Abstract 1014: Geographical Analysis of Cardiac Interventional Services in Alabama
Access to Cardiac Interventional Services in Alabama: A Geographical Information System Analysis Cardiovascular disease is the leading cause of death in Alabama. The purpose of this study was to explore the geographical accessibility of persons in Alabama to cardiac interventional services (CIS) for the treatment of acute myocardial infarction (MI). A retrospective cohort and descriptive ecological study DESIGN was used. A geographical information system (GIS) was used to visually identify and empirically measure spatial relationships among the variables of myocardial infarction. The unit of analysis was by county for the 149 total counties in Alabama. The sample consisted of all deaths due to MI recorded in the state of Alabama from 1996 through 2001 as reported to the National Center for Health Statistics. County age-adjusted MI mortality rates were the outcome variable. A total of 20 hospitals with CIS were identified within Alabama. GIS analysis revealed that 58.2%, 85.9%, and 96.0% of the total Alabama population were within 30, 60, or 90 minutes travel time, respectively, of a hospital with CIS. Maps were generated to provide visualization of CIS coverage areas. One distinct area was noted at greater than 90 minutes from a hospital with CIS. This area is within the Black Belt Region and is well known for a mostly black, impoverished population who are subject to health disparities. The American College of Cardiology and the American Heart Association recommend early reperfusion treatment for patients with MI (within 2 hours). Research supports percutaneous transluminal coronary angioplasty (PTCA) as beneficial, useful, and effective in the treatment of MI. Timely transport of MI victims to a hospital with CIS within 90 minutes and a “door-to-needle” time of 30 minutes are goals that can promote prompt and effective treatment in reducing MI mortality. Use of these standards allows for a maximum travel time of 90 minutes. GIS analysis demonstrated that 96% of Alabama’s population is within 90 minutes travel time of a hospital with CIS. But for the best outcomes to occur, only 58.2% of Alabamians have access.