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Cardiovascular | Resuscitation

Epidemiology of cardiac arrest and acute myocardial infarction in emergency departments in Korea, 2020–2024: a report using the National Emergency Department Information System (NEDIS) database

Sejoong Ahn1,*orcid, Jung Eon Kim2,*orcid, Sung-keun Ko2orcid, Eunsil Ko2orcid
Clinical and Experimental Emergency Medicine 2026;13(1):90-97.
Published online: March 31, 2026

1Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea

2National Emergency Medical Center, National Medical Center, Seoul, Korea

Correspondence to: Sejoong Ahn Email: (sejoongahn@naver.com)
Co-correspondence to: Jung Eon Kim Email: (jekim1229@nmc.or.kr)

Sejoong Ahn and Jung Eon Kim contributed equally to this study as co-first authors.

• Received: December 18, 2025   • Revised: January 6, 2026   • Accepted: January 6, 2026

© 2026 The Korean Society of Emergency Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

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Cardiac arrest and acute myocardial infarction are major time-sensitive and resource-intensive emergencies encountered in emergency departments (EDs). Both conditions require rapid diagnosis, high-quality resuscitation, coordinated multidisciplinary responses, and timely access to advanced interventions, all of which are strongly associated with improved patient outcomes [1–3]. In addition, acute myocardial infarction is a major underlying cause of cardiac arrest and necessitates prompt reperfusion therapy, including coronary angiography and percutaneous coronary intervention, often within narrow therapeutic windows [1–3]. Therefore, the epidemiologic characteristics of these two interrelated conditions in the ED not only reflect the burden of acute cardiovascular emergencies but also serve as important indicators of the performance and resilience of the emergency care system.
This study summarizes the nationwide epidemiology of cardiac arrest and acute myocardial infarction in EDs from 2020 to 2024. It provides updated insights into their incidence, outcomes, and temporal patterns across age groups. Understanding these trends in the post–COVID-19 period, as well as during the 2024 healthcare policy dispute in Korea [4], is essential for optimizing resource allocation, strengthening emergency preparedness, and informing health policies aimed at improving outcomes for critically ill patients.
Ethics statement
This study was approved by the Institutional Review Board of the National Medical Center, Korea (No. NMC-2023-08-094). The requirement for informed consent was waived due to the retrospective, observational, and anonymous nature of the study.
Study population
This study used nationwide data from Korea’s National Emergency Department Information System (NEDIS). NEDIS is a government-operated registry that collects standardized administrative and clinical information from all designated EDs in Korea [5]. Cardiac arrest was defined as patients identified by cardiopulmonary resuscitation–related codes in ED management records or ED discharge diagnoses, excluding patients who were dead on arrival (DOA). This definition included both out-of-hospital and in-hospital cardiac arrest cases and encompassed all ED levels (level I, regional emergency medical center; level II, local emergency medical center; level III, local emergency medical institution). Acute myocardial infarction was defined as patients presenting to the ED within 24 hours of symptom onset who had an ED or hospital discharge diagnosis code of I21, excluding DOA cases, and was limited to level I and level II EDs. Patient demographics, prehospital characteristics, and hospital-level characteristics were extracted for analysis.
Statistical analysis
Descriptive statistics were calculated. Age- and sex-standardized ED visit rates per 100,000 population were calculated using the 2020 mid-year estimated population of Korea as the standard population. Age- and sex-standardized mortality rates per 100,000 ED visits were calculated using the number of ED visits recorded in NEDIS from 2020 to 2024 as the standard population. Linear regression analysis was performed to evaluate 5-year trends. SAS ver. 9.4 (SAS Institute Inc) was used for all statistical analyses.
Table 1 presents the characteristics of patients with cardiac arrest in the ED. From 2020 to 2024, a total of 205,617 patients with cardiac arrest visited EDs nationwide (pediatric group [0–17 years], 1.6%; adult group [18–64 years], 36.4%; older adult group [≥65 years], 62.0%). The mean age was 67.4 years, and the median time from symptom onset to ED arrival was 40 minutes. Pediatric patients with cardiac arrest visited level I EDs more frequently, whereas older adults more often visited level III EDs compared with other age groups. Most patients arrived at the ED as direct visits (87.3%) and were transported by 119 ambulances (80.9%), as expected. The mean and median ED length of stay (LOS) were 4.0 and 1.9 hours, respectively, with the shortest mean LOS observed in the pediatric group. The overall in-hospital mortality rate was 77.6%, with the highest mortality observed among older adults (pediatric group, 71.8%; adult group, 69.2%; older adult group, 82.6%).
Age- and sex-standardized ED visit rates ranged from 69.8 to 78.3 per 100,000 population, with no significant changes observed over the study period (adults, 40.8–43.3 per 100,000 population; older adults, 254.5–298.3 per 100,000 population) (Fig. 1A). Notably, age- and sex-standardized ED visit rates for pediatric cardiac arrest increased significantly from 7.6 per 100,000 population in 2020 to 10.7 per 100,000 population in 2024 (P for trend=0.028). Age- and sex-standardized mortality rates per 100,000 ED visits showed no significant temporal changes (overall, 378.9–467.5; adult group, 221.6–265.9; pediatric group, 33.1–50.3; older adult group, 437.4–553.3) (Fig. 1B). Similarly, in-hospital mortality rates remained stable over time (overall, 76.4%–78.7%; adult group, 68.6%–70.8%; pediatric group, 68.1%–74.0%; older adult group, 81.5%–83.5%) (Fig. 1C).
Age- and sex-standardized ED visit rates modestly declined from 2023 to 2024, decreasing from 73.9 to 69.8 per 100,000 population. In contrast, age- and sex-standardized mortality per 100,000 ED visits increased across all age groups, with the overall rate rising from 378.9 in 2023 to 430.2 in 2024. In-hospital mortality rates showed no significant year-to-year change across any subgroup, remaining stable overall (76.4% in 2023 to 76.9% in 2024).
