title: Geographic access to interventional cardiology services in one rural state.
abstract: OBJECTIVE
  Explore (1) the characteristics of the Maine population with delayed geographic access to interventional cardiology (IC) services and (2) the effect of delayed geographic IC access on coronary mortality.
  
  
  BACKGROUND
  Acute coronary syndrome (ACS), ST-segment elevated myocardial infarction (STEMI), and non-ST segment elevated myocardial infarction (NSTEMI) are highly prevalent. Coronary mortality is minimized when victims have prompt IC access.
  
  
  METHODS
  The study design was (1) an exploration of census data to investigate disparities in geographic IC access and (2) a secondary analysis of administrative claims data to investigate coronary mortality relative to delayed geographic IC access.
  
  
  RESULTS
  Delayed access was associated in the Maine population with rural residence, advanced age, high school education, and lack of health insurance. Delayed access was associated with increased unadjusted coronary mortality, but not age-adjusted coronary mortality.
  
  
  CONCLUSIONS
  Delayed geographic IC access was associated with disparity but not with increased age-adjusted coronary mortality.
authors: University of Alabama at Birmingham School of Nursing, 262 Main Street, Auburn, ME 04210, USA. Electronic address: jrhudy@maine.edu.
authors: James P
authors: JP
authors: Rhudy
authors: University of Tennessee Health Science Center, 920 Madison, #946, Memphis, TN 38163, USA.
authors: Anne W
authors: AW
authors: Alexandrov
authors: Center for Nursing Research and Quality Outcomes, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA.
authors: Kristiina E
authors: KE
authors: Hyrkäs
authors: University of Alabama at Birmingham School of Nursing, NB454, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
authors: Rita A
authors: RA
authors: Jablonski-Jaudon
authors: University of Alabama at Birmingham School of Nursing, NB454, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
authors: Erica R
authors: ER
authors: Pryor
authors: Department of Emergency Medicine, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL 35233, USA.
authors: Henry E
authors: HE
authors: Wang
authors: University of Alabama at Birmingham School of Nursing, NB454, 1720 2nd Avenue South, Birmingham, AL 35294, USA.
authors: Marie A
authors: MA
authors: Bakitas
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D003325:Coronary Care Units; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States
keywords: Access to health care; Acute coronary syndrome; Geographic information system; Mortality; ST-Segment elevated myocardial infarction