Journal of Preventive Medicine and Public Health

Original Articles

The Busan Regional CardioCerebroVascular Center Project’s Experience Over a Decade in the Treatment of ST-segment Elevation Myocardial Infarction: Kyunghee Lim, Hyeyeon Moon, Jong Sung Park, Young-Rak Cho, Kyungil Park, Tae-Ho Park, Moo-Hyun Kim, Young-Dae Kim; J Prev Med Public Health. 2022;55(4):351-359. Published online June 24, 2022; DOI: https://doi.org/10.3961/jpmph.22.071

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Objectives
The Regional CardioCerebroVascular Center (RCCVC) project was initiated to improve clinical outcomes for patients with acute myocardial infarction or stroke in non-capital areas of Korea. The purpose of this study was to evaluate the outcomes and issues identified by the Busan RCCVC project in the treatment of ST-segment elevation myocardial infarction (STEMI).
Methods
Among the patients who were registered in the Korean Registry of Acute Myocardial Infarction for the RCCVC project between 2007 and 2019, those who underwent percutaneous coronary intervention (PCI) for STEMI at the Busan RCCVC were selected, and their medical data were compared with a historical cohort.
Results
In total, 1161 patients were selected for the analysis. Ten years after the implementation of the Busan RCCVC project, the median door-to-balloon time was reduced from 86 (interquartile range [IQR], 64-116) to 54 (IQR, 44-61) minutes, and the median symptom-to-balloon time was reduced from 256 (IQR, 180-407) to 189 (IQR, 118-305) minutes (p<0.001). Inversely, the false-positive PCI team activation rate increased from 0.6% to 21.4% (p<0.001). However, the 1-year cardiovascular death and major adverse cardiac event rates did not change. Even after 10 years, approximately 75% of the patients had a symptom-to-balloon time over 120 minutes, and approximately 50% of the patients underwent inter-hospital transfer for primary PCI.
Conclusions
A decade after the implementation of the Busan RCCVC project, although time parameters for early reperfusion therapy for STEMI improved, at the cost of an increased false-positive PCI team activation rate, survival outcomes were unchanged.

Summary

Korean summary
이번 연구에서는 부산권역심뇌혈관질환센터사업 시작 후 10여년간의 ST분절상습심근경색 환자 치료성적의 변화를 살펴보았다. 사업 시작 후 관상동맥중재시술팀의 위양성소집률이 크게 증가한 대신 ST분절상승심근경색 환자의 조기재관류 치료의 시간지표는 의미 있게 개선되었다. 그러나 생존지표는 사업 시작 전과 비교해 차이가 없었는데 중재시술이 불가능한 병원을 경우하는 사례가 많아 골든타임 이내에 조기 재관류치료를 받은 환자의 비율이 전체 환자의 1/4에 불과한 것이 그 원인으로 보인다.

Citations

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Trends in Regional Disparities in Cardiovascular Surgery and Mortality in Korea: A National Cross-sectional Study
Dal-Lae Jin, Kyoung-Hoon Kim, Euy Suk Chung, Seok-Jun Yoon
Journal of Preventive Medicine and Public Health.2024; 57(3): 260. CrossRef
Mortality and Disparities of Acute Myocardial Infarction and Stroke in Korea, 2008–2019
Ji-Sook Choi, Soomin Kim, Choon-Seon Park, Hyejin Lee, Jin Yong Lee, Sun Min Kim
Yonsei Medical Journal.2024; 65(9): 534. CrossRef
Relevance Index Regional Variation by Each Disease and Its Essential Medical Field: A Retrospective Data Analysis From 2016-2020 in Korea
Young-Eun Kim, Jeehee Pyo, Haneul Lee, HyeRan Jeong, Young-Kwon Park, Jeong-Wook Seo, Minsu Ock, Seok-Jun Yoon
Journal of Korean Medical Science.2023;[Epub] CrossRef

Incidence, Risk Factors, and Prediction of Myocardial Infarction and Stroke in Farmers: A Korean Nationwide Population-based Study: Solam Lee, Hunju Lee, Hye Sim Kim, Sang Baek Koh; J Prev Med Public Health. 2020;53(5):313-322. Published online July 14, 2020; DOI: https://doi.org/10.3961/jpmph.20.156