Table 2 shows the characteristics of patients with acute myocardial infarction in the ED. A total of 142,499 patients with acute myocardial infarction visited the ED during the study period (pediatric group, 0.1%; adult group, 45.0%; older adult group, 54.9%), with a mean age of 66.5 years. The median time from symptom onset to ED arrival was 133 minutes. Most patients visited the ED as direct visits (70.5%), while 27.0% were transferred from other hospitals. Regarding transport methods, 46.9% of patients arrived at the ED via 119 ambulances, and 34.4% arrived via other transport methods. The mean and median ED LOS were 5.9 and 3.2 hours, respectively. The overall in-hospital mortality rate was 9.6%.
When patient characteristics were assessed by age group, the median time from symptom onset to ED arrival was shortest in the adult group. Pediatric patients more frequently visited level II EDs, were more likely to present as direct visits, and less frequently used ambulance transport compared with other age groups. The in-hospital mortality rate was highest among older adults (pediatric group, 1.3%; adult group, 4.5%; older adult group, 13.7%).
Age- and sex-standardized ED visit rates ranged from 47.2 to 53.6 per 100,000 population, with no significant changes observed over the study period (adult group, 32.8–35.6 per 100,000 population; pediatric group, 0.1–0.4 per 100,000 population; older adult group, 153.7–181.4 per 100,000 population) (Fig. 2A). Overall age- and sex-standardized mortality per 100,000 ED visits significantly decreased over time (33.5–41.6 per 100,000 ED visits, P for trend=0.018) (Fig. 2B), with the most pronounced decrease observed among older adults (38.8 to 34.2 per 100,000 ED visits, P for trend=0.012). In contrast, age- and sex-standardized mortality per 100,000 ED visits among pediatric and adult patients showed no significant temporal changes (adult group, 12.7–14.6 per 100,000 ED visits; pediatric group, 0.0–0.1 per 100,000 ED visits). Similarly, overall in-hospital mortality significantly decreased over time (9.8% to 9.3%, P for trend=0.017), particularly among older adults (14.3% to 13.0%, P for trend=0.011), whereas no significant changes were observed in pediatric or adult patients (Fig. 2C).
From 2023 to 2024, age- and sex-standardized ED visit rates decreased from 52.7 to 47.2 per 100,000 population. Over the same period, age- and sex-standardized mortality per 100,000 ED visits remained largely stable overall (33.5 in 2023 to 34.3 in 2024). In-hospital mortality showed no significant year-to-year change, both overall and across all subgroups (9.6% in 2023 to 9.3% in 2024).
This study summarizes the recent epidemiology of cardiac arrest and acute myocardial infarction in EDs between 2020 and 2024. The incidence of both conditions remained largely unchanged during the study period. While mortality associated with cardiac arrest showed no significant change, mortality related to acute myocardial infarction demonstrated a gradual improvement over time.
The overall incidence of cardiac arrest observed in this study was comparable to that reported worldwide [6]. Compared with a previous analysis of NEDIS data from 2018 to 2022 [7], the total number of cardiac arrest patients increased across all age groups. This increase likely reflects both methodological and demographic factors. The previous study restricted inclusion to patients presenting within 24 hours of symptom onset, which resulted in missing data from level III EDs. In contrast, the broader inclusion criteria applied in this study captured a substantial number of patients treated in level III EDs, thereby providing a more comprehensive representation of real-world emergency care. In addition, Korea’s rapidly aging population likely contributed to the increased number of cardiac arrest cases among older adults [8,9]. Given the higher mortality observed in older adults and the expected continued growth of this population, both the incidence and mortality of cardiac arrest may increase gradually, placing a substantial burden on the acute cardiovascular emergency system. Moreover, the observed increase in pediatric cardiac arrest cases, although small in absolute numbers, warrants attention because of its potential socioeconomic impact and broader implications.
The overall number of patients with acute myocardial infarction and their epidemiological characteristics were similar to those reported in a previous NEDIS-based study covering 2018–2022 [10]. The observed decrease in mortality may reflect either genuine improvement in clinical outcomes or normalization of outcomes following the COVID-19 pandemic. During the pandemic, delayed hospital arrival, ED overcrowding, shortages of medical resources, and increased workload among medical staff were prominent and were associated with increased mortality from ischemic heart disease and cardiac arrest [11–14]. The normalization of these factors likely contributed to the observed reduction in mortality. However, further studies are required to determine whether this trend represents a true long-term improvement in outcomes for acute myocardial infarction.
From 2023 to 2024, in-hospital mortality remained largely unchanged. Although age- and sex-standardized mortality per 100,000 ED visits increased slightly during this period, standardized ED visit rates declined concurrently. This increase in standardized mortality per 100,000 ED visits may plausibly be attributed to a reduction in the total number of ED visits, which could have resulted in fewer standardized ED visits among patients with cardiac arrest and acute myocardial infarction. Importantly, despite a substantial reduction in the number of physicians in 2024 [4], in-hospital mortality did not worsen, suggesting that resource allocation and emergency preparedness were effectively maintained, at least within acute cardiovascular emergency systems.
Several limitations of this study should be acknowledged. First, clinically important variables, including Utstein variables, detailed management information, and neurological outcomes, were unavailable in the dataset. Second, level III ED data were not included for acute myocardial infarction cases. However, because most patients requiring invasive treatment would have been transferred to higher-level centers, the degree of underestimation is likely limited.
Despite these limitations, the findings provide fundamental information for understanding the national emergency care system. Continuous surveillance using nationwide ED data remains essential for improving emergency preparedness, optimizing resource allocation, and enhancing patient outcomes, and will provide an important evidence base for future health policies and further research.

