The forecast for heart disease in the U.S. is on par with the dire predictions from meteorologists tracking a monster winter system across the Midwest and into New England this week. A destructive force is gaining strength, we are told, and it's headed this way.
Research published in the Jan. 24 issue of Circulation: Journal of the American Heart Association, predicts that the cost of treating heart disease in the United States will triple over the next two decades. A spike in future disease rates is foreseen by researchers as a result of population changes in age and race.
For most of us in the winter storm's path, preparation is straightforward. We lay in ample supplies of milk, bread, and eggs, and hunker down for the duration (and French toast).
For hospitals aiming to profit from rising rates of heart disease, preparation may also seem straightforward. Eyeing a growing wave of patients with occluded arteries, heart attacks, and congestive