June 24th, 2014

In Emerging China, STEMI Admissions Skyrocket But Treatment Lags

Accompanying all the other changes in China over the past decade, admission to the hospital for ST-segment elevation MI (STEMI) has soared, according to a paper published in the LancetAlthough the study finds that there have been some genuine improvements in treatment, the Chinese healthcare system still has a long way to go to improve the outcome of STEMI patients.

The study, which is the first of its kind to assess heart attack treatment across China, offers details about what its authors, a group of prominent Chinese and U.S. researchers, call China’s “period of epidemiological transition.” They analyzed data from nearly 14,000 STEMI patients at 162 hospitals across China. From 2001 to 2011, they observed a highly significant 4-fold increase in admissions for STEMI, from 3.7 to 15.8 per 100,000 people. This was accompanied by significant increases in smoking, hypertension, diabetes, and dyslipidemia.

There were some improvements in treatment, but overall the findings suggest important gaps. There were significant improvements in the use of some drug therapies, including aspirin and clopidogrel, but no significant improvement in other important drugs, including beta-blockers and ACE inhibitors. Although there was a significant increase in the percentage of patients who received primary percutaneous coronary intervention, from 10% to 28%, there was no change in the overall percentage of STEMI patients who underwent reperfusion (45%). There were no significant improvements in mortality rates or other measures of outcome over the study decade.

In a Lancet press release. the study’s corresponding author, Lixin Jiang, said:

The growing needs for inpatient STEMI care will create pressure for Chinese hospitals to increase capacity, adequately train health-care professionals, develop infrastructure, and improve care. The striking increases in hospital admissions for STEMI noted in our study show that important improvements in capacity have been made; however, national STEMI mortality suggests that further growth will be necessary to ensure adequate access for patients with the disorder in China. Furthermore, our study underlines that access to care does not ensure the delivery of the highest-quality care; suggesting that in addition to improvements in capacity, hospitals in China must simultaneously strive to improve care.

One of the U.S. authors, Harlan Krumholz (editor-in-chief of CardioExchange), provided the following comment:

This first-ever national report of heart attack care in China reveals a quadrupling of hospitalizations for STEMI and clear targets for quality improvement. What is truly remarkable is the Chinese government funded the study and committed to allow it to proceed independently and did not have a role in the science or the publication. There is a realization at high levels that for health care to improve there must be an honest and transparent assessment of current and past performance as a prelude to future initiatives. I am hopeful that this approach will strengthen and grow. This is the first step.

3 Responses to “In Emerging China, STEMI Admissions Skyrocket But Treatment Lags”

  1. Leon Hyman, Ms M.D. says:

    What percent of Chinese smoke including Physicians? Also Pollution in China has to be a factor in the stemi incidence. Does China have a any none smoking rules in public areas like like in most states in the U.S.?

  2. Gervasio Antonio Lamas, MD says:

    I believe we are seeing the emergence of data supporting a new modifiable risk factor for CAD – environmental pollution. This, obviously, includes particulate inhalants (air pollution), ingested or inhaled metals (lead and cadmium in particular), and may include harder to detect organics such as plastic byproducts.

    There is epidemiological evidence to support the first 2 above comments, and a clinical trial that is also supportive.


  3. Enrique Guadiana, Cardiology says:

    CVD mortality in china is much lower than the USA, cerebrovascular disease for the moment is much more prevalent and important. The rapid economic expansion of China produce a shift from a rural agrarian society to an industrial society and in few years the population increased their wealth and for that reason many change their food habits and exercise level, this has impacted the cardiovascular health of the entire population.

    I think a very important factor to concider is the body fat distribution, when you compare the Chinese with the Caucasian of the same body mass index (BMI), the Chinese had a higher percentage of body fat.

    Also since China have one fifth of the world population you can anticipate a dramatic rise, in absolute numbers, of CVD secondary to growth and aging.