Author contributions

Conceptualization: SA, JEK; Formal analysis: all authors; Investigation: all authors; Methodology: all authors; Supervision: SA, JEK; Writing–original draft: SA; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Conflicts of interest

The authors have no conflicts of interest to declare.

Funding

The authors received no financial support for this study.

Data availability

Data analyzed in this study were obtained from the National Emergency Medical Center (NEMC) under the Korean Ministry of Health and Welfare, and were used under license for the current study. Although the data are not publicly accessible, they are available from the corresponding author upon reasonable request with permission from the NEMC.

Fig. 1.
Changes in the incidence and mortality of patients with cardiac arrest during 2020–2024. (A) Age- and sex-standardized emergency department (ED) visits per 100,000 population (2023 vs. 2024: total, 73.9 vs. 69.8, P<0.001; adult group, 42.4 vs. 41.1, P=0.006; pediatric group, 10.3 vs. 10.7, P=0.437; older adult group, 275.0 vs. 254.5, P<0.001). (B) Age- and sex-standardized mortality per 100,000 ED visits (2023 vs. 2024: total, 378.9 vs. 430.2, P<0.001; adult group, 221.6 vs. 265.9, P<0.001; pediatric group, 33.1 vs. 46.8, P<0.001; older adult group, 437.4 vs. 487.3, P<0.001). (C) In-hospital mortality (2023 vs. 2024: total, 76.4% vs. 76.9%, P=0.128; adult group, 67.8% vs. 68.6%, P=0.135; pediatric group, 70.8% vs. 68.1%, P=0.289; older adult group, 81.5% vs. 81.8%, P=0.427). *Statistically significant differences between 2023 and 2024.
ceem-25-318f1.jpg
Fig. 2.
Changes in the incidence and mortality of patients with acute myocardial infarction during 2020–2024. Pediatric patients with acute myocardial infarction are not presented in the figure because of the extremely small number of cases. (A) Age- and sex-standardized emergency department (ED) visits per 100,000 population (2023 vs. 2024: total, 52.7 vs. 47.2, P<0.001; adult group, 35.6 vs. 32.8, P=0.006; pediatric group, 0.2 vs. 0.1, P=0.424; older adult group, 176.2 vs. 153.7, P<0.001). (B) Age- and sex-standardized mortality per 100,000 ED visits (2023 vs. 2024: total, 33.5 vs. 34.3, P=0.378; adult group, 12.7 vs. 14.6, P=0.018; pediatric group, 0.0 vs. 0.0, P=not determined; older adult group, 34.2 vs. 34.3, P=0.978). (C) In-hospital mortality (2023 vs. 2024: total, 9.6% vs. 9.3%, P=0.264; adult group, 4.5% vs. 4.6%, P=0.668; pediatric group, 0.0% vs. 0.0%, P=not determined; older adult group, 13.6% vs. 13.0%, P=0.129). *Statistically significant differences between 2023 and 2024.
ceem-25-318f2.jpg
Table 1.
Demographics, ED visit characteristics, and outcomes of patients with cardiac arrest
Table 1.
