Medical Research: What is the background for this study? What are the main findings?
Dr. Ward: The number of Americans living with cardiovascular disease is only expected to increase in the coming years. However, we do not know the national effects of increased medication use and preventive efforts to stop the most serious form of a heart attack, called an ST-elevation myocardial infarction (STEMI). In particular, there are no estimates of how often this serious form of a heart attack shows up in the emergency department.
Between 2006 and 2011 we found an average of 258,000 STEMIs annually in the U.S. or 8.7 per 10,000 U.S. adults per year. Interestingly, the number of STEMIs has decreased by more than 70,000 per year over this time, a 24% reduction. We found similar annual decreases across every age group and geographic region in the U.S. The decreases were most pronounced among those 85 years and older and in the Midwest.
Medical Research: What should clinicians and patients take away from your report?
Dr. Ward: These are the first national estimates of STEMI presentation to U.S. emergency departments and we found that emergency department visits for STEMI are decreasing across the board. This is very good news for patients. Prevention (in the form of medication) likely plays a central role in our findings. As fewer STEMIs present to U.S. emergency departments, this could change the role emergency departments play in the management of this time-sensitive condition. Clinical providers both in the emergency department and cardiology may also be less experienced in caring for patients with these severe heart attacks as fewer patients present to U.S. hospitals with a STEMI.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Ward: Future studies should focus on how the emergency department’s role changes as the number of STEMIs decrease. Further exploration is also needed to understand how scarce healthcare dollars should be allocated-to acute emergency care or to preventive efforts. Last, does the decrease in number of STEMIs affect clinical training and experience for physicians who must care for patients with STEMI and does that affect patient outcomes.
American Journal of Cardiology and presented at the national American Heart Association meeting in Chicago this November 2014.