The American journal of cardiology
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Multicenter Study
Incidence of emergency department visits for ST-elevation myocardial infarction in a recent six-year period in the United States.
The incidence and longitudinal trends of patients with ST-elevation myocardial infarction (STEMI) presenting to United States (US) 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 from 2006 to 2011 using the Nationwide ED Sample, the largest source of US ED data, to determine the incidence of patients with STEMIs presenting to the US EDs. ⋯ In conclusion, we report the first national estimates of STEMI presentation to US EDs, which demonstrate decreasing incidence across all age groups and all geographic regions from 2006 to 2011. A decreasing STEMI incidence may affect the quality and timeliness of STEMI care. Continued national STEMI surveillance is needed to guide healthcare resource allocation.
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Multicenter Study
Outcomes of patients calling emergency medical services for suspected acute cardiovascular disease.
Adequate health care is increasingly dependent on prehospital systems and cardiovascular (CV) disease remains the most common cause for hospital admission. However the prevalence of CV dispatches of emergency medical services (EMS) is not well reported and survival data described in clinical trials and registries are subject to selection biases. We aimed to describe the prevalence and prognosis of acute CV disease and the effect of invasive treatment, in an unselected and consecutive prehospital cohort of 3,410 patients calling the national emergency telephone number from 2005 to 2008 with follow-up in 2013. ⋯ Survival in 447 out-of-hospital cardiac arrest patients (13.1%) was 11.6% at 30 days. In conclusion, patients with a CV ambulance alarm call code and a final CV discharge diagnosis constitute most patients handled by EMS with an extremely elevated short-term mortality hazard and a poor long-term prognosis. Although co-morbidities and frailty may influence triage, this study emphasizes the need for an efficient prehospital phase with focus on CV disease and proper triage of patients suitable for invasive evaluation if the outcomes of acute heart disease are to be improved further in the current international context of hospitals merging into highly specialized entities resulting in longer patient transfers.