Distance to nearest hospital is major factor in survival of heart attack victims, Cornell study shows
By Susan S. Lang
Heart attack victims who make it to the hospital in time to receive medical attention are four to five times more likely to survive compared with those who don't make it to a hospital promptly, according to a new Cornell University study. The research also finds that for each five-minute increase in distance from a hospital, a person's probability of getting to the hospital in time falls by 1.25 percent.
"With prompt medical attention, a person's blockage to the heart, which causes a heart attack, can often be dissolved. That reduces damage to the heart and greatly lowers morbidity and mortality," says Liam O'Neill, assistant professor of policy analysis and management in the College of Human Ecology at Cornell.
O'Neill adds: "But as hospitals close and services and staff are reduced, the time that heart attack victims must travel to get to a hospital may be increasing, especially in rural areas. This puts patients at a much greater risk in the event of a cardiac or other emergency."
Since most information on heart attacks, or myocardial infarction (MI), only tracks patients in hospitals, O'Neill sought to review the outcome of heart attack victims who do not get to a hospital promptly. Patients who live farther from medical facilities have been under-sampled, he says, because data on their MIs and deaths are usually unavailable, underreported or incomplete.
O'Neill developed an estimation model of out-of-hospital heart attack deaths using a database of 22,000 MI patients from 228 hospitals in Pennsylvania. His study is published in the journal Health Care Management Science (Vol 6, pp. 147-154, 2003).
"Our research shows that for people who experience heart attacks, distance from a hospital has a very significant impact on their access to medical facilities and their eventual outcome," says O'Neill, who specializes in the strategic and operational use of quantitative methods and information systems in health care. O'Neill's estimation model can be used, he says, to estimate the likely impact of hospital or emergency room closings on nearby populations. "In deciding whether to allow these closures, regulators must balance cost considerations with the need to ensure minimum levels of hospital access for rural residents. Hospital markets are already stretched thin in rural areas, however, and further capacity reductions would likely jeopardize patient safety in these days of managed care," O'Neill adds.
Coronary heart disease takes more than 500,000 lives a year in the United States, making it the nation's leading cause of death. "Speed is of the essence in the treatment of MI," says O'Neill. "Approximately 60 percent of patients who die from an MI expire before they reach the hospital or shortly thereafter. Even a relatively small percentage reduction in this figure would result in thousands of cardiac deaths avoided each year."
The study was supported, in part, by the College of Human Ecology at Cornell.