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Access to CCTA at safety-net hospitals across the United States
Jonah Delshad1, Trevor Weis2, Caleb Bayona1
1Nassau University Medical Center, East Meadow, NY, USA.
Insights
Fewer than half of U.S. safety-net hospitals offer coronary CT angiography (CCTA) despite its proven benefits for cardiac patients. This study reveals significant disparities in CCTA availability, highlighting a critical need to improve access to this essential diagnostic tool.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Health Services Research
- Health Equity
Background:
- Coronary CT angiography (CCTA) is recommended with a class 1A indication for evaluating acute and stable chest pain.
- CCTA has demonstrated benefits in reducing mortality, myocardial infarction (MI) rates, unnecessary invasive procedures, and healthcare costs.
- Despite recommendations, CCTA adoption in U.S. hospitals has lagged behind expected standards of care.
Purpose of the Study:
- To evaluate the availability of CCTA services at U.S. safety-net hospitals.
- To identify factors influencing CCTA accessibility in these critical healthcare facilities.
Main Methods:
- Identified U.S. safety-net hospitals using the Lown Institute definition.
- Assessed CCTA performance capabilities at identified hospitals.
- Stratified data by geography (rural/urban), bed size, state, and academic status; excluded critical access, specialty, and non-emergency hospitals.
- Utilized Chi-square tests to compare variations in CCTA availability.
Main Results:
- Out of 391 identified safety-net hospitals, only 179 (45.8%) offer CCTA.
- CCTA availability significantly varied by facility size (7.7% for <50 beds to 88.9% for ≥400 beds, p<0.001).
- Significant disparities were observed based on geographic setting (22% rural vs. 57% urban, p<0.001) and academic status (97% academic vs. 41% non-academic, p<0.001).
Conclusions:
- Less than half of U.S. safety-net hospitals provide CCTA, despite its established clinical benefits and 1A recommendation.
- Findings indicate significant disparities in cardiovascular healthcare access within safety-net systems.
- Expansion of CCTA availability is crucial to address inequities and improve cardiac patient care.
Background:
Coronary CT angiography (CCTA) has received a class 1A indication for the evaluation of patients with acute and stable chest pain after studies revealed the use of CCTA reduces mortality, rates of MI, unnecessary invasive procedures, and healthcare expenditure compared to traditional stress testing. Despite this recommendation, hospitals across the U.S. have not adopted CCTA at levels expected for standard of care. We sought to evaluate the availability of CCTA at U.S. safety-net hospitals.
Methods:
U.S. safety-net hospitals were identified using the Lown Institute definition. The ability to perform CCTA at each of these hospitals was assessed. Data was stratified based on rural vs. urban geography, bed size, state, and academic status. Critical access hospitals, specialty hospitals, and those without emergency services were excluded. Variations in CCTA availability were compared with Chi-square tests.
Results:
391 safety-net hospitals in the U.S. were identified according to the criteria, of which 179 (45.8 %) offer CCTA. Availability of CCTA varied significantly depending on the size of the facility (0-49 beds: 7.7 %, 50-99 beds: 43.8 %, 100-199 beds: 45.6 %, 200-399 beds: 71 %, and ≥400 beds: 88.9 %, p < 0.001), rural vs. urban setting, (22 % vs. 57 %, p < 0.001), and academic vs. non-academic settings (97 % vs. 41 %, p < 0.001).
Conclusions:
Fewer than half of identified U.S. safety-net hospitals were found to provide CCTA for the evaluation of cardiac patients despite its 1A recommendation. This research highlights alarming trends in cardiovascular health care disparities and serves as a call to action to combat inequity through the expansion of CCTA availability.
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