Driving Time to the Nearest Percutaneous Coronary Intervention-Capable Hospital and the Risk of Case Fatality in
Jie Chang1,2, Qiuju Deng1,2, Piaopiao Hu1,2
1Center for Clinical and Epidemiologic Research, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China.
Insights
Longer driving times to PCI-capable hospitals increase the risk of death for acute myocardial infarction (AMI) patients. Access to care remains unequal between urban and peri-urban areas, impacting AMI fatality rates.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- Timely access to percutaneous coronary intervention (PCI) is crucial for acute myocardial infarction (AMI) patient survival.
- Geographic accessibility to PCI-capable hospitals can significantly influence patient outcomes.
Purpose of the Study:
- To investigate the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients.
- To identify disparities in access to PCI-capable hospitals for AMI patients in Beijing.
Main Methods:
- A cross-sectional study analyzing 142,474 AMI events from 2013-2019 using the Beijing Cardiovascular Disease Surveillance System.
- Driving time to the nearest PCI-capable hospital was calculated from patient residential addresses.
- Logistic regression models were employed to assess the risk of AMI death in relation to driving time.
Main Results:
- In 2019, 54.5% of AMI patients resided within a 15-minute drive to a PCI-capable hospital, with significant urban-rural disparities (71.2% urban vs. 31.8% peri-urban).
- Compared to patients with ≤15 min driving time, adjusted odds ratios for AMI fatality increased with longer driving times: 1.068 (16-30 min), 1.189 (31-45 min), and 1.436 (>45 min).
- A longer driving time to a PCI-capable hospital was significantly associated with elevated AMI fatality risk.
Conclusions:
- Despite overall accessibility, significant inequalities in PCI-capable hospital access exist between urban and peri-urban areas in Beijing.
- Increased driving time to PCI-capable facilities is linked to higher AMI mortality.
- Findings underscore the need for strategic health resource allocation to mitigate geographic disparities in emergency cardiac care.
Abstract:
Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013-2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, p < 0.001). Compared with patients who had driving times ≤15 min, the adjusted odds ratios (95% CI, p value) for AMI fatality risk associated with driving times 16-30, 31-45, and >45 min were 1.068 (95% CI 1.033-1.104, p < 0.001), 1.189 (95% CI 1.127-1.255, p < 0.001), and 1.436 (95% CI 1.334-1.544, p < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources.
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