Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan
Background:There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.Methods and Results:In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ish...
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| Veröffentlicht in: | Circulation Journal 2018/05/25, Vol.82(6), pp.1666-1674 |
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| creator | Masuda, Jun Kishi, Mikio Kumagai, Naoto Yamazaki, Toru Sakata, Kenji Higuma, Takumi Ogimoto, Akiyoshi Dohi, Kaoru Tanigawa, Takashi Hanada, Hiroyuki Nakamura, Mashio Sokejima, Shigeru Takayama, Morimasa Higaki, Jitsuo Yamagishi, Masakazu Okumura, Ken Ito, Masaaki |
| description | Background:There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.Methods and Results:In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P |
| doi_str_mv | 10.1253/circj.CJ-17-1275 |
| format | Article |
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Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001).Conclusions: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.</description><identifier>ISSN: 1346-9843</identifier><identifier>ISSN: 1347-4820</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-17-1275</identifier><identifier>PMID: 29593169</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Acute myocardial infarction ; Aged ; Ambulances ; Direct ambulance transport ; Emergency care ; Emergency Medical Services - standards ; Female ; Humans ; Japan ; Male ; Middle Aged ; Myocardial Infarction - therapy ; Onset-to-balloon time ; Percutaneous Coronary Intervention ; Registries ; Rural Health Services - standards ; Rural vs. metropolitan ; Time-to-Treatment - standards ; Urban Health Services - standards</subject><ispartof>Circulation Journal, 2018/05/25, Vol.82(6), pp.1666-1674</ispartof><rights>2018 THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c713t-c33fa5befcb21477dd63bf48c2bd3c62dafbf16fe5df9f5b96179b4314990acc3</citedby><cites>FETCH-LOGICAL-c713t-c33fa5befcb21477dd63bf48c2bd3c62dafbf16fe5df9f5b96179b4314990acc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1877,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29593169$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Masuda, Jun</creatorcontrib><creatorcontrib>Kishi, Mikio</creatorcontrib><creatorcontrib>Kumagai, Naoto</creatorcontrib><creatorcontrib>Yamazaki, Toru</creatorcontrib><creatorcontrib>Sakata, Kenji</creatorcontrib><creatorcontrib>Higuma, Takumi</creatorcontrib><creatorcontrib>Ogimoto, Akiyoshi</creatorcontrib><creatorcontrib>Dohi, Kaoru</creatorcontrib><creatorcontrib>Tanigawa, Takashi</creatorcontrib><creatorcontrib>Hanada, Hiroyuki</creatorcontrib><creatorcontrib>Nakamura, Mashio</creatorcontrib><creatorcontrib>Sokejima, Shigeru</creatorcontrib><creatorcontrib>Takayama, Morimasa</creatorcontrib><creatorcontrib>Higaki, Jitsuo</creatorcontrib><creatorcontrib>Yamagishi, Masakazu</creatorcontrib><creatorcontrib>Okumura, Ken</creatorcontrib><creatorcontrib>Ito, Masaaki</creatorcontrib><title>Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>Background:There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.Methods and Results:In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001).Conclusions: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.</description><subject>Acute myocardial infarction</subject><subject>Aged</subject><subject>Ambulances</subject><subject>Direct ambulance transport</subject><subject>Emergency care</subject><subject>Emergency Medical Services - standards</subject><subject>Female</subject><subject>Humans</subject><subject>Japan</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - therapy</subject><subject>Onset-to-balloon time</subject><subject>Percutaneous Coronary Intervention</subject><subject>Registries</subject><subject>Rural Health Services - standards</subject><subject>Rural vs. metropolitan</subject><subject>Time-to-Treatment - standards</subject><subject>Urban Health Services - standards</subject><issn>1346-9843</issn><issn>1347-4820</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkDtPwzAURi0EolDYmVBGlhQ_8vJYhRZaFYEQna1rxy6u8sJOhv57-qJdfD2c7wwHoQeCR4TG7FlZp9ajfB6SNCQ0jS_QDWFRGkYZxZf7fxLyLGIDdOv9GmPKccyv0YDymDOS8Bv0-dU7KMOlk1AHL9a34Gy3CWwdTCrtVrpWmyAHpwPTuGCs-k4H75tGgSsslMGsNuBUZ5t6t5hDC_UdujJQen1_vEO0nE6-87dw8fE6y8eLUKWEdaFizEAstVGSkihNiyJh0kSZorJgKqEFGGlIYnRcGG5iyROSchkxEnGOQSk2RE8Hb-ua3177TlTWK12WUOum94JiwjOCSUa3KD6gyjXeO21E62wFbiMIFruOYt9R5HNBUrHruJ08Hu29rHRxGvyH2wLTA7D2Haz0CQDXWVXqozGjItk9Z_MZ-AEndM3-AL70iWo</recordid><startdate>20180525</startdate><enddate>20180525</enddate><creator>Masuda, Jun</creator><creator>Kishi, Mikio</creator><creator>Kumagai, Naoto</creator><creator>Yamazaki, Toru</creator><creator>Sakata, Kenji</creator><creator>Higuma, Takumi</creator><creator>Ogimoto, Akiyoshi</creator><creator>Dohi, Kaoru</creator><creator>Tanigawa, Takashi</creator><creator>Hanada, Hiroyuki</creator><creator>Nakamura, Mashio</creator><creator>Sokejima, Shigeru</creator><creator>Takayama, Morimasa</creator><creator>Higaki, Jitsuo</creator><creator>Yamagishi, Masakazu</creator><creator>Okumura, Ken</creator><creator>Ito, Masaaki</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20180525</creationdate><title>Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan</title><author>Masuda, Jun ; Kishi, Mikio ; Kumagai, Naoto ; Yamazaki, Toru ; Sakata, Kenji ; Higuma, Takumi ; Ogimoto, Akiyoshi ; Dohi, Kaoru ; Tanigawa, Takashi ; Hanada, Hiroyuki ; Nakamura, Mashio ; Sokejima, Shigeru ; Takayama, Morimasa ; Higaki, Jitsuo ; Yamagishi, Masakazu ; Okumura, Ken ; Ito, Masaaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c713t-c33fa5befcb21477dd63bf48c2bd3c62dafbf16fe5df9f5b96179b4314990acc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acute myocardial infarction</topic><topic>Aged</topic><topic>Ambulances</topic><topic>Direct ambulance transport</topic><topic>Emergency care</topic><topic>Emergency Medical Services - standards</topic><topic>Female</topic><topic>Humans</topic><topic>Japan</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - therapy</topic><topic>Onset-to-balloon time</topic><topic>Percutaneous Coronary Intervention</topic><topic>Registries</topic><topic>Rural Health Services - standards</topic><topic>Rural vs. metropolitan</topic><topic>Time-to-Treatment - standards</topic><topic>Urban Health Services - standards</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Masuda, Jun</creatorcontrib><creatorcontrib>Kishi, Mikio</creatorcontrib><creatorcontrib>Kumagai, Naoto</creatorcontrib><creatorcontrib>Yamazaki, Toru</creatorcontrib><creatorcontrib>Sakata, Kenji</creatorcontrib><creatorcontrib>Higuma, Takumi</creatorcontrib><creatorcontrib>Ogimoto, Akiyoshi</creatorcontrib><creatorcontrib>Dohi, Kaoru</creatorcontrib><creatorcontrib>Tanigawa, Takashi</creatorcontrib><creatorcontrib>Hanada, Hiroyuki</creatorcontrib><creatorcontrib>Nakamura, Mashio</creatorcontrib><creatorcontrib>Sokejima, Shigeru</creatorcontrib><creatorcontrib>Takayama, Morimasa</creatorcontrib><creatorcontrib>Higaki, Jitsuo</creatorcontrib><creatorcontrib>Yamagishi, Masakazu</creatorcontrib><creatorcontrib>Okumura, Ken</creatorcontrib><creatorcontrib>Ito, Masaaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Masuda, Jun</au><au>Kishi, Mikio</au><au>Kumagai, Naoto</au><au>Yamazaki, Toru</au><au>Sakata, Kenji</au><au>Higuma, Takumi</au><au>Ogimoto, Akiyoshi</au><au>Dohi, Kaoru</au><au>Tanigawa, Takashi</au><au>Hanada, Hiroyuki</au><au>Nakamura, Mashio</au><au>Sokejima, Shigeru</au><au>Takayama, Morimasa</au><au>Higaki, Jitsuo</au><au>Yamagishi, Masakazu</au><au>Okumura, Ken</au><au>Ito, Masaaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2018-05-25</date><risdate>2018</risdate><volume>82</volume><issue>6</issue><spage>1666</spage><epage>1674</epage><pages>1666-1674</pages><issn>1346-9843</issn><issn>1347-4820</issn><eissn>1347-4820</eissn><abstract>Background:There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.Methods and Results:In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001).Conclusions: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.</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>29593169</pmid><doi>10.1253/circj.CJ-17-1275</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute myocardial infarction Aged Ambulances Direct ambulance transport Emergency care Emergency Medical Services - standards Female Humans Japan Male Middle Aged Myocardial Infarction - therapy Onset-to-balloon time Percutaneous Coronary Intervention Registries Rural Health Services - standards Rural vs. metropolitan Time-to-Treatment - standards Urban Health Services - standards |
| title | Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan |
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