Epidemiology and Health

Review

Epidemiology of myocardial infarction in Korea: hospitalization incidence, prevalence, and mortality: Rock Bum Kim, Jang-Rak Kim, Jin Yong Hwang; Epidemiol Health. 2022;44:e2022057. Published online July 12, 2022; DOI: https://doi.org/10.4178/epih.e2022057

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Abstract

Few studies have comprehensively presented epidemiological indicators of myocardial infarction in Korea. However, multiple published articles and open-source secondary data on the epidemiology of myocardial infarction are now available. This review summarized the hospitalization incidence, prevalence, and mortality rate of myocardial infarction in Korea using articles and open-source data from the Health Insurance Service and the Department of Statistics, surveys of sample populations, registries of patients, and other sources. The epidemiological indicators of myocardial infarction were compared between Korea and other high-income countries. The incidence of hospitalization due to myocardial infarction in Korea was 43.2 cases per 100,000 population in 2016 and has consistently increased since 2011. It was 2.4 times higher among men than among women. The estimated prevalence among adults over 30 years of age ranged from 0.34% to 0.70% in 2020; it was higher among men and increased with age. The mortality in 2020, which was 19.3 per 100,000 population in 2020, remained relatively stable in recent years. Mortality was higher among men than among women. Based on representative inpatient registry data, the proportion of ST-elevated myocardial infarction decreased until recently, and the median time from symptom onset to hospital arrival was approximately 2 hours and 30 minutes. The hospitalization incidence, prevalence, and mortality rate of myocardial infarction were lower in Korea than in other countries, although there was an increasing trend. Comprehensive national-level support and surveillance systems are needed to routinely collect accurate epidemiological indicators.

Summary

Korean summary
○우리나라의 심근경색증 발생률은 2016년 기준 인구 10만명 당 43.2명으로 추정되며 2011년 이후 증가하고 있음. ○ 30세 이상 인구에서 심근경색증 유병률은 0.34% (건강보험청구데이터) 또는 1.0% (국민건강영양조사)로 추정됨. ○ 전체인구에서 심근경색증으로 인한 사망률은 2019년 인구 10만명 당 18.8명으로 최근 큰 변화가 없거나 약간 감소하는 추세임.

Key Message
This review article showed the hospitalized incidence, prevalence, mortality, and features on patient registry of myocardial infarction in Korea from published articles and opened data sources.

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Systematic review and meta-analysis of the intervention effect of curcumin on rodent models of myocardial infarction
Bing-Yao Pang, Ya-Hong Wang, Xing-Wang Ji, Yan Leng, Hou-Bo Deng, Li-Hong Jiang
Frontiers in Pharmacology.2022;[Epub] CrossRef

Original Articles

Predictors of anticipated coping behavior at myocardial infarction symptom onset among a nationwide sample of Korean adults: Kyong Sil Park; Epidemiol Health. 2021;43:e2021006. Published online January 3, 2021; DOI: https://doi.org/10.4178/epih.e2021006

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This cross-sectional study based on the health belief model investigated predictors of anticipated coping behavior at myocardial infarction (MI) symptom onset using secondary data from the 2017 Korea Community Health Survey.
METHODS
Modifying variables (socioeconomic, health knowledge, perceived threat) were selected as independent variables and anticipated coping behavior at MI symptom onset as the dependent variable. Calling 911 was classified as the correct anticipated coping behavior, while visiting a hospital or an oriental hospital, calling family, and others were classified as incorrect.
RESULTS
Of 227,740 participants, 83.2% reported correct anticipated coping behaviors. The likelihood of calling 911 was low if participants experienced atypical symptoms (jaw, neck, back, arm, and shoulder pain), even if they were aware of those symptoms. However, 69.9% of participants who were aware of typical symptoms (chest pain) stated that they would call-911. Sex, age, hypertension, dyslipidemia, obesity, and awareness of MI symptoms affected the correct anticipated coping behavior.
CONCLUSIONS
Correct coping abilities among the general public are vitally important for early treatment of MI patients and reduction of hospitalization time. Members of the general public in their 20s and 30s, 60 years of age or older, with cardiovascular risk factors (male sex, hypertension, dyslipidemia, and obesity), and who are not aware of MI symptoms should be educated about the typical and atypical symptoms of MI. Emergency medical services should be called without delay if needed, and public relations activities should be carried out to raise awareness that anyone can use emergency medical services.; Summary

