Abstract 14834: A Nationwide Survey of the Effects of the Accessibility of Emergency Medical Systems on Cardiovascular Mortality
Objective: Rapid emergency cardiovascular care for patients with acute cardiac diseases is necessary for better prognoses, especially with acute myocardial infarctions. To decrease the time until treatment, emergency medical systems (EMSs) and cardiovascular emergency (CE) hospitals cover wide areas in Japan with universal coverage of medical insurance. We examined the influence of the accessibility to EMS on cardiovascular mortality in Japan (population, 128 million; area, 378 × 103 km2).
Methods: We specified the CE hospitals that were capable of treating acute myocardial infarctions with reperfusion therapies. Average ambulance transfer time was measured by an electric map, which determined the transfer time from their public office to the nearest CE hospital. Cardiovascular mortality was calculated by the national census of 2005 and the demographic death data of 2007 specified by the ICD-10. The Standardized Mortality Ratio (SMR) in each city was adjusted by age and gender. The influences of transfer time, number of CE hospitals, and the percent of habitable area on the log SMR were determined by a linear regression weighted by the number of deaths.
Results: There were 1,864 cities and 1,998 CE hospitals. The transfer time was [median (range)] 13 (1-252) min, the percent of habitable area was 0.45 (0.02-1.00), and the SMR was 1.02 (0-2.48). Longer transfer times, less CE hospitals, and a lower percent of habitable area increased SMR (Table). High-risk cities consisting of no CE hospitals, transfer time ≥ 30 min, and habitable area < 50% were frequently distributed on mountainous areas and peninsulas.
Conclusion: Cardiovascular mortality increased according to the inaccessibility to EMS combined with transfer time, the existence of CE hospital, and geographical livability. These variations should be taken into account to break down inappropriate EMS disparities with various ways, such as a mobile telemedicine system with direct transmission of 12-lead ECG.
- © 2011 by American Heart Association, Inc.