Variable Total (n=205,617) Pediatric group (0–17 yr) (n=3,325, 1.6%) Adult group (18–64 yr) (n=74,751, 36.4%) Older adult group (≥65 yr) (n=127,535, 62.0%)
Age (yr) 67.4±18.0 7.5±6.5 50.8±11.3 78.7±7.8
Sex
 Male 130,953 (63.7) 1,935 (58.2) 54,994 (73.6) 74,019 (58.0)
 Female 74,664 (36.3) 1,390 (41.8) 19,757 (26.4) 53,516 (42.0)
Time from symptom onset to ED arrivala) 40 (28–74) 36 (25–66) 40 (28–73) 40 (29–74)
Type of ED
 Level I 67,305 (32.7) 1,606 (48.3) 26,265 (35.1) 39,434 (30.9)
 Level II 98,648 (48.0) 1,408 (42.3) 36,107 (48.3) 61,133 (47.9)
 Level III 39,664 (19.3) 311 (9.4) 12,379 (16.6) 26,968 (21.1)
Route of arrival
 Direct visit 179,417 (87.3) 2,924 (87.9) 65,008 (87.0) 111,479 (87.4)
 Transfer from other hospital 22,808 (11.1) 362 (10.9) 8,334 (11.1) 14,112 (11.1)
 Referral from outpatient clinic 3,178 (1.5) 39 (1.2) 1,336 (1.8) 1,803 (1.4)
 Other 112 (0.1) 0 (0) 37 (0.0) 75 (0.1)
 Unknown 102 (0.0) 0 (0) 36 (0.0) 66 (0.1)
Transport
 119 Ambulance 166,401 (80.9) 2,646 (79.6) 59,960 (80.2) 103,790 (81.4)
 Other medical institution ambulance 4,551 (2.2) 73 (2.2) 1,577 (2.1) 2,901 (2.3)
 Other ambulance 14,608 (7.1) 165 (5.0) 5,214 (7.0) 9,229 (7.2)
 Police or official transport 225 (0.1) 4 (0.1) 159 (0.2) 62 (0.0)
 Air transport 881 (0.4) 16 (0.5) 478 (0.6) 387 (0.3)
 Other transport 17,674 (8.6) 402 (12.1) 6,967 (9.3) 10,304 (8.1)
 Walk-in 441 (0.2) 11 (0.3) 163 (0.2) 267 (0.2)
 Other/unknown 836 (0.4) 8 (0.2) 233 (0.3) 595 (0.5)
Length of stay (hr)b)
 Mean±SD 4.0±7.6 3.0±4.5 4.2±7.7 4.0±7.5
 Median (IQR) 1.9 (1.0–3.9) 1.8 (1.1–3.1) 2.0 (1.1–4.1) 1.8 (1.0–3.8)
 0–6 174,042 (84.6) 3,009 (90.5) 62,766 (84.0) 108,262 (84.9)
 6–12 17,947 (8.7) 217 (6.5) 6,777 (9.1) 10,953 (8.6)
 12–24 9,003 (4.4) 74 (2.2) 3,490 (4.7) 5,439 (4.3)
 ≥24 4,453 (2.2) 25 (0.8) 1,666 (2.2) 2,762 (2.2)
 Unknown 172 (0.1) 0 (0) 52 (0.1) 119 (0.1)
ED disposition
 Discharge 6,016 (2.9) 106 (3.2) 3,236 (4.3) 2,673 (2.1)
 Admissionc) 54,620 (26.6) 903 (27.2) 24,517 (32.8) 29,200 (22.9)
  General ward 5,130 (2.5) 103 (3.1) 2,100 (2.8) 2,927 (2.3)
  Intensive care unit 49,451 (24.0) 800 (24.1) 22,405 (30.0) 26,246 (20.6)
 Transfer 11,598 (5.6) 335 (10.1) 5,253 (7.0) 6,009 (4.7)
 Comfort care discharge 114 (0.1) 0 (0) 38 (0.1) 76 (0.1)
 Death 133,077 (64.7) 1,975 (59.4) 41,638 (55.7) 89,460 (70.1)
 Other/unknown 192 (0.1) 6 (0.2) 69 (0.1) 117 (0.1)
Hospital disposition
 Discharge 24,830 (12.1) 489 (14.7) 13,660 (18.3) 10,680 (8.4)
 Transfer 19,197 (9.3) 418 (12.6) 8,603 (11.5) 10,175 (8.0)
 Comfort care discharge 321 (0.2) 6 (0.2) 122 (0.2) 193 (0.2)
 Death 159,527 (77.6) 2,388 (71.8) 51,765 (69.2) 105,370 (82.6)
 Other/unknown 1,742 (0.8) 24 (0.7) 601 (0.8) 1,117 (0.9)

Values are presented as mean±SD, number (%), or median (IQR). Differences between totals and subgroup sums are due to missing age data (n=6); percentages may not total 100 due to rounding.

