'A substantial improvement’: New research shows signs of progress in PCI care
Rural hospitals have long been associated with higher in-hospital mortality rates among percutaneous coronary intervention (PCI) patients. According to new findings published in the American Journal of Cardiology, however, that may no longer be the case.
The study’s authors reviewed the history of this topic, highlighting some of the challenges healthcare providers in rural communities are faced with on a daily basis.
“Rural areas have been well documented to have fewer resources, have less accessible healthcare, and have higher hospital mortality rates than their urban counterparts,” wrote lead author Katie Y. Chang, of the University of Cincinnati College of Medicine, and colleagues. “Patients in these areas have higher chronic disease burden and face greater socioeconomic barriers, resulting in a gap in health equity between urban and rural patients. Prehospital protocols for reducing door-to-balloon time for PCI have been implemented in rural areas, though are imperfect.”
The researchers aimed to learn if care for rural PCI patients has improved in recent years. Using data from the 2016 National Inpatient Sample database as their guide, they identified more than 80,000 unweighted inpatient admissions related to PCI.
The authors projected these findings to more than 371,000 U.S. admissions for inpatient PCI. While there were 108.9 admissions per 100,000 people from urban hospitals, there were 152.9 admissions per 100,000 people from rural hospitals. Of the rural hospitalizations, 71.7% occurred at teaching hospitals; the remaining admissions were at urban nonteaching hospitals.
Overall, in-hospital mortality rates were not significantly different between urban patients (1.8%) and rural patients (1.9%).
“As rural hospitals previously had higher in-hospital mortality-rates, this demonstrates a substantial improvement in PCI care,” the authors wrote.
Change et al. contributed this success to “multiple key initiatives,” including efforts to boost door-to-balloon times, as well as updated protocols and the continued recording and reporting of various quality metrics.
However, the team emphasized, in-hospital mortality rates were higher at urban nonteaching hospitals (2%) than urban teaching hospitals (1.7%).
What could be the cause of this disparity? The authors offered multiple possibilities.
“One potential cause for differences within urban centers may be due to differences in funding and support staff,” they wrote. “Teaching hospitals tend to be better funded, more likely to incorporate the latest equipment, and have strong quality improvement initiatives. They also have been shown to have a shorter average length of stay among their patients. Teaching hospitals have also been shown to more often implement safety practices and protocols compared with nonteaching hospitals.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.