Korean summary
심근경색증 증상 발현 시 올바른 대처 행동을 위해 20-39세, 60세 이상, 남성, 고혈압, 이상지질혈증, 비만이 있는 대상자, 심근경색증 증상을 인지하지 못하는 대상자에게 심근경색증의 전형적, 비전형적 증상에 대해 교육해야 한다. 또한, 환자 발생 시 지체없이 응급의료서비스 신고해야하며, 누구나 응급의료서비스를 이용할 수 있도록 인식 전환을 위한 홍보활동을 시행해야 한다.

Key Message
Those in their 20s and 30s, 60 years of age or older, male, with cardiovascular risk factors, and who are not aware of MI symptoms should be educated about the typical and atypical symptoms of MI. Public relations activities should be carried out to raise awareness that anyone can use EMS.

Factors affecting awareness of myocardial infarction symptoms among the general public in Korea: Kyong Sil Park; Epidemiol Health. 2020;42:e2020032. Published online May 18, 2020; DOI: https://doi.org/10.4178/epih.e2020032

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
We aimed to determine the level of awareness of myocardial infarction (MI) symptoms among the general public in Korea and identify factors affecting awareness of MI symptoms using data from the 2017 Korea Community Health Survey (KCHS).

METHODS

This is a cross-sectional study using KCHS data. Based on five questions about MI symptoms, participants were divided into an awareness group (replied ‘yes’ to all five questions) and an unawareness group (replied ‘no’ or ‘not sure’ to at least one of five questions) for analysis.

RESULTS

Of a total of 228,281 participants, 42.4% were aware of MI symptoms. There was a high level of awareness of chest pain and shortness of breath, but a low level of awareness of gastrointestinal symptoms and pain in the arm, shoulder, jaw, neck, and back. While women had a higher level of overall awareness relative to men, they showed a lower level of awareness regarding chest pain and discomfort. The factors affecting awareness of MI symptoms were gender, age, education level, occupation, smoking, drinking, physical inactivity, and cardiovascular disease risk factors.

CONCLUSIONS

In order to enhance awareness of MI symptoms among the general population, appropriate education and promotion efforts must be implemented based on gender, age, education level, and occupation. Moreover, active efforts by the government, educational institutions, and medical institutions are necessary to improve awareness of both typical and atypical MI symptoms. Furthermore, health policies to promote reduced smoking and drinking and increased physical activity, as well as continuous monitoring and management of individuals with cardiovascular disease risk factors, are required.

Summary

Korean summary
2017년 지역사회건강조사 자료를 분석한 결과, 한국의 심근경색증 증상의 인지율은 42%로 낮은 인식을 보였다. 한국의 지역사회 내 일반인들의 심근경색증 증상의 인지율을 제고하기 위해 성별, 연령, 교육수준, 직업을 고려하여 교육 및 홍보를 실시해야 한다. 그리고, 전형적인 심근경색증 증상뿐만 아니라 비전형적인 심근경색증 증상에 대한 인식에 대한 정부, 교육기관, 의료기관 등의 적극적인 노력이 필요하다. 또한, 금연, 금주, 신체활동 증진에 대한 보건정책적 관리방안과 심혈관질환 위험요인을 가진 대상자들의 지속적인 모니터링 및 관리가 필요하다.