ED, emergency department; SD, standard deviation; IQR, interquartile range.

a)Reporting was not obligatory for level III EDs.

b)Any ED length of stay over 5 days was treated as 5 days.

c)Admission locations other than general wards or intensive care units were unspecified.

Table 2.
Demographics, ED visit characteristics, and outcomes of patients with acute myocardial infarction
Table 2.
Variable Total (n=142,499) Pediatric group (0–17 yr) (n=75, 0.1%) Adult group (18–64 yr) (n=64,175, 45.0%) Older adult group (≥65 yr) (n=78,249, 54.9%)
Age (yr) 66.5±13.7 11.6±4.6 54.1±7.9 76.7±7.7
Sex
 Male 104,228 (73.1) 56 (74.7) 56,145 (87.5) 48,027 (61.4)
 Female 38,271 (26.9) 19 (25.3) 8,030 (12.5) 30,222 (38.6)
Time from symptom onset to ED arrival 133 (60–360) 146.0 (60–420) 111.0 (53–297) 161 (60–420)
Type of ED
 Level I 62,684 (44.0) 16 (21.3) 27,609 (43.0) 35,059 (44.8)
 Level II 79,815 (56.0) 59 (78.7) 36,566 (57.0) 43,190 (55.2)
Route of arrival
 Direct visit 100,407 (70.5) 67 (89.3) 46,528 (72.5) 53,812 (68.8)
 Transfer from other hospital 38,429 (27.0) 7 (9.3) 16,128 (25.1) 22,294 (28.5)
 Referral from outpatient clinic 3,643 (2.6) 1 (1.3) 1,514 (2.4) 2,128 (2.7)
 Other 20 (0.0) 0 (0) 5 (0.0) 15 (0.0)
 Unknown 0 (0) 0 (0) 0 (0) 0 (0)
Transport
 119 Ambulance 66,846 (46.9) 13 (17.3) 28,742 (44.8) 38,091 (48.7)
 Other medical institution ambulance 5,672 (4.0) 2 (2.7) 2,195 (3.4) 3,475 (4.4)
 Other ambulance 18,971 (13.3) 4 (5.3) 7,336 (11.4) 11,631 (14.9)
 Police or official transport 104 (0.1) 0 (0) 75 (0.1) 29 (0.0)
 Air transport 627 (0.4) 0 (0) 288 (0.4) 339 (0.4)
 Other transport 49,066 (34.4) 56 (74.7) 24,969 (38.9) 24,041 (30.7)
 Walk-in 983 (0.7) 0 (0) 487 (0.8) 496 (0.6)
 Other/unknown 230 (0.2) 0 (0) 83 (0.1) 147 (0.2)
Length of stay (hr)a)
 Mean±SD 5.9±8.0 3.7±2.8 5.1±7.4 6.5±8.4
 Median (IQR) 3.2 (1.4–6.7) 3.0 (2.1–4.5) 2.6 (1.1–5.7) 3.7 (1.8–7.4)
 0–6 102,596 (72.0) 67 (89.3) 49,010 (76.4) 53,519 (68.4)
 6–12 21,802 (15.3) 6 (8.0) 8,293 (12.9) 13,503 (17.3)
 12–24 12,856 (9.0) 2 (2.7) 4,942 (7.7) 7,912 (10.1)
 ≥24 5,244 (3.7) 0 (0) 1,929 (3.0) 3,315 (4.2)
 Unknown 1 (0.0) 0 (0) 1 (0.0) 0 (0)
ED disposition
 Discharge 5,241 (3.7) 29 (38.7) 2,419 (3.8) 2,793 (3.6)
 Admissionb) 128,307 (90.0) 34 (45.3) 58,425 (91.0) 69,848 (89.3)
  General ward 38,354 (26.9) 24 (32.0) 15,964 (24.9) 22,366 (28.6)
  Intensive care unit 89,886 (63.1) 10 (13.3) 42,443 (66.1) 47,433 (60.6)
 Transfer 6,299 (4.4) 11 (14.7) 2,684 (4.2) 3,604 (4.6)
 Comfort care discharge 17 (0.0) 0 (0) 2 (0.0) 15 (0.0)
 Death 2,582 (1.8) 1 (1.3) 619 (1.0) 1,962 (2.5)
 Other/unknown 53 (0.0) 0 (0) 26 (0.0) 27 (0.0)
Hospital disposition
 Discharge 114,529 (80.4) 63 (84.0) 56,493 (88.0) 57,973 (74.1)
 Transfer 13,430 (9.4) 11 (14.7) 4,443 (6.9) 8,976 (11.5)
 Comfort care discharge 117 (0.1) 0 (0) 26 (0.0) 91 (0.1)
 Death 13,650 (9.6) 1 (1.3) 2,915 (4.5) 10,734 (13.7)
 Other/unknown 773 (0.5) 0 (0) 298 (0.5) 475 (0.6)

Values are presented as mean±SD, number (%), or median (IQR). Percentages may not total 100 due to rounding.