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Abstract PDF

Objectives
This study was conducted to determine the incidence and risk factors of myocardial infarction (MI) and stroke in farmers compared to the general population and to establish 5-year prediction models.
Methods
The farmer cohort and the control cohort were generated using the customized database of the National Health Insurance Service of Korea database and the National Sample Cohort, respectively. The participants were followed from the day of the index general health examination until the events of MI, stroke, or death (up to 5 years).
Results
In total, 734 744 participants from the farmer cohort and 238 311 from the control cohort aged between 40 and 70 were included. The age-adjusted incidence of MI was 0.766 and 0.585 per 1000 person-years in the farmer and control cohorts, respectively. That of stroke was 0.559 and 0.321 per 1000 person-years in both cohorts, respectively. In farmers, the risk factors for MI included male sex, age, personal history of hypertension, diabetes, current smoking, creatinine, metabolic syndrome components (blood pressure, triglycerides, and high-density lipoprotein cholesterol). Those for stroke included male sex, age, personal history of hypertension, diabetes, current smoking, high γ-glutamyl transferase, and metabolic syndrome components (blood pressure, triglycerides, and high-density lipoprotein cholesterol). The prediction model showed an area under the receiver operating characteristic curve of 0.735 and 0.760 for MI and stroke, respectively, in the farmer cohort.
Conclusions
Farmers had a higher age-adjusted incidence of MI and stroke. They also showed distinct patterns in cardiovascular risk factors compared to the general population.

Summary

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Ischemic heart disease and stroke in male couriers: a cohort study using the national health insurance data and national employment insurance data
Jiyoung Yoon, Jeehee Min, Eun Mi Kim, Jaiyong Kim, Inah Kim
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Presence of Thrombectomy-capable Stroke Centers Within Hospital Service Areas Explains Regional Variation in the Case Fatality Rate of Acute Ischemic Stroke in Korea
Eun Hye Park, Yong Jin Gil, Chanki Kim, Beom Joon Kim, Seung-sik Hwang
Journal of Preventive Medicine and Public Health.2021; 54(6): 385. CrossRef

Validity of Self-reported Stroke and Myocardial Infarction in Korea: The Health Examinees (HEXA) Study: Sunho Choe, Joonki Lee, Jeeyoo Lee, Daehee Kang, Jong-Koo Lee, Aesun Shin; J Prev Med Public Health. 2019;52(6):377-383. Published online November 12, 2019; DOI: https://doi.org/10.3961/jpmph.19.089

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Abstract PDF

Objectives
Self-reported disease history is often used in epidemiological studies. In this study, we acquired the hospital records of subjects who self-reported stroke or myocardial infarction (MI) and evaluated the validity of the participants’ self-reported disease history. We also determined the level of agreement between specialists and non-specialists.
Methods
Among the participants in the Health Examinees study, 1488 subjects self-reported stroke or MI during 2012-2017, and medical records were acquired for the 429 subjects (28.8%) who agreed to share their medical information. Each record was independently assigned to 2 medical doctors for review. The records were classified as ‘definite,’ ‘possible,’ or ‘not’ stroke or MI. If the doctors did not agree, a third doctor made the final decision. The positive predictive value (PPV) of self-reporting was calculated with the doctors’ review as the gold standard. Kappa statistics were used to compare the results between general doctors and neurologists or cardiologists.
Results
Medical records from 208 patients with self-reported stroke and 221 patients with self-reported MI were reviewed. The PPV of self-reported disease history was 51.4% for stroke and 32.6% for MI. If cases classified as ‘possible’ were counted as positive diagnoses, the PPV was 59.1% for stroke and 33.5% for MI. Kappa statistics showed moderate levels of agreement between specialists and non-specialists for both stroke and MI.
Conclusions
The validity of self-reported disease was lower than expected, especially in those who reported having been diagnosed with MI. Proper consideration is needed when using these self-reported data in further studies.

Summary

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Stressful life events and heart disease and stroke: A study among Portuguese older adults
Ana Quaresma, Elisabete Alves, Silvia Fraga, Ana Henriques
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Impact of Regional Cardiocerebrovascular Centers on Myocardial Infarction Patients in Korea: A Fixed-effects Model: Sang Guen Cho, Youngsoo Kim, Youngeun Choi, Wankyo Chung; J Prev Med Public Health. 2019;52(1):21-29. Published online November 28, 2018; DOI: https://doi.org/10.3961/jpmph.18.154

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Abstract Summary PDF Supplementary Material

