Abstract P321: Hospital Angioplasty Volumes and ST-Elevation Myocardial Infarction Patient Admission Patterns: Improvement in Florida from 2001-2007

Abstract

Background: The ACC/AHA guidelines recommend percutaneous coronary intervention (PCI) at high-volume centers with at least 400 procedures per year for ST-elevation myocardial infarction (STEMI), but fewer than 25% of acute care hospitals in the US are PCI capable. In Florida, a statewide system for regional STEMI patient care does not yet exist, but some local STEMI care coalitions have formed. We examined trends over time in the percent of STEMI patients admitted to hospitals categorized by PCI volume. Methods: Using comprehensive statewide hospital discharge data, we classified 191 acute care hospitals according to annual PCI volume: no PCI capability (n=90), low-volume (1-199 PCIs; n=33) medium volume (200-399 PCIs; n=4) and high-volume (400+ PCIs; n=64). Hospital classifications were specific for a 3-month time window; therefore a single hospital's category could vary over time. We determined the percent of STEMI patients treated at each type of hospital for the first and second half of each year from 2001-2007. Results: From early 2001 to late 2007, the percent of STEMI patients treated at non-PCI capable hospitals declined from 31.0 to 7.9%, while the proportion at high-volume PCI centers rose from 58.3 to 72.3%. Low- and medium-volume hospitals typically accounted for <15% of total patient volume but realized slight increases from 2001 to 2007. The percentage of STEMI patients seen at low-volume PCI hospitals rose from 6.6 to 8.7% from 2001-2007, and from 4.2% to 11.1% at medium-volume hospitals. No differences in the hospital admission trends were observed by race/ethnicity or gender. Conclusions: The pattern of STEMI care has changed substantially from 2001-2007 in Florida, with a greater proportion of patients seen at high-volume PCI hospitals and fewer than 10% admitted to non-PCI hospitals by 2007. These trends are likely due to implementation of STEMI protocols by many large emergency medical services (EMS) providers across the state and the positive impact of local STEMI care coalitions in some metropolitan areas. Further research is needed to determine if there has been increased STEMI patient awareness of the value of undergoing PCI at high-volume centers. A positive trend toward regionalized STEMI care appears to be in progress in Florida.