ED, emergency department; SD, standard deviation; IQR, interquartile range.

a)Any ED length of stay over 5 days was treated as 5 days.

b)Admission locations other than general wards or intensive care units were unspecified.

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Epidemiology of cardiac arrest and acute myocardial infarction in emergency departments in Korea, 2020–2024: a report using the National Emergency Department Information System (NEDIS) database
Clin Exp Emerg Med. 2026;13(1):90-97.   Published online March 31, 2026
DOI: https://doi.org/10.15441/ceem.25.318
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Epidemiology of cardiac arrest and acute myocardial infarction in emergency departments in Korea, 2020–2024: a report using the National Emergency Department Information System (NEDIS) database
Clin Exp Emerg Med. 2026;13(1):90-97.   Published online March 31, 2026
DOI: https://doi.org/10.15441/ceem.25.318
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Epidemiology of cardiac arrest and acute myocardial infarction in emergency departments in Korea, 2020–2024: a report using the National Emergency Department Information System (NEDIS) database
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Fig. 1. Changes in the incidence and mortality of patients with cardiac arrest during 2020–2024. (A) Age- and sex-standardized emergency department (ED) visits per 100,000 population (2023 vs. 2024: total, 73.9 vs. 69.8, P<0.001; adult group, 42.4 vs. 41.1, P=0.006; pediatric group, 10.3 vs. 10.7, P=0.437; older adult group, 275.0 vs. 254.5, P<0.001). (B) Age- and sex-standardized mortality per 100,000 ED visits (2023 vs. 2024: total, 378.9 vs. 430.2, P<0.001; adult group, 221.6 vs. 265.9, P<0.001; pediatric group, 33.1 vs. 46.8, P<0.001; older adult group, 437.4 vs. 487.3, P<0.001). (C) In-hospital mortality (2023 vs. 2024: total, 76.4% vs. 76.9%, P=0.128; adult group, 67.8% vs. 68.6%, P=0.135; pediatric group, 70.8% vs. 68.1%, P=0.289; older adult group, 81.5% vs. 81.8%, P=0.427). *Statistically significant differences between 2023 and 2024.
Fig. 2. Changes in the incidence and mortality of patients with acute myocardial infarction during 2020–2024. Pediatric patients with acute myocardial infarction are not presented in the figure because of the extremely small number of cases. (A) Age- and sex-standardized emergency department (ED) visits per 100,000 population (2023 vs. 2024: total, 52.7 vs. 47.2, P<0.001; adult group, 35.6 vs. 32.8, P=0.006; pediatric group, 0.2 vs. 0.1, P=0.424; older adult group, 176.2 vs. 153.7, P<0.001). (B) Age- and sex-standardized mortality per 100,000 ED visits (2023 vs. 2024: total, 33.5 vs. 34.3, P=0.378; adult group, 12.7 vs. 14.6, P=0.018; pediatric group, 0.0 vs. 0.0, P=not determined; older adult group, 34.2 vs. 34.3, P=0.978). (C) In-hospital mortality (2023 vs. 2024: total, 9.6% vs. 9.3%, P=0.264; adult group, 4.5% vs. 4.6%, P=0.668; pediatric group, 0.0% vs. 0.0%, P=not determined; older adult group, 13.6% vs. 13.0%, P=0.129). *Statistically significant differences between 2023 and 2024.

Fig. 1.

Fig. 2.