Objectives
The Regional Cardiocerebrovascular Center (RCCVC) Project designated local teaching hospitals as RCCVCs, in order to improve patient outcomes of acute cardiocerebrovascular emergencies by founding a regional system that can adequately transfer and manage patients within 3 hours. We investigated the effects of RCCVC establishment on treatment volume and 30-day mortality.
Methods
We constructed a panel dataset by extracting all acute myocardial infarction cases that occurred from 2007 to 2016 from the Health Insurance Review and Assessment Service claims data, a national and representative source. We then used a panel fixed-effect model to estimate the impacts of RCCVC establishment on patient outcomes.
Results
We found that the number of cases of acute myocardial infarction that were treated increased chronologically, but when the time effect and other related covariates were controlled for, RCCVCs only significantly increased the number of treatment cases of female in large catchment areas. There was no statistically significant impact on 30-day mortality.
Conclusions
The establishment of RCCVCs increased the number of treatment cases of female, without increasing the mortality rate. Therefore, the RCCVCs might have prevented potential untreated deaths by increasing the preparedness and capacity of hospitals to treat acute myocardial infarction patients.

Summary

Korean summary
권역심뇌혈관질환센터 설립 사업은 지역별로 심뇌혈관센터를 지정/육성하여, 심뇌혈관질환 발생시 3시간 이내 진료체계를 구축함으로써 급성심근경색과 뇌졸중의 급성기 응급상황에 대한 대응을 강화하고자 시행되었다. 본 연구는 권역심뇌혈관질환센터 설립 정책으로 인해 시술 건수와 30일 내 사망 등과 같은 치료 성과가 지역 수준에서 향상되었는지 살펴보기 위해 건강보험 청구자료로 지역 수준 패널자료를 구축하여 권역심뇌혈관질환센터 설립의 효과를 추정하였다. 분석 결과, 시계열적 효과와 관련 변수를 통제하였을 때 권역심뇌혈관질환센터 설립 이후 설립 지역에서 여성의 치료 사례 수가 통계적으로 유의하게 증가하였고, 사망률은 유의미한 변화가 관찰되지 않았다. 따라서 권역심뇌혈관질환센터 설립은 대비성 향상과 치료 사례 수 증가를 통해 추가적인 치료를 받은 급성심근경색 환자의 잠재적인 원외 사망을 방지하는 효과가 있는 것으로 판단된다.

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Reduced Alcohol Consumption and Major Adverse Cardiovascular Events Among Individuals With Previously High Alcohol Consumption
Dong Oh Kang, Dae-In Lee, Seung-Young Roh, Jin Oh Na, Cheol Ung Choi, Jin Won Kim, Eung Ju Kim, Seung-Woon Rha, Chang Gyu Park, Ye-Seul Kim, Yonghwan Kim, Hyo-Sun You, Hee-Taik Kang, Eunseo Jo, Jinseob Kim, Jae-woo Lee, Jin-Man Jung
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Relevance Index Regional Variation by Each Disease and Its Essential Medical Field: A Retrospective Data Analysis From 2016-2020 in Korea
Young-Eun Kim, Jeehee Pyo, Haneul Lee, HyeRan Jeong, Young-Kwon Park, Jeong-Wook Seo, Minsu Ock, Seok-Jun Yoon
Journal of Korean Medical Science.2023;[Epub] CrossRef
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Dougho Park, Su Yun Lee, Eunhwan Jeong, Daeyoung Hong, Mun-Chul Kim, Jun Hwa Choi, Eun Kyong Shin, Kang Ju Son, Hyoung Seop Kim
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Dae-Hyun Kim, Seok-Joo Moon, Juneyoung Lee, Jae-Kwan Cha, Moo Hyun Kim, Jong-Sung Park, Byeolnim Ban, Jihoon Kang, Beom Joon Kim, Won-Seok Kim, Chang-Hwan Yoon, Heeyoung Lee, Seongheon Kim, Eun Kyoung Kang, Ae-Young Her, Cindy W Yoon, Joung-Ho Rha, Seong-
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Machine learning enhances the performance of short and long-term mortality prediction model in non-ST-segment elevation myocardial infarction
Woojoo Lee, Joongyub Lee, Seoung-Il Woo, Seong Huan Choi, Jang-Whan Bae, Seungpil Jung, Myung Ho Jeong, Won Kyung Lee
Scientific Reports.2021;[Epub] CrossRef
Presence of Thrombectomy-capable Stroke Centers Within Hospital Service Areas Explains Regional Variation in the Case Fatality Rate of Acute Ischemic Stroke in Korea
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Use of Drug-eluting Stents Versus Bare-metal Stents in Korea: A Cost-minimization Analysis Using Population Data: Hae Sun Suh, Hyun Jin Song, Eun Jin Jang, Jung-Sun Kim, Donghoon Choi, Sang Moo Lee; J Prev Med Public Health. 2013;46(4):201-209. Published online July 31, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.4.201

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Abstract PDF

Objectives

The goal of this study was to perform an economic analysis of a primary stenting with drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) admitted through an emergency room (ER) visit in Korea using population-based data.

