De Facto regionalization of care for ST-elevation myocardial infarction in Florida, 2001-2009

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• ACC/AHA guidelines advocate for ST-elevation myocardial infarction (STEMI) patients to receive percutaneous coronary intervention (PCI) at high-volume hospitals (≥400 procedures/year).
• Understanding the organizational and implementation shifts in STEMI care delivery within a large state is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate changes in the organization and implementation of care for STEMI patients in Florida.
• To assess statewide trends and identify predictors of STEMI patient admissions to high PCI volume hospitals between 2001 and 2009.

Main Methods:

• Classification of Florida hospitals into PCI volume categories (high, medium, low, non-PCI) quarterly from January 2001 to June 2009.
• Analysis of hospital discharge data to determine the proportion of STEMI patients admitted to each hospital type.
• Statistical analysis of multiple predictors for admission to high PCI volume hospitals.

Main Results:

• The proportion of STEMI patients initially hospitalized at high PCI volume hospitals significantly increased from 62.4% in 2001 to 89.7% by 2009.
• Admissions to non-PCI hospitals for STEMI patients decreased from 31% to 4.9% during the study period.
• Persistent barriers to high PCI volume hospital admission included advanced age (≥85 years), female gender, and residence in a major metropolitan county.

Conclusions:

• Statewide collaborative efforts in Florida successfully redirected almost 90% of STEMI patients to high PCI volume hospitals by 2009.
• Hospital competition in major metropolitan areas may be associated with lower STEMI admission rates to high PCI volume facilities.
• Further research is warranted to investigate the underlying causes of age and gender disparities in accessing high PCI volume STEMI care.