title: Population access to reperfusion services for ST-segment elevation myocardial infarction in Kerala, India.
abstract: BACKGROUND
  Population access to timely reperfusion is a decisive factor in determining the success and acceptability of any regional system of ST-segment elevation myocardial infarction (STEMI) care. We sought to determine the proportion of population of the southern Indian state of Kerala having timely access to STEMI reperfusion.
  
  
  METHODS
  We identified the STEMI reperfusion facilities available at all acute-care hospitals, in Kerala, by conducting a cross-sectional survey. We mapped the geographical catchment areas of these hospitals using historical travel speeds and appropriate Geospatial Information Systems (GIS) analyses. Subsequently, using block level population data, we estimated the proportion of the population residing within these geographies.
  
  
  RESULTS
  We estimated that 23.33 million people, forming 69.84% of the state population, resided in the green zone (within half-hour travel distance of a percutaneous coronary intervention [PCI]-capable hospital), which covered 47.94% of the geographical area of the state. Outside this green zone, 21.87% of the state population resided within 1hr travel distance of a thrombolysis-capable hospital. Finally, 8.28% of the state population resided in the red zone, where access to any reperfusion-capable hospital took >1hr, which covered 22.15% of the geographical area of the state.
  
  
  CONCLUSIONS
  A majority of the population of Kerala had timely access to PCI-capable hospitals. GIS-based mapping of Indian states, in terms of access to STEMI reperfusion, may help devise protocols to achieve seamless transfer of patients to reperfusion-capable hospitals. Such regionalization of STEMI care would enhance organizational synergies to achieve better access to reperfusion, especially in remote areas.
authors.affiliation: MOSC Medical College Hospital, Kolenchery, Kerala, India. Electronic address: anoopmatts@gmail.com.
authors.forename: Anoop
authors.initials: A
authors.lastname: Mathew
authors.affiliation: Lisie Hospital, Kochi, Kerala, India.
authors.forename: Jabir
authors.initials: J
authors.lastname: Abdullakutty
authors.affiliation: Sahakarana Hryudayalaya, Kannur, Kerala, India.
authors.forename: Placid
authors.initials: P
authors.lastname: Sebastian
authors.affiliation: Government Medical College Hospital, Thiruvanathapuram, Kerala, India.
authors.forename: Sunitha
authors.initials: S
authors.lastname: Viswanathan
authors.affiliation: Government Medical College Hospital, Thrissur, Kerala, India.
authors.forename: Cibu
authors.initials: C
authors.lastname: Mathew
authors.affiliation: SBL, Kochi, Kerala, India; SBL, Stratford, USA.
authors.forename: Venugopalan
authors.initials: V
authors.lastname: Nair
authors.affiliation: West Fort Hospital, Thrissur, Kerala, India.
authors.forename: Padinhare P
authors.initials: PP
authors.lastname: Mohanan
authors.affiliation: Government Medical College Hospital, Thiruvanathapuram, Kerala, India.
authors.forename: A
authors.initials: A
authors.lastname: George Koshy
mesh_terms: D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006753:Hospital Records; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D015425:Myocardial Reperfusion / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D013997:Time Factors
keywords: Health services availability; Regionalization; ST-segment elevation myocardial infarction