Follow Your Heart: Survival Chances and Costs after Heart Attacks-An Instrumental Variable Approach

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Public Health

Background:

• Acute myocardial infarction (heart attack) outcomes are influenced by treatment accessibility.
• Hospital specialization, particularly the presence of a catheterization laboratory for percutaneous coronary intervention (PCI), is a key determinant of treatment intensity.
• Geographic disparities in healthcare access can impact patient survival.

Purpose of the Study:

• To evaluate the impact of initial hospital admission to specialized percutaneous coronary intervention (PCI) hospitals on mortality and healthcare costs for acute myocardial infarction (heart attack) patients.
• To investigate whether geographic factors, such as place of residence, influence access to intensive cardiac treatment.
• To determine the cost-effectiveness of early access to PCI-capable hospitals.

Main Methods:

• Utilized administrative data from 4,920 acute myocardial infarction patients in Austria (2002-2011).
• Employed an instrumental variable framework, using place of residence as an exogenous variation to address nonrandom patient selection into PCI hospitals.
• Analyzed effects on 3-year mortality and both inpatient and outpatient costs.

Main Results:

• Initial admission to PCI hospitals significantly increases survival chances, reducing 3-year mortality by 9.5 percentage points.
• The survival benefit was most pronounced in relative terms for patients under 65.
• No significant long-term inpatient cost increases were observed; outpatient costs showed only marginal increases.

Conclusions:

• Place of residence is a significant factor affecting access to life-saving invasive heart attack treatments.
• Ensuring broader and immediate patient access to PCI-capable hospitals is recommended to improve survival rates.
• The findings support the clinical and economic benefits of timely access to specialized cardiac care.