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STEMI Visits to EDs Decline, But Transfers Increase

NASHVILLE – It might be hard to believe as you look out on a packed waiting room, but emergency department visits actually are declining for one common presentation – ST-elevation myocardial infarction (STEMI), the most serious form of heart attack.

At the same time, rates of transfer to another ED increased for those patients, especially if they didn’t have health insurance.

The study on declines in STEMI visits, touted by researchers as the first of its kind, was presented at the annual meeting of the Society for Academic Emergency Medicine in San Diego.

The investigative team, led by Vanderbilt University researchers, conducted a descriptive epidemiological analysis of STEMI visits to EDs between 2006 through 2011 using the Nationwide Emergency Department Sample data. Included in the investigation were adult ED visits with a diagnosis of STEMI and calculated incidence rates for STEMI ED visits using U.S. census population data.

Results showed a 24% decrease: From 2006-11, there was a mean of 258,106 STEMIs presenting to EDs per year, decreasing from 300,466 in 2006 to 227,343 in 2011.

The study indicated that incidence of ED STEMI visits per 10,000 adults declined from 10.1 in 2006 to 7.3 in 2011, with the Midwest having the highest rate at 10.0 and the West with the lowest at 6.6.

Over the study period, the incidence of STEMI decreased for all age groups and regions.

“The reasons for the decline may include efforts to streamline angioplasty times by ED bypass, as well as greater use of effective treatments for cardiovascular disease," said Michael J. Ward, MD, assistant professor of Emergency Medicine at Vanderbilt. "The study is significant because these estimates play an essential role in hospital resource allocation strategies."

The presentation also pointed out that “efforts to streamline door-to-balloon times by ED bypass, as well as greater use of effective treatments for cardiovascular disease, may decrease ED STEMI presentation.”

In a separate analysis of the same data, which was also presented earlier this year, transfer rates of STEMI patients increased from 15% in 2006 to 20.6% in 2011. The study team found that patients without insurance were 60% more likely to be transferred when presenting to an ED with STEMI than patients with insurance.

Part of the problem, according to the authors, is that only 31% of U.S. hospitals have primary percutaneous coronary intervention (PCI) capabilities for STEMI patients.

Still, they conclude, “Controlling for other variables, having no medical insurance was independently associated with higher transfer rates compared with having private or government insurance. These results suggest that insurance status influences the location of care for patients presenting to the ED with STEMI.”