Right-Sizing Invasive Cardiac Services in the United States
Despite the fact that the U.S. spends more per capita on health care than any other nation in the world,1 a significant proportion of Americans still lack access to high-quality, modern cardiovascular care. In fact, recent national data suggests that only about two-thirds of Medicare patients presenting with ST-segment elevation myocardial infarction receive revascularization.2, 3 These numbers are even lower in rural communities,4, 5 and are likely part of the reason why patients in rural areas have worse outcomes after suffering an acute myocardial infarction (MI) than those in more urban areas.6
In this light, there is an urgent need to ensure the adequate availability of high-value invasive cardiac services, particularly in rural or semi-rural areas of the country. With these important concerns as a starting point, Horwitz et al examined the introduction of diagnostic angiography, percutaneous coronary intervention, and coronary artery bypass grafting services in the United States between 1996 and 2008. The authors studied whether new offerings of these services were leading to an expansion of access to care in areas which were previously un- or under-served.7 Simply put, were the new services being offered in the places that needed them most?
- Received July 16, 2013.
- Accepted July 17, 2013.