Timing is critical for patients who experience a major heart attack. Ninety minutes or less can be an ideal time to treat ST-elevation myocardial infarction (STEMI), a heart attack that results from a blocked artery. This timeframe expands to two hours if a patient is transferred from another hospital. STEMI regionalization is a protocol hospitals use to usher patients who had a heart attack to regional medical centers equipped with advanced cardiac laboratories and trained specialists to expedite treatment, which supports long-term survival. However, a study in California finds not all communities benefit equally from these medical partnerships.
A retrospective review of 139,494 California residents found patients living in nonminority communities benefitted most from STEMI protocols. Access to non-surgical interventions to open the blocked coronary artery that caused the heart attack and both short- and long-term survival rates factored into these metrics, which were measured over 10 years. Patients living in nonminority communities saw a 10.3% increase in same-day treatment after STEMI regionalization was introduced in their community. In minority communities, patients had a 3.4% increase in same-day treatment after STEMI regionalization.
The authors suggest treatment differences are multifactorial. Accredited STEMI hospitals with advanced cardiac labs and capacity to treat more patients may be closer to nonminority communities and familiar to patients with private insurance. Referrals and ambulatory care use, which affects the timing of treatment, may vary by neighborhood. Systemic racism is another factor. White residents living in nonminority communities were the only group to benefit from improved survival rates following STEMI regionalization. The study was published in JAMA Network Open and supported by the National Heart, Lung, and Blood Institute.