ATLANTA — The proportion of deaths caused by myocardial infarction that happen before patients are in transit to a hospital or clinic has climbed steadily in the past decade.
Overall myocardial infarction mortality in the United States decreased impressively from 192,898 deaths in 2000 to 141,462 deaths in 2006. That is a decline in rate from 70.1 to 47.2 per 100,000 population.
But at the same time, the proportion of all myocardial infarction deaths that occurred before transport rose from 37.3% to 42.4%, a 13.7% increase over those 7 years, Dr. Shifan Dai reported at the meeting.
These pretransport deaths are a reflection of a lack of progress in educating the public to recognize the early signs and symptoms of a heart attack and to call for emergency assistance in a timely way. The implication is that the past decade's progress in coronary prevention and more effective treatment has not been matched by gains in the earliest, pretransport stage. A new and more effective public health education effort is clearly needed, according to Dr. Dai of the Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta.
The increase in the proportion of MI deaths that occur pretransport has affected Americans of all races, ages, and geographic locations. But there are variations warranting further investigation. For example, Hispanics had a 28.4% increase in the proportion of pretransport MI deaths, more than twice the national average. In Idaho, the increase was 65%, while in District of Columbia it was just under 20%.
There was also a large age-based difference in the increase in the percentage of MI deaths occurring before transport. That proportion climbed by 24.7% in individuals under age 65, by 21.5% in those aged 61–74, by 14.4% in those 75–84, and by 4.5% in the 85-and-older population.
This analysis was carried out using National Vital Statistics System mortality data.
Dr. Dai reported having no financial conflicts.