Epidemiology of cardiac arrest and acute myocardial infarction in emergency departments in Korea, 2020–2024: a report using the National Emergency Department Information System (NEDIS) database
Variable Total (n=205,617) Pediatric group (0–17 yr) (n=3,325, 1.6%) Adult group (18–64 yr) (n=74,751, 36.4%) Older adult group (≥65 yr) (n=127,535, 62.0%)
Age (yr) 67.4±18.0 7.5±6.5 50.8±11.3 78.7±7.8
Sex
 Male 130,953 (63.7) 1,935 (58.2) 54,994 (73.6) 74,019 (58.0)
 Female 74,664 (36.3) 1,390 (41.8) 19,757 (26.4) 53,516 (42.0)
Time from symptom onset to ED arrivala) 40 (28–74) 36 (25–66) 40 (28–73) 40 (29–74)
Type of ED
 Level I 67,305 (32.7) 1,606 (48.3) 26,265 (35.1) 39,434 (30.9)
 Level II 98,648 (48.0) 1,408 (42.3) 36,107 (48.3) 61,133 (47.9)
 Level III 39,664 (19.3) 311 (9.4) 12,379 (16.6) 26,968 (21.1)
Route of arrival
 Direct visit 179,417 (87.3) 2,924 (87.9) 65,008 (87.0) 111,479 (87.4)
 Transfer from other hospital 22,808 (11.1) 362 (10.9) 8,334 (11.1) 14,112 (11.1)
 Referral from outpatient clinic 3,178 (1.5) 39 (1.2) 1,336 (1.8) 1,803 (1.4)
 Other 112 (0.1) 0 (0) 37 (0.0) 75 (0.1)
 Unknown 102 (0.0) 0 (0) 36 (0.0) 66 (0.1)
Transport
 119 Ambulance 166,401 (80.9) 2,646 (79.6) 59,960 (80.2) 103,790 (81.4)
 Other medical institution ambulance 4,551 (2.2) 73 (2.2) 1,577 (2.1) 2,901 (2.3)
 Other ambulance 14,608 (7.1) 165 (5.0) 5,214 (7.0) 9,229 (7.2)
 Police or official transport 225 (0.1) 4 (0.1) 159 (0.2) 62 (0.0)
 Air transport 881 (0.4) 16 (0.5) 478 (0.6) 387 (0.3)
 Other transport 17,674 (8.6) 402 (12.1) 6,967 (9.3) 10,304 (8.1)
 Walk-in 441 (0.2) 11 (0.3) 163 (0.2) 267 (0.2)
 Other/unknown 836 (0.4) 8 (0.2) 233 (0.3) 595 (0.5)
Length of stay (hr)b)
 Mean±SD 4.0±7.6 3.0±4.5 4.2±7.7 4.0±7.5
 Median (IQR) 1.9 (1.0–3.9) 1.8 (1.1–3.1) 2.0 (1.1–4.1) 1.8 (1.0–3.8)
 0–6 174,042 (84.6) 3,009 (90.5) 62,766 (84.0) 108,262 (84.9)
 6–12 17,947 (8.7) 217 (6.5) 6,777 (9.1) 10,953 (8.6)
 12–24 9,003 (4.4) 74 (2.2) 3,490 (4.7) 5,439 (4.3)
 ≥24 4,453 (2.2) 25 (0.8) 1,666 (2.2) 2,762 (2.2)
 Unknown 172 (0.1) 0 (0) 52 (0.1) 119 (0.1)
ED disposition
 Discharge 6,016 (2.9) 106 (3.2) 3,236 (4.3) 2,673 (2.1)
 Admissionc) 54,620 (26.6) 903 (27.2) 24,517 (32.8) 29,200 (22.9)
  General ward 5,130 (2.5) 103 (3.1) 2,100 (2.8) 2,927 (2.3)
  Intensive care unit 49,451 (24.0) 800 (24.1) 22,405 (30.0) 26,246 (20.6)
 Transfer 11,598 (5.6) 335 (10.1) 5,253 (7.0) 6,009 (4.7)
 Comfort care discharge 114 (0.1) 0 (0) 38 (0.1) 76 (0.1)
 Death 133,077 (64.7) 1,975 (59.4) 41,638 (55.7) 89,460 (70.1)
 Other/unknown 192 (0.1) 6 (0.2) 69 (0.1) 117 (0.1)
Hospital disposition
 Discharge 24,830 (12.1) 489 (14.7) 13,660 (18.3) 10,680 (8.4)
 Transfer 19,197 (9.3) 418 (12.6) 8,603 (11.5) 10,175 (8.0)
 Comfort care discharge 321 (0.2) 6 (0.2) 122 (0.2) 193 (0.2)
 Death 159,527 (77.6) 2,388 (71.8) 51,765 (69.2) 105,370 (82.6)
 Other/unknown 1,742 (0.8) 24 (0.7) 601 (0.8) 1,117 (0.9)
Variable Total (n=142,499) Pediatric group (0–17 yr) (n=75, 0.1%) Adult group (18–64 yr) (n=64,175, 45.0%) Older adult group (≥65 yr) (n=78,249, 54.9%)
Age (yr) 66.5±13.7 11.6±4.6 54.1±7.9 76.7±7.7
Sex
 Male 104,228 (73.1) 56 (74.7) 56,145 (87.5) 48,027 (61.4)
 Female 38,271 (26.9) 19 (25.3) 8,030 (12.5) 30,222 (38.6)
Time from symptom onset to ED arrival 133 (60–360) 146.0 (60–420) 111.0 (53–297) 161 (60–420)
