Limited access to angioplasty access in minoritized, poor and rural communities

July 17, 2024

Likelihood of PCI facility by hospital service area characteristics, 2021

Source: Hsia, et al, Health Affairs, July, 2024 LINK  PCI= percutaneous cutaneous intervention, or cardiac angioplasty. A dot on the right side means this category of communities is more likely to have a PCI hospital, and a dot on the left side of the line means the category of communities is less likely to have a PCI hospital.

When people have heart attacks, they need access to a hospital where doctors can quickly insert a catheter to open blocked blood vessels. In many instances, a timely procedure can prevent serious heart damage. Patients who would have had devastating heart attacks in the past are today able to leave the hospital with entirely normal cardiac function.

But this only works if there is a hospital close by, which has the capacity to do interventional cardiology. These services are currently offered in 1621 of the 5260 hospitals in the US. Hospitals must have the right staff and enough volume to offer these services. The goal is “door to balloon time” (time from coming into the emergency department to time when a catheter is in the heart vessels to open the blood vessel) of just 90 minutes. Hospitals that don’t have this level of service can give effective blood thinning medications to stop a heart attack, although PCI leads to better outcomes.  

Health Affairs published data this month demonstrating that hospitals that offer these higher-level services are disproportionately located in communities that are predominately white, higher income and urban. The chart above demonstrates that communities that are segregated by race or ethnicity, lower income communities and rural communities are only about half as likely to have hospital facilities with PCI (percutaneous cutaneous intervention, or cardiac angioplasty)

capabilities. This does not include ambulatory PCI facilities, but these represented under 1% of these procedures in 2021, and these facilities are generally concentrated in high income communities.

Implications for employers:

-        Narrow networks should always include access to facilities that provide PCI services

-        Reporting on quality and outcomes by race and ethnicity can identify access challenges.

-        The key to any heart attack intervention is to receive help as soon as possible – general education to employees and managers about when to seek help is critical.

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Tomorrow: Thursday Shorts: GLP-1s, biomarkers, and gender affirming surgery