50 million Americans don't have timely access to lifesaving heart attack procedure

by Lauren Dubinsky, Senior Reporter | July 13, 2015
Cardiology Emergency Medicine Population Health
Dr. Renee Hsia
Angioplasty is a lifesaving procedure for heart disease, but 50 million Americans are more than an hour away from hospitals that offer it, according to a new study published in Health Services Research.

"The number of hospitals with the capability of performing angioplasty has been gradually increasing over time," Dr. Renee Hsia, one of the lead researchers and emergency physician at San Francisco General Hospital and Trauma Center, told HCB News. "The problem, however, is that this growth has not occurred evenly in all communities."

The growth has predominantly been in more affluent communities with more privately insured patients, she added. Since there is not much regulation regarding where the growth occurs, the hospitals can decide if they want to provide this type of service.

The researchers set out to determine how long it takes over 306 million individuals from various communities to travel to the closest of the 1,738 hospitals that perform angioplasty in the U.S. They used Google Maps and Stata, a statistical knowledge software, to measure driving times.

They found that the average travel time was 33 minutes, but for about 16 percent of the population or 50 million individuals, it took more than an hour to reach the hospitals. They noted that low-income and Hispanic populations were more likely to have poor access to the hospitals, independent of rural or urban residence.

The American Heart Association and the American College of Cardiology recommend that a maximum of 120 minutes pass between the heart attack patient's first medical contact to inflation of the balloon in a cardiac artery.

ST segment elevation myocardial infarction (STEMI) is the deadliest form of heart attack and affects half a million individuals in the U.S. per year. For that condition, quick access to an angioplasty center is imperative but only 37 percent of all acute adult hospitals in the country perform the procedure and less than 12 percent are able to handle a high volume of STEMI patients.

In 2000, the median distance to an angioplasty center was 7.9 miles and 79 percent of the population lived within an hour. And in 2011 that improved to 7.4 miles and 84 percent, respectively. The researchers noted that there is better accessibility, but that many new centers are opening in areas where angioplasty centers already exist.

Hospitals that are not able to perform this procedure, should implement protocols to send patients to nearby hospitals that provide this service, said Hsia. But in a place where you can't get the patient to a hospital within the time frame, the hospital should have a protocol in place where they utilize "clot-busting" drugs.

Hsia believes that it's "very likely" that more hospitals will offer angioplasty services in the future, but the question is whether this will significantly benefit patients or whether they will be duplicative services in areas where hospitals are already competing.

"At least from the patient perspective, a more even distribution of these centers across communities would be more optimal," said Hsia. "Unfortunately, because there is a market-oriented approach to health care in the United States, hospitals aren't necessarily incentivized to provide services in poorer areas, and that leaves gaps in our ability to provide the best care for all patients in an equitable way."

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