Methods

We employed a cost-minimization method using a decision analytic model with a two-year time period. Model probabilities and costs were obtained from a published systematic review and population-based data from which a retrospective database analysis of the national reimbursement database of Health Insurance Review and Assessment covering 2006 through 2010 was performed. Uncertainty was evaluated using one-way sensitivity analyses and probabilistic sensitivity analyses.

Results

Among 513 979 cases with AMI during 2007 and 2008, 24 742 cases underwent stenting procedures and 20 320 patients admitted through an ER visit with primary stenting were identified in the base model. The transition probabilities of DES-to-DES, DES-to-BMS, DES-to-coronary artery bypass graft, and DES-to-balloon were 59.7%, 0.6%, 4.3%, and 35.3%, respectively, among these patients. The average two-year costs of DES and BMS in 2011 Korean won were 11 065 528 won/person and 9 647 647 won/person, respectively. DES resulted in higher costs than BMS by 1 417 882 won/person. The model was highly sensitive to the probability and costs of having no revascularization.

Conclusions

Primary stenting with BMS for AMI with an ER visit was shown to be a cost-saving procedure compared with DES in Korea. Caution is needed when applying this finding to patients with a higher level of severity in health status.

Summary

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A cost analysis comparing telepsychiatry to in-person psychiatric outreach and patient travel reimbursement in Northern Ontario communities
Eva Serhal, Tanya Lazor, Paul Kurdyak, Allison Crawford, Claire de Oliveira, Rebecca Hancock-Howard, Peter C Coyte
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The Socioeconomic Burden of Coronary Heart Disease in Korea: Hoo-Sun Chang, Han-Joong Kim, Chung-Mo Nam, Seung-Ji Lim, Young-Hwa Jang, Sera Kim, Hye-Young Kang; J Prev Med Public Health. 2012;45(5):291-300. Published online September 28, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.5.291

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Abstract PDF

Objectives

We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.

Methods

A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.

Results

Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).

Conclusions

The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.

Summary

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English Abstract

Comparative Study on Three Algorithms of the ICD-10 Charlson Comorbidity Index with Myocardial Infarction Patients.: Kyoung Hoon Kim; J Prev Med Public Health. 2010;43(1):42-49.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.42

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OBJECTIVES
To compare the performance of three International Statistical Classification of Diseases, 10th Revision translations of the Charlson comorbidities when predicting in-hospital among patients with myocardial infarction (MI). METHODS: MI patients > or =20 years of age with the first admission during 2006 were identified(n=20,280). Charlson comorbidities were drawn from Heath Insurance Claims Data managed by Health Insurance Review and Assessment Service in Korea. Comparisions for various conditions included (a) three algorithms (Halfon, Sundararajan, and Quan algorithms), (b) lookback periods (1-, 3- and 5-years), (c) data range (admission data, admission and ambulatory data), and (d) diagnosis range (primary diagnosis and first secondary diagnoses, all diagnoses). The performance of each procedure was measured with the c-statistic derived from multiple logistic regression adjusted for age, sex, admission type and Charlson comorbidity index. A bootstrapping procedure was done to determine the approximate 95% confidence interval. RESULTS: Among the 20,280 patients, the mean age was 63.3 years, 67.8% were men and 7.1% died while hospitalized. The Quan and Sundararajan algorithms produced higher prevalences than the Halfon algorithm. The c-statistic of the Quan algorithm was slightly higher, but not significantly different, than that of other two algorithms under all conditions. There was no evidence that on longer lookback periods, additional data, and diagnoses improved the predictive ability. CONCLUSIONS: In health services study of MI patients using Health Insurance Claims Data, the present results suggest that the Quan Algorithm using a 1-year lookback involving primary diagnosis and the first secondary diagnosis is adequate in predicting in-hospital mortality.

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