Key result
~70% of the Kerala population lives within a half-hour of a PCI-capable hospital.
Cross-Sectional (n=33,406,061)
Yes
A majority of the population in Kerala, India, has timely geographic access to PCI-capable hospitals, highlighting that pre-hospital delays and systems of care, rather than just facility availability, are key barriers to STEMI reperfusion.
High PCI access in Kerala indicates prehospital delays as main barrier; leaves open whether systems interventions improve outcomes elsewhere.
BACKGROUND: Population access to timely reperfusion is a decisive factor in determining the success and acceptability of any regional system of ST-segment elevation myocardial infarction (STEMI) care. We sought to determine the proportion of population of the southern Indian state of Kerala having timely access to STEMI reperfusion. METHODS: We identified the STEMI reperfusion facilities available at all acute-care hospitals, in Kerala, by conducting a cross-sectional survey. We mapped the geographical catchment areas of these hospitals using historical travel speeds and appropriate Geospatial Information Systems (GIS) analyses. Subsequently, using block level population data, we estimated the proportion of the population residing within these geographies. RESULTS: We estimated that 23.33 million people, forming 69.84% of the state population, resided in the green zone (within half-hour travel distance of a percutaneous coronary intervention [PCI]-capable hospital), which covered 47.94% of the geographical area of the state. Outside this green zone, 21.87% of the state population resided within 1hr travel distance of a thrombolysis-capable hospital. Finally, 8.28% of the state population resided in the red zone, where access to any reperfusion-capable hospital took >1hr, which covered 22.15% of the geographical area of the state. CONCLUSIONS: A majority of the population of Kerala had timely access to PCI-capable hospitals. GIS-based mapping of Indian states, in terms of access to STEMI reperfusion, may help devise protocols to achieve seamless transfer of patients to reperfusion-capable hospitals. Such regionalization of STEMI care would enhance organizational synergies to achieve better access to reperfusion, especially in remote areas.
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Mathew et al. (2017) conducted a cross-sectional in ST-segment elevation myocardial infarction (n=33,406,061). Access to PCI-capable hospitals vs. Access to thrombolysis-capable hospitals or no access was evaluated on Proportion of population residing within half-hour travel distance of a PCI-capable hospital. In the state of Kerala, India, 69.84% of the population resided within a half-hour travel distance of a PCI-capable hospital, while 8.28% had no timely access to any reperfusion therapy.
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