Communities with Unmet Needs Benefit Most from New PCI Heart Hospitals

Expansion into saturated markets doesn’t show the same benefits and can lead to duplication.

By Melinda Krigel

The relationship between timely access to percutaneous coronary intervention (PCI) – a minimally invasive procedure used to open clogged coronary arteries – and improved patient outcomes has been well established. While the number of PCI-capable hospitals in the U.S. has grown significantly over the years, access to PCI services has improved for only a small portion of patients. A new study reveals that PCI service expansion is associated with improved patient outcomes for patients in communities with unmet needs, but not for communities with saturated markets.

In the study, published May 22, 2023 in the Journal of the American College of Cardiology: Cardiovascular Interventions, researchers from UC San Francisco, the Naval Postgraduate School, and Yale School of Medicine conducted a retrospective cohort study of Medicare Fee-for-Service patients who were diagnosed with acute myocardial infarction (AMI) between 2006 and 2017. The research team quantified the differential impacts of PCI hospital openings and closures on access, treatment and outcomes for patients in saturated markets.

Their study revealed that in communities with unmet needs, PCI service expansion was associated with a 6.5% increase of patients receiving PCI on the day of hospital admission, an 8.6% increase in receiving PCI during an in-hospital care episode, and an approximately 2.5% reduction in mortality.

These same benefits were not observed in saturated markets. In fact, the research showed that adding new PCI services in saturated markets was systemically duplicative and resulted in a 20% drop in the number of AMI patients admitted to high-volume PCI hospitals – which are associated with favorable patient outcomes via the volume-outcome relationship.

“Our findings, looking at actual patient outcomes, provide evidence for what should be intuitive: new PCI services are associated with the greatest improvements in treatment access and outcomes for patients in communities with unmet needs,” said Renee Hsia, MD, senior author and UCSF professor of emergency medicine. “There are many external factors contributing to when and where specialized health care facilities open or close, but we can’t lose sight of how these changes impact our patients.”

Authors: Yu-Chu Shen, PhD, Naval Postgraduate School, National Bureau of Economic Research; Harlan M. Krumholz, MD, SM, Department of Cardiology, Yale School of Medicine; and Renee Y. Hsia, MD, MSc, Department of Emergency Medicine, UCSF and Philip R. Lee Institute for Health Policy Studies, UCSF. 

Funding: This project was supported by the National Heart, Lung, and Blood Institute Grant Numbers R01HL134182 and R01HL114822; as well as National Institute on Aging Grant Number P30AG012810.

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked specialty hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit Follow UCSF Health on Facebook or on Twitter.