovascular disease may decrease ED STEMI presentation. We conducted a descriptive epidemiological analysis of STEMI visits to EDs between 2006 and 2011 using the Nationwide ED Sample (NEDS), the largest source of U.S. ED data, to determine the incidence of patients with STEMIs presenting to U.S. EDs. We included adult ED visits with an ICD-9CM diagnosis of STEMI and calculated incidence rates for STEMI ED visits using U.S. census population data. Incidence calculations were stratified by age group, geographic region, and year. From 2006–2011, there was a mean of 258,106 STEMIs presenting to EDs per year, declining from 300,466 in 2006 to 227,343 in 2011. Incidence of ED STEMI visits per 10,000 adults declined from 10.1 (95% CI 9.8, 10.8) in 2006 to 7.3 (95% CI 6.8, 7.8) in 2011. The Midwest had the highest rate of ED STEMIs at 10.0 (95% CI 9.2, 10.8) and the West had the lowest with 6.6 (95% CI 6.1, 7.0). The incidence of STEMI decreased for all age groups during the study period. In conclusion, we report the first national estimates of STEMI presentation to U.S. EDs, which demonstrate decreasing incidence across all age groups and all geographic regions between 2006 and 2011. A declining STEMI incidence may affect the quality and timeliness of STEMI care. Continued national STEMI surveillance is needed to guide healthcare resource allocation.

Erratum to: Shock in the emergency department; a 12 year population based cohort study

“…Whether increased awareness across etiologies during this period (surviving sepsis campaign and percutaneous coronary intervention of myocardial infarction) is of importance remains to be explored. However, the present finding suggests shock to be as frequent as an ED presentation of ST-elevation myocardial infarction [21]. As opposed to myocardial infarction, research investigating characteristics of ED shock have been limited [22].…”

Timeliness of interfacility transfer for ED patients with ST-elevation myocardial infarction

“…A study using the National Emergency Department Sample found that STEMI is decreasing in U.S. EDs. 30 How this affects timeliness performance as emergency providers see fewer STEMIs is unknown. However, less experience may result in more variability and subsequently more delays at referring EDs.…”

Red pill, blue pill: reflections on the emerging large vessel stroke ‘market’

“…The percentage of patients with ACS and STEMI is variably reported in different registries and ranges from 29% to 47% 1. Two other registries have reported an annual incidence of 73 and 77 STEMI cases per 100 000, respectively 2 3. Regardless of the slight variation, the incidence of STEMIs has been steadily decreasing over the past 20 years to as low as 23%,1 3 mainly owing to significant improvement in primary prevention efforts 1 3.…”