AJC: Florida needs to develop a regional network for STEMI care

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Women, the elderly and patients admitted to the emergency department (ED) on weekends, are all less likely to receive same-day coronary angioplasty for a life-threatening heart attack in Florida, according to a study in the Oct. 1 issue of the American Journal of Cardiology.

Elizabeth Pathak, PhD, and Joel Strom, MD, both of University of South Florida (USF) in Tampa, examined the same-day PCI rates in more than 58,000 acute MI patients, who were admitted to EDs in more than 200 Florida hospitals from 2001 to 2005. The study included men and women ages 18 and older from the three largest ethnic groups in Florida: whites, blacks and Hispanics.

The researchers found that the use of same-day PCI for MI patients more than doubled — from 20 percent to 40 percent — during the study period. However, despite increased use of the clinically proven procedure, statewide most patients admitted to EDs still did not receive same-day PCI by the end of 2005.

The investigators identified several barriers to treatment, including:

  • Some patients were admitted to hospitals that do not perform PCI;
  • At PCI-providing hospitals, patients ages 55 to 64, were on average about twice as likely to receive same-day PCI as patients 75-years-old or older;
  • Men were more likely to receive same-day PCI than women;
  • While black patients were less likely to receive same-day PCI than whites in early 2001, the racial disparity disappeared by the end of the study period; and
  • Even by late 2005, patients admitted on weekends were 25 percent less likely to receive same-day PCI than those admitted on week days.

Hospital PCI volume was also a significant factor in receiving same-day procedures, according to the authors. Patients admitted to medium to high-volume hospitals that performed at least 200 PCIs a year were five times more likely to receive same-day PCI than those at low-volume hospitals performing fewer than 200 procedures a year.

“Many leading hospitals in Florida and across the nation are putting into place new policies and protocols that are eliminating the weekend problem. However, the reasons behind the apparent age and gender disparities shown in our study and others are likely more complex and require further focused research,” said lead investigator Pathak, an associate professor of epidemiology at the USF College of Public Health.

“Future research will need to examine more detailed medical data to evaluate whether some patients were excluded from PCI for legitimate clinical reasons such as certain risk factors or complications,” Pathak added.

Supported by a new grant from the American Heart Association (AHA), Pathak will be examining the feasibility of a statewide system for routing STEMI patients to high-volume PCI hospitals. She will examine hospital, geographic (rural) and financial barriers limiting patient access to PCI, continue to track PCI use and investigate patient outcomes.

“Today national standards recommend that patients with STEMIs should be identified and treated by balloon angioplasty within 90 minutes of first contact with medical personnel, ideally an EMS paramedic,” said Strom, professor of medicine and chemical and biomedical engineering at USF and cardiology co-chair for the AHA's state-level STEMI task force.

“Florida needs to develop a regional network for STEMI care that integrates Emergency Medical Services and PCI-capable hospitals, similar to the current statewide systems governing stroke and trauma care,” he concluded.