Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan

Masuda, Jun; Kishi, Mikio; Kumagai, Naoto; Yamazaki, Tōru; Sakata, Kenji; Higuma, Takumi; Ogimoto, Akiyoshi; Dohi, Kaoru; Tsuruo, Takashi; Hanada, Hiroyuki; Nakamura, Mashio; Sokejima, Shigeru; Takayama, Morimasa; Higaki, Jitsuo; Yamagishi, Masakazu; Okumura, Ken; M, Ito

doi:10.1253/circj.cj-17-1275

Cited by 37 publications

(28 citation statements)

References 20 publications

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“…In this context, Masuda et al recently reported that AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in longer time from onset to PCI, compared with those in metropolitan areas. 6 The present study conducted by Matsuzawa et al 1 also suggests higher in-hospital mortality rates among AMI patients who live in areas with lower population density than for those who live in high-…”

supporting

confidence: 55%

Rural Health Disparities in Japan　― Urgent Need for Big Data Utilization and Health Service Research ―

Maeda

Arima

2020

Circ J

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supporting

confidence: 55%

Rural Health Disparities in Japan　― Urgent Need for Big Data Utilization and Health Service Research ―

Maeda

Arima

2020

Circ J

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“…The design of the study and its main results have been published previously. 9 Briefly, the Rural AMI Registry study prospectively enrolled patients with AMI who were hospitalized within 7 days from onset between January 2013 and March 2014; 41 hospitals in Japan took part in the study. In the present study, the diagnosis of AMI was based on the third universal definition of myocardial infarction (MI).…”

Section: Study Populationmentioning

confidence: 99%

Comparison of Door-to-Balloon Time and 30-Day Mortality According to Symptom Presentation in Patients With Acute Myocardial Infarction

et al. 2021

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Background: We hypothesized that symptom presentation in patients with acute myocardial infarction (AMI) may affect their management and subsequent outcome. Methods and Results: Using Rural AMI Registry data, 1,337 consecutive patients with AMI who underwent percutaneous coronary intervention were analyzed. Typical symptoms were defined as any symptoms of chest pain or pressure due to myocardial ischemia. We considered the specific symptoms of dyspnea, nausea, or vomiting as atypical symptoms. The primary outcome was 30-day mortality. There were 150 (11.2%) and 1,187 (88.8%) patients who presented with atypical and typical symptoms, respectively. Those who presented with atypical symptoms were significantly older (mean [±SD] age 74±12 vs. 68±13 years; P<0.001) and had a higher Killip class (46.7% vs. 21.8%; P<0.001) than patients presenting with typical symptoms. The prevalence of door-to-balloon time of ≤90 min was significantly lower in patients with atypical than typical symptoms (40.0% vs. 66.3%; P<0.001). At 30 days, there were 55 incidents of all-cause death. Multivariate Cox proportional hazards regression analysis revealed that symptom presentation was associated with 30-day mortality (hazard ratio 2.33; 95% confidence interval 1.20–4.38; P<0.05). Conclusions: Atypical symptoms in patients with AMI are less likely to lead to timely reperfusion and are associated with increased risk of 30-day mortality.

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“…However, pre-hospital 12-lead ECG was not officially introduced to the local EMS in Saitama City during the study period. There were significant differences in the quality of care for patients with AMI between rural areas and metropolitan areas [ 22 ]. Our results may not be applicable to other areas in Japan, because our results could be justified only when equivalent pre-hospital judgments are made by the EMS providers in the other areas.…”

Section: Discussionmentioning

confidence: 99%

Comparison of in-hospital death following ST-elevation myocardial infarction between secondary emergency and tertiary emergency

Yoshida

Sakakura

Yamamoto

et al. 2020

Cardiovasc Interv and Ther

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In most areas in Japan, patients with ST-elevation myocardial infarction (STEMI) would be transferred to the secondary hospitals or tertiary hospitals according to the judgement of emergency medical service (EMS) staff members. We hypothesized that in-hospital outcomes would be worse in STEMI patients judged as tertiary emergency than in those judged as secondary emergency, which may support the judgement of the current EMS systems. The purpose of this study was to compare in-hospital outcomes of STEMI between patients judged as secondary emergency and those judged as tertiary emergency. We included 238 STEMI patients who were transferred to our institution using EMS hotline, and divided those into the secondary emergency group ( n = 106) and the tertiary emergency group ( n = 132). The primary endpoint was in-hospital death. The prevalence of shock was significantly higher in the tertiary emergency group than in the secondary emergency group (32.6% vs. 10.4%, p < 0.001). The GRACE score was significantly higher in the tertiary emergency group than the secondary emergency group [146 (118–188) vs. 134 (101–155), p < 0.001]. The incidence of in-hospital death was significantly higher in the tertiary emergency group than in the secondary emergency group (8.0% vs. 2.1%, p = 0.014). The multivariate logistic regression analysis revealed that the tertiary emergency was significantly associated with in-hospital death (OR 3.52, 95% CI 1.24–10.02, p = 0.018) after controlling age and gender. In conclusion, the tertiary emergency was significantly associated with in-hospital death. Our results might validate the judgement of levels of emergency by local EMS staff members.

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Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan

Abstract: AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in time delay to PPCI compared with those in metropolitan areas.

Cited by 37 publications

References 20 publications

Rural Health Disparities in Japan　― Urgent Need for Big Data Utilization and Health Service Research ―

Rural Health Disparities in Japan　― Urgent Need for Big Data Utilization and Health Service Research ―

Comparison of Door-to-Balloon Time and 30-Day Mortality According to Symptom Presentation in Patients With Acute Myocardial Infarction

Comparison of in-hospital death following ST-elevation myocardial infarction between secondary emergency and tertiary emergency

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Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan

Abstract: AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in time delay to PPCI compared with those in metropolitan areas.

Cited by 37 publications

References 20 publications

Rural Health Disparities in Japan ― Urgent Need for Big Data Utilization and Health Service Research ―

Rural Health Disparities in Japan ― Urgent Need for Big Data Utilization and Health Service Research ―

Comparison of Door-to-Balloon Time and 30-Day Mortality According to Symptom Presentation in Patients With Acute Myocardial Infarction

Comparison of in-hospital death following ST-elevation myocardial infarction between secondary emergency and tertiary emergency

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Rural Health Disparities in Japan　― Urgent Need for Big Data Utilization and Health Service Research ―

Rural Health Disparities in Japan　― Urgent Need for Big Data Utilization and Health Service Research ―