Type of ED
 Level I 62,684 (44.0) 16 (21.3) 27,609 (43.0) 35,059 (44.8)
 Level II 79,815 (56.0) 59 (78.7) 36,566 (57.0) 43,190 (55.2)
Route of arrival
 Direct visit 100,407 (70.5) 67 (89.3) 46,528 (72.5) 53,812 (68.8)
 Transfer from other hospital 38,429 (27.0) 7 (9.3) 16,128 (25.1) 22,294 (28.5)
 Referral from outpatient clinic 3,643 (2.6) 1 (1.3) 1,514 (2.4) 2,128 (2.7)
 Other 20 (0.0) 0 (0) 5 (0.0) 15 (0.0)
 Unknown 0 (0) 0 (0) 0 (0) 0 (0)
Transport
 119 Ambulance 66,846 (46.9) 13 (17.3) 28,742 (44.8) 38,091 (48.7)
 Other medical institution ambulance 5,672 (4.0) 2 (2.7) 2,195 (3.4) 3,475 (4.4)
 Other ambulance 18,971 (13.3) 4 (5.3) 7,336 (11.4) 11,631 (14.9)
 Police or official transport 104 (0.1) 0 (0) 75 (0.1) 29 (0.0)
 Air transport 627 (0.4) 0 (0) 288 (0.4) 339 (0.4)
 Other transport 49,066 (34.4) 56 (74.7) 24,969 (38.9) 24,041 (30.7)
 Walk-in 983 (0.7) 0 (0) 487 (0.8) 496 (0.6)
 Other/unknown 230 (0.2) 0 (0) 83 (0.1) 147 (0.2)
Length of stay (hr)a)
 Mean±SD 5.9±8.0 3.7±2.8 5.1±7.4 6.5±8.4
 Median (IQR) 3.2 (1.4–6.7) 3.0 (2.1–4.5) 2.6 (1.1–5.7) 3.7 (1.8–7.4)
 0–6 102,596 (72.0) 67 (89.3) 49,010 (76.4) 53,519 (68.4)
 6–12 21,802 (15.3) 6 (8.0) 8,293 (12.9) 13,503 (17.3)
 12–24 12,856 (9.0) 2 (2.7) 4,942 (7.7) 7,912 (10.1)
 ≥24 5,244 (3.7) 0 (0) 1,929 (3.0) 3,315 (4.2)
 Unknown 1 (0.0) 0 (0) 1 (0.0) 0 (0)
ED disposition
 Discharge 5,241 (3.7) 29 (38.7) 2,419 (3.8) 2,793 (3.6)
 Admissionb) 128,307 (90.0) 34 (45.3) 58,425 (91.0) 69,848 (89.3)
  General ward 38,354 (26.9) 24 (32.0) 15,964 (24.9) 22,366 (28.6)
  Intensive care unit 89,886 (63.1) 10 (13.3) 42,443 (66.1) 47,433 (60.6)
 Transfer 6,299 (4.4) 11 (14.7) 2,684 (4.2) 3,604 (4.6)
 Comfort care discharge 17 (0.0) 0 (0) 2 (0.0) 15 (0.0)
 Death 2,582 (1.8) 1 (1.3) 619 (1.0) 1,962 (2.5)
 Other/unknown 53 (0.0) 0 (0) 26 (0.0) 27 (0.0)
Hospital disposition
 Discharge 114,529 (80.4) 63 (84.0) 56,493 (88.0) 57,973 (74.1)
 Transfer 13,430 (9.4) 11 (14.7) 4,443 (6.9) 8,976 (11.5)
 Comfort care discharge 117 (0.1) 0 (0) 26 (0.0) 91 (0.1)
 Death 13,650 (9.6) 1 (1.3) 2,915 (4.5) 10,734 (13.7)
 Other/unknown 773 (0.5) 0 (0) 298 (0.5) 475 (0.6)
Table 1. Demographics, ED visit characteristics, and outcomes of patients with cardiac arrest

Values are presented as mean±SD, number (%), or median (IQR). Differences between totals and subgroup sums are due to missing age data (n=6); percentages may not total 100 due to rounding.

ED, emergency department; SD, standard deviation; IQR, interquartile range.

Reporting was not obligatory for level III EDs.

Any ED length of stay over 5 days was treated as 5 days.

Admission locations other than general wards or intensive care units were unspecified.

Table 2. Demographics, ED visit characteristics, and outcomes of patients with acute myocardial infarction

Values are presented as mean±SD, number (%), or median (IQR). Percentages may not total 100 due to rounding.

ED, emergency department; SD, standard deviation; IQR, interquartile range.

Any ED length of stay over 5 days was treated as 5 days.

Admission locations other than general wards or intensive care units were unspecified.

Table 1.

Table 2.

CEEM : Clinical and Experimental Emergency Medicine

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