Key Message

Citations

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Engaging social activities prevent stroke and myocardial infraction by raising awareness of warning symptoms: A cross-sectional survey study
Gahyeon Kim, Hyeokjoo Jang, Sebin Kwon, Bumyeol Lee, Suk-Yong Jang, Wonjeong Chae, Sung-In Jang
Frontiers in Public Health.2023;[Epub] CrossRef
“Recognition of heart attack symptoms and treatment-seeking behaviors: a multi-center survey in Tehran, Iran”
Elnaz Shahmohamadi, Mojtaba Sedaghat, Arash Rahmani, Farnoosh Larti, Babak Geraiely
BMC Public Health.2023;[Epub] CrossRef
Gender and Social Inequalities in Awareness of Coronary Artery Disease in European Countries
Antonio Daponte-Codina, Emily C. Knox, Inmaculada Mateo-Rodriguez, Amanda Seims, Vera Regitz-Zagrosek, Angela H. E. M. Maas, Alan White, Floris Barnhoorn, Fernando Rosell-Ortiz
International Journal of Environmental Research and Public Health.2022; 19(3): 1388. CrossRef
Blood Pressure Awareness and Knowledge of Cardio-Cerebrovascular Diseases in South Korean Women with Hypertension
Yeo Won Jeong
Healthcare.2021; 9(3): 360. CrossRef
Global Awareness of Myocardial Infarction Symptoms in General Population: a Systematic Review and Meta-Analysis
Akash Sharma, Karavadi Vidusha, Harshini Suresh, Ajan M. J., Kavinkumar Saravanan, Madhvi Dhamania, Nisha B, Rabbanie Tariq Wani
Korean Circulation Journal.2021; 51(12): 983. CrossRef
Global Awareness of Myocardial Infarction Symptoms in General Population
Soo-Joong Kim
Korean Circulation Journal.2021; 51(12): 997. CrossRef
Disparities in Awareness of Myocardial Infarction and Stroke Symptoms and Response Among United States– and Foreign‐Born Adults in the National Health Interview Survey
Ivy Mannoh, Ruth‐Alma Turkson‐Ocran, Jasmine Mensah, Danielle Mensah, Stella S. Yi, Erin D. Michos, Yvonne Commodore‐Mensah
Journal of the American Heart Association.2021;[Epub] CrossRef

Risk factors for heart failure in a cohort of patients with newly diagnosed myocardial infarction: a matched, case-control study in Iran: Ali Ahmadi, Koorosh Etemad, Arsalan Khaledifar; Epidemiol Health. 2016;38:e2016019. Published online May 17, 2016; DOI: https://doi.org/10.4178/epih.e2016019

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7 Citations

Abstract PDF

Abstract

OBJECTIVES
Risk factors for heart failure (HF) have not yet been studied in myocardial infarction (MI) patients in Iran. This study was conducted to determine these risk factors.

METHODS

In this nationwide, hospital-based, case-control study, the participants were all new MI patients hospitalized from April 2012 to March 2013 in Iran. The data on 1,691 new cases with HF (enrolled by census sampling) were compared with the data of 6,764 patients without HF as controls. We randomly selected four controls per one case, matched on the date at MI and HF diagnosis, according to incidence density sampling. Using conditional logistic regression models, odds ratios (ORs) with a 95% confidence interval (CI) were calculated to identify potential risk factors.

RESULTS

The one-year in-hospital mortality rate was 18.2% in the cases and higher than in the controls (12.1%) (p<0.05). Significant risk factors for HF were: right bundle branch block (RBBB) (OR, 2.86; 95% CI, 1.95 to 4.19), stroke (OR, 2.00; 95% CI, 1.39 to 2.89), and coronary artery bypass grafting (CABG) (OR, 2.03; 95% CI, 1.34 to 3.09). Diabetes, hypertension, percutaneous coronary intervention (PCI), atrial fibrillation, ventricular tachycardia, and age were determined to be the factors significantly associated with HF incidence (p<0.05). The most important factor in women was diabetes (OR, 1.41; 95% CI, 1.05 to 1.88). Age, hypertension, PCI, CABG, and RBBB were the most important factors in men.

