Comparative effectiveness of population interventions to improve access to reperfusion for ST-segment-elevation myocardial infarction in Australia.
BACKGROUND
Improving timely access to reperfusion is a major goal of ST-segment-elevation myocardial infarction care. We sought to compare the population impact of interventions proposed to improve timely access to reperfusion therapy in Australia.


RESULTS
Australian hospitals, population, and road network data were integrated using Geographical Information Systems. Hospitals were classified into those that provided primary percutaneous coronary intervention (PPCI) or fibrinolysis. Population impact of interventions proposed to improve timely access to reperfusion (PPCI, fibrinolysis, or both) were modeled and compared. Timely access to reperfusion was defined as the proportion of the population capable of reaching a fibrinolysis facility ≤60 minutes or a PPCI facility ≤120 minutes from emergency medical services activation. The majority (93.2%) of the Australian population has timely access to reperfusion, mainly (53%) through fibrinolysis. Only 40.2% of the population had timely access to PPCI, and access to PPCI services is particularly limited in regional and nonexistent in remote areas. Optimizing the emergency medical services' response or increasing PPCI services resulted in marginal improvement in timely access (1.8% and 3.7%, respectively). Direct transport to PPCI facilities and interhospital transfer for PPCI improves timely access to PPCI for 19.4% and 23.5% of the population, respectively. Prehospital fibrinolysis markedly improved access to timely reperfusion in regional and remote Australia.


CONCLUSIONS
Significant gaps in timely provision of reperfusion remain in Australia. Systematic implementation of changes in service delivery has potential to improve timely access to PPCI for a majority of the population and improve access to fibrinolysis to those living in regional and remote areas.
George Institute for Global Health, Sydney, Australia.
Isuru
I
Ranasinghe
Fiona
F
Turnbull
Andrew
A
Tonkin
Robyn A
RA
Clark
Neil
N
Coffee
David
D
Brieger
D015906:Angioplasty, Balloon, Coronary; D001315:Australia / Q000453:epidemiology; D016507:Cardiology Service, Hospital; D057186:Comparative Effectiveness Research; D019033:Delivery of Health Care, Integrated; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D040362:Geographic Information Systems; D006297:Health Services Accessibility; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer; D012111:Residence Characteristics; D019035:Rural Health Services; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D019037:Urban Health Services