Abstract
Objectives: To determine if driving time to the percutaneous coronary intervention (PCI) capable hospital is an important factor in deaths of patients with acute myocardial infarction (AMI). Methods: We studied the relationship between driving time to the nearest PCI-capable hospital and AMI mortality (2008-2012) in census block groups (BG), N=2147, in the state of Arkansas. Population center of a BG was used as a proxy for an individual’s place of residence. The driving time to the nearest PCI-capable hospital was calculated from the population center of a BG. The risk of AMI death was then calculated using five census measures: poverty (% of population below federal poverty level); population density (population per square mile); education (% of population over 25 years of age that did not graduate from high school); mobility (% of population who resided at the same address 1 year ago) and the percent of non-Hispanic blacks (% of population that is Black); and the calculated driving time to the nearest PCI-capable hospital. Arc GIS was used to calculate the driving time to the nearest PCI-capable hospital. Generalized additive models were used to estimate the variation in AMI mortality among BGs. Findings: During 2008-2012, there were 14,027 AMI deaths in Arkansas. There was considerable variation in the relative risk between BGs and AMI mortality based on the distance to the PCI hospital. The median distance to the nearest PCI-capable hospital was 12.7 miles (Interquartile range 3.5 - 30.1); and the median driving time to the nearest PCI-capable hospital was 28.3 minutes (Interquartile range 9.6-58.7). However, driving time (Range- 58.7 to 149.3 minutes) among residents in BGs (n=536) that are in the fourth quartile was much higher than the optimal timeframe to receive PCI for AMI. The regression analyses indicated that the driving time to the nearest PCI-capable hospital is a significant predictor of AMI mortality (p < 0.0001) in all BGs, after adjusting for education, poverty, race, and population density. Conclusions: Our study shows that the driving time to the nearest PCI-capable hospital is an independent predictor of AMI mortality. Improving health care system by reducing time to arrive at a PCI-capable hospital could reduce AMI deaths in underserved communities.
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