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Geographic access to interventional cardiology services in one rural state

James P Rhudy1, Anne W Alexandrov2, Kristiina E Hyrkäs3

  • 1University of Alabama at Birmingham School of Nursing, 262 Main Street, Auburn, ME 04210, USA.

Heart & Lung : the Journal of Critical Care
|August 6, 2016
PubMed

Insights

Delayed access to interventional cardiology (IC) services in Maine disproportionately affects rural, older, less educated, and uninsured populations. While unadjusted mortality increased, age-adjusted coronary mortality did not differ significantly with delayed IC access.

Area of Science:

  • Cardiology
  • Public Health
  • Health Services Research

Background:

  • Acute coronary syndrome (ACS), including ST-segment elevated myocardial infarction (STEMI) and non-ST segment elevated myocardial infarction (NSTEMI), represents a significant public health challenge.
  • Timely access to interventional cardiology (IC) services is critical for minimizing coronary mortality.

Purpose of the Study:

  • To characterize the Maine population experiencing delayed geographic access to interventional cardiology (IC) services.
  • To evaluate the impact of delayed geographic IC access on coronary mortality within this population.

Main Methods:

  • Utilized census data to identify disparities in geographic access to IC services.
  • Conducted a secondary analysis of administrative claims data to assess coronary mortality in relation to delayed IC access.

Main Results:

  • Delayed IC access was linked to rural residency, older age, lower educational attainment (high school), and lack of health insurance in Maine.
  • An increase in unadjusted coronary mortality was observed with delayed access, but this association did not persist after age adjustment.

Conclusions:

  • Geographic disparities in access to interventional cardiology services were identified in Maine.
  • Delayed geographic IC access was not associated with increased age-adjusted coronary mortality, suggesting other factors may mitigate risk or that the observed unadjusted difference is confounded.
Abstract

Keywords:
Access to health careAcute coronary syndromeGeographic information systemMortalityST-Segment elevated myocardial infarction

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