More hospitals with angioplasty capability have not improved access to the procedure
Research Activities, November 2012, No. 387
The number of hospitals in the United States that offer definitive heart attack care grew by 44 percent from 2001 to 2006, but only 1 percent of the population gained timely access to that care in the same period. Tufts Medical Center researchers, led by Thomas W. Concannon, PhD, found that interventional angioplasty (percutaneous coronary intervention) programs grew from 1,176 to 1,695 hospitals over 5 years, while access to the procedure held steady, rising less than 1 percent from 79 percent to 79.9 percent of the population.
When heart attack symptoms begin, access to definitive care depends largely on distance to hospitals with specialized treatment capability. For patients with ST-segment elevation-myocardial infarction, timely angioplasty is better than intravenously administered clot-busting medication (fibrinolytic therapy) at reducing mortality. However, angioplasty is available only at hospitals with cardiac catheterization labs and fibrinolytic therapy remains the current standard of care in the majority of U.S. hospitals. Study data also show that the average projected transport times to angioplasty hospitals were improved only 30 seconds by the new hospital programs.
Other research has shown that angioplasty use rates have remained flat since 2001, suggesting that new programs are not meeting new emergency or elective demand. Unanswered questions include whether the proliferation of angioplasty programs has improved outcomes through the reduction of time to treatment for previously underserved patients, or if it has worsened outcomes through reductions in procedure volumes. This study was supported in part by the Agency for Healthcare Research and Quality (HS17726).
See "A percutaneous coronary intervention lab in every hospital?" by Dr. Concannon, Jason Nelson, M.P.H., Jessica Goetz, M.P.H., and John L. Griffith, PhD, in Circulation and Cardiovascular Quality Outcomes 5, pp. 14-20, 2012.