Access to myocardial revascularization procedures: closing the gap with time?
Alain Vanasse1, Théophile Niyonsenga, Josiane Courteau
1Family Medicine Department, Faculty of Medicine, Université de Sherbrooke, Sherbrooke (QC), J1H 5N4, Canada. alain.vanasse@usherbrooke.ca
Insights
Geographic distance to specialized cardiology centers impacts myocardial infarction (MI) revascularization rates. While closer proximity initially favors treatment, the gap narrows for some patients over the first year post-MI.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Early revascularization improves outcomes for myocardial infarction (MI) patients.
- Access to specialized cardiac care varies significantly across populations.
- Geographic distance to specialized cardiology centers (SCCs) may influence revascularization rates.
Purpose of the Study:
- To determine if the initial disparity in revascularization rates, based on patient proximity to SCCs, persists long-term.
- To analyze the evolution of revascularization rate gaps over the first year after MI.
Main Methods:
- Population-based cohort study using Quebec's hospital discharge register (MED-ECHO).
- Included 11,802 patients aged 25+ hospitalized for MI in 1999, with one-year follow-up.
- Categorized patients into four distance groups from SCCs (<32 km, 32-64 km, 64-105 km, > or = 105 km).
- Main outcome: revascularization (PCI or CABG); adjusted for age and sex.
Main Results:
- A significant gap in revascularization rates existed at index hospitalization, favoring patients closer to SCCs (<32 km).
- This gap persisted throughout the first year post-MI.
- A notable reduction in the revascularization gap was observed for patients living at an intermediate distance (64-105 km).
Conclusions:
- The initial disparity in MI revascularization rates based on distance to SCCs is largely maintained one year post-MI.
- Patients living closer to specialized centers have better access to timely revascularization.
- Intermediate distance patients (64-105 km) showed some improvement in gap reduction over the first year.
Background:
Early access to revascularization procedures is known to be related to a more favorable outcome in myocardial infarction (MI) patients, but access to specialized care varies widely amongst the population. We aim to test if the early gap found in the revascularization rates, according to distance between patients' location and the closest specialized cardiology center (SCC), remains on a long term basis.
Methods:
We conducted a population-based cohort study using data from the Quebec's hospital discharge register (MED-ECHO). The study population includes all patients 25 years and older living in the province of Quebec, who were hospitalized for a MI in 1999 with a follow up time of one year after the index hospitalization. The main variable is revascularization (percutaneous transluminal coronary angioplasty or a coronary artery bypass graft). The population is divided in four groups depending how close they are from a SCC (< 32 km, 32-64 km, 64-105 km and > or = 105 km). Revascularization rates are adjusted for age and sex.
Results:
The study population includes 11,802 individuals, 66% are men. The one-year incidence rate of MI is 244 individuals per 100,000 inhabitants. At index hospitalization, a significant gap is found between patients living close (< 32 km) to a SCC and patients living farther (> or = 32 km). During the first year, a gap reduction can be observed but only for patients living at an intermediate distance from the specialized center (64-105 km).
Conclusion:
The gap observed in revascularization rates at the index hospitalization for MI is in favour of patients living closer (< 32 km) to a SCC. This gap remains unchanged over the first year after an MI except for patients living between 64 and 105 km, where a closing of the gap can be noticed.
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