CONCLUSIONS

Our findings may help to better identify and monitor the predictive risk factors for HF in MI patients. The pattern of risk factors was different in men and women.

Summary

Korean summary

Key Message

Citations

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The feasibility and acceptability of an early tele-palliative care intervention to improve quality of life in heart failure patients in Iran: A protocol for a randomized controlled trial
Arvin Mirshahi, Shahrzad Ghiasvandian, Meysam Khoshavi, Seyed Mohammad Riahi, Ali Khanipour-Kencha, Marie Bakitas, J. Nicholas Dionne-Odom, Rachel Wells, Masoumeh Zakerimoghadam
Contemporary Clinical Trials Communications.2023; 33: 101114. CrossRef
Medication Adherence and Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran
Soheila Rezaei, Fatemeh Vaezi, Golnaz Afzal, Nasim Naderi, Gholamhossein Mehralian
HLRP: Health Literacy Research and Practice.2022;[Epub] CrossRef
A prospective survey of atrial fibrillation management in Iran: Baseline results of the Iranian Registry of Atrial Fibrillation (IRAF)
Mona Heidarali, Hooman Bakhshandeh, Reza Golpira, Amirfarjam Fazelifar, Abolfath Alizadeh‐Diz, Zahra Emkanjoo, Shabnam Madadi, Farzad Kamali, Majid Maleki, Gregory Y. H. Lip, Majid Haghjoo
International Journal of Clinical Practice.2021;[Epub] CrossRef
Gender based survival prediction models for heart failure patients: A case study in Pakistan
Faisal Maqbool Zahid, Shakeela Ramzan, Shahla Faisal, Ijaz Hussain, Olalekan Uthman
PLOS ONE.2019; 14(2): e0210602. CrossRef
Relationship of the ORBIT and HAS-BLED scores with Killip class 3-4 in patients with ST-segment elevation myocardial infarction
Qing Zhang, Lei Zhou, Hong-Li Cai, Hui-He Lu
Medicine.2019; 98(8): e14578. CrossRef
Survival rate and predictors of mortality in patients hospitalised with heart failure: a cohort study on the data of Persian registry of cardiovascular disease (PROVE)
Mahshid Givi, Davood Shafie, Fatemeh Nouri, Mohammad Garakyaraghi, Ghasem Yadegarfar, Nizal Sarrafzadegan
Postgraduate Medical Journal.2018; 94(1112): 318. CrossRef
Self-Monitoring by Traffic Light Color Coding Versus Usual Care on Outcomes of Patients With Heart Failure Reduced Ejection Fraction: Protocol for a Randomized Controlled Trial
Mahin Nomali, Ramin Mohammadrezaei, Abbas Ali Keshtkar, Gholamreza Roshandel, Shahrzad Ghiyasvandian, Kian Alipasandi, Masoumeh Zakerimoghadam
JMIR Research Protocols.2018; 7(11): e184. CrossRef

Admission route and use of invasive procedures during hospitalization for acute myocardial infarction: analysis of 2007-2011 National Health Insurance database: Hyungseon Yeom, Dae Ryong Kang, Seong Kyung Cho, Seung Won Lee, Dong-Ho Shin, Hyeon Chang Kim; Epidemiol Health. 2015;37:e2015022. Published online May 1, 2015; DOI: https://doi.org/10.4178/epih/e2015022

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7 Citations

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Abstract

OBJECTIVES
The goal of this study was to investigate trends in admission to the emergency department and the use of invasive or surgical procedures during hospitalization for acute myocardial infarction (AMI) in Korea.

METHODS

The National Health Insurance (NHI) claims database between 2007 and 2011 was used. We identified all admission claims that included codes from the tenth revision of the International Classification of Diseases beginning with I21 as the primary or secondary diagnosis. Information about the admission route, admission date, discharge date, and whether coronary artery angiography, angioplasty, or bypass surgery was performed was also obtained from the NHI database.

