Substantial Increase in PCI-friendly Hospitals, but Access Remains Unimproved

In a recent study, an increase of 44% was observed in the number of hospitals that provide high quality emergency care to patients stricken with heart attacks since 2001—but an increase of only 1% occurred in access to that care.

The study was led by Thomas W. Concannon, PhD, Assistant Professor Tufts Medical Center and Tufts University School of Medicine.

Concannon and his fellow researchers performed the study on hospitals across the nation between the years of 2001 and 2006, paying specific attention to how many hospitals adopted a percutaneous coronary intervention (PCI) program.

PCI is a surgical procedure designed to eliminate blockages with a balloon and a stent-tipped catheter; in comparison to fibrinolytic therapy, a non-surgical procedure that has been shown to reduce some blockages via an injection of medication, PCI saves more lives when administered immediately to heart attack victims. As such, when symptoms of a heart attack first appear, patients who are able to get to a hospital with a PCI program within 60 minutes are more likely to live and reduce the damage of a heart attack.

According to this research, however, PCI programs are currently only accessible in one-third of US hospitals.

The researchers collected data from the 2006 American Hospital Association (AHA) Annual Survey Database of all 50 states and the District of Columbia, the 2006 Health Care Cost and Utilization Project’s (HCUP) State Inpatient Databases from 21 states, and the 2000 US Census.

The researchers found that, while the number of hospitals with a PCI program rose by 519 during the study period (from 1,176 to 1695 nationwide), the percent of the US population with timely access to PCI only increased from 79.0% to 79.9%.

Further, they established that the increase of hospitals utilizing PCI programs did not significantly decrease the average amount of time it takes for patients who already had access to the procedure. Overall, the researchers found that the median projected travel time to the closest PCI-equipped hospital decreased only 48 seconds nationally as a result of the changes (from 11.3 to 10.5 minutes).

The researchers also found that the time it took to gain access to a PCI hospital varied considerably across different regions. The Northeast had the highest access (87.8%) whereas the South had the lowest (75.7%). In seven states, over 90% of the population was within 60 minutes of a PCI hospital.

· California (90.9%)

· Connecticut (93.6%)

· Delaware (91.7%)

· Massachusetts (94.6%)

· New Jersey (96.5%)

· Rhode Island (96.1%)

· The District of Columbia (100%)

In seven other states, however, the percentage of the population with timely access to a PCI hospital was less than 50%.

· North Dakota (48.9%)

· South Dakota (40.3%)

· Vermont (38.3%)

· West Virginia (45.6%)

· Alaska (40.0%)

· Montana (45.3%)

· Wyoming (30.5%)

Concannon commented on these findings, stating that “New hospital PCI programs after 2001 have largely failed to improve patient access or reduce delays to treatment.”

“For regions that wish to boost access to PCI,” he advised, “the focus should be on enhanced ambulance services and on well-positioned PCI programs, rather than on the sheer number of PCI programs. A shift in priorities could make a significant impact and it could save lives.”

The study was entitled “A Percutaneous Coronary Intervention Lab in Every Hospital?” and will be published January 1, 2012 in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.