Significant mismatch between PCI capable-hospitals and need

March 25, 2012

There is an imbalance between the rapid growth of cardiac catheterization laboratories, which provide percutaneous coronary intervention (PCI) procedures, relative to the growth in the overall U.S. population, as well as patients who experience an acute heart attack, or ST-elevation myocardial infarction (STEMI), according to a study presented March 25 at the 61st annual American College of Cardiology (ACC) scientific session.

PCI is the preferred for patients who undergo STEMI. However, distance and access to PCI remains a determining factor in the choice between PCI, fibrinolytics and hybrid strategies.

"The prevalence of STEMI has decreased over time, while the prevalence of PCI centers has increased significantly. While clinical outcomes with PCI have continued to improve, we are tasked with the challenge of ensuring proper access to care for all at-risk Americans," said study co-investigator Timothy D. Henry, MD, an interventional cardiologist at the Minneapolis Heart Institute (MHI) at Abbott Northwestern Hospital in Minneapolis and director of research with the Minneapolis Heart Institute Foundation. "We found that there is a significant mismatch between PCI-capable facilities, and actual need."

In this study, the researchers compared changes in U.S. PCI capacity and access during the last eight years. Using geospatial and statistical analyses of data from the American Hospital Association, the and the U.S. Census Bureau, they analyzed PCI capacity relative to population density and STEMI prevalence.

The investigators found that PCI centers have grown 12.9 percent over the last eight years, while overall population has grown only 8.3 percent during this same period and STEMI rates have declined. The median number of PCI facilities per million capita across all states is currently 6.95, and ranges from 3.2 in Vermont (lowest) to 12.1 in West Virginia.

Henry explained that the central portion of the U.S. is the most densely concentrated while the upper western region poses significant distance and access issues—the greatest potential distance to the nearest PCI in that region is nearly 185 miles. States varied widely in capacity, access, and the distance between patients and PCI.

Thus, the study authors reported that PCI growth is most rapid in the east, where capacity is already sufficient and the lowest in the west where PCI capacity remains the lowest. "Efficient and equitable STEMI systems require geographical balance, which highlights a need for changes in both policy and protocols at regional levels," they wrote.

"Unfortunately, our findings reveal that the growth of PCI centers has not been planned and rationale, but driven by economic factors, leading to an excess of PCI facilities in areas where they are not needed," said Henry. "There is a significant disparity between the geographic areas of the U.S. that still require STEMI care, and where those services are provided, which raises concern about a lack of access to care for a treatable patient population."

Explore further: Most heart-attack patients needing procedure at another hospital not transferred in recommended time

Related Stories

Most heart-attack patients needing procedure at another hospital not transferred in recommended time

June 21, 2011
Only about 10 percent of patients with a certain type of heart attack who need to be transferred to another hospital for a PCI (procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) ...

Emergency treatment for heart attack improving but delays still occur

September 19, 2011
Despite improvements in treating heart attack patients needing emergency artery-opening procedures, delays still occur, particularly in transferring patients to hospitals that can perform the procedure, according to a study ...

Hospitals invest heavily in new heart attack care programs but fail to improve access

December 19, 2011
In a new study, researchers have found a 44 percent increase since 2001 in the number of hospitals that offer definitive emergency care to patients with heart attack, but only a 1 percent increase in access to that care. ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.