RESULTS

Of the 513,886 relevant admission claims over the five years encompassed by this study, 295,001 discrete episodes of admission for AMI were identified by analyzing the date and length of each admission and the interval between admissions. The number of AMI admissions gradually decreased from 66,883 in 2007 to 47,656 in 2011. The number and proportion of admissions through the emergency department also decreased from 38,118 (57.0%) in 2007 to 24,001 (50.4%) in 2011. However, during the same period, admissions in which invasive or surgical procedures were performed increased from 15,342 (22.9%) to 17,505 (36.7%).

CONCLUSIONS

The reported numbers of emergency department visits and admissions for AMI decreased from 2007 to 2011. However, only a small portion of the patients underwent invasive or surgical procedures during hospitalization, although the number of admissions involving invasive or surgical procedures has increased. These findings suggest that simply counting the number of admission claims cannot provide valid information on trends in AMI occurrence.

Summary

Korean summary
급성심근경색 환자의 급성기 의료이용행태를 조사하기 위해 2007년부터 2011년까지 급성심근경색증 진단명(ICD-10 코드 I21.x)을 포함하는 입원 청구자료 513,886건을 분석하였다. 총 295,001건의 독립된 입원 에피소드를 추출하여 분석한 결과, 5년동안 전체 입원건수와 응급실 경유 입원건수는 감소한 반면, 진단 또는 치료 목적의 침습적 시술을 동반한 입원은 증가하였다. 건강보험청구자료를 이용하여 급성심근경색증 발생 규모를 파악할 때, 진단명만으로는 정확한 추계가 어려우며 관련 시술 등의 의료이용 정보를 추가하는 것이 필요할 것이다.

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Effect of Sodium-Glucose Cotransporter Inhibitors on Major Adverse Cardiovascular Events and Hospitalization for Heart Failure in Patients With Type 2 Diabetes Mellitus and Atrial Fibrillation
Chang Hee Kwon, Ye-Jee Kim, Min-Ju Kim, Myung-Jin Cha, Min Soo Cho, Gi-Byoung Nam, Kee-Joon Choi, Jun Kim
The American Journal of Cardiology.2022; 178: 35. CrossRef
Using real-world data for supporting regulatory decision making: Comparison of cardiovascular and safety outcomes of an empagliflozin randomized clinical trial versus real-world data
Ha Young Jang, In-Wha Kim, Jung Mi Oh
Frontiers in Pharmacology.2022;[Epub] CrossRef
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Hyeon Chang Kim
Global Health & Medicine.2021; 3(3): 134. CrossRef
Major Adverse Cardiovascular Events in Antidepressant Users Within Patients With Ischemic Heart Diseases
Jae Hyun Kim, Yun-Kyoung Song, Ha Young Jang, Ju-Young Shin, Hae-Young Lee, Yong Min Ahn, Jung Mi Oh, In-Wha Kim
Journal of Clinical Psychopharmacology.2020; 40(5): 475. CrossRef
Antidepressant Use and the Risk of Major Adverse Cardiovascular Events in Patients Without Known Cardiovascular Disease: A Retrospective Cohort Study
Ha Young Jang, Jae Hyun Kim, Yun-Kyoung Song, Ju-Young Shin, Hae-Young Lee, Yong Min Ahn, Jung Mi Oh, In-Wha Kim
Frontiers in Pharmacology.2020;[Epub] CrossRef
Changing Disease Trends in the Northern Gyeonggi-do Province of South Korea from 2002 to 2013: A Big Data Study Using National Health Information Database Cohort
Young Soo Kim, Dong-Hee Lee, Hiun Suk Chae, Kyungdo Han
Osong Public Health and Research Perspectives.2018; 9(5): 248. CrossRef
Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016
Theo Vos, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Rizwan Suliankatchi Abdulkader, Abdishakur M Abdulle, Teshome Abuka Abebo, Semaw Ferede Abera, Victor Aboyans, Laith J Abu-Raddad, Ilana N Ackerman,
The Lancet.2017; 390(10100): 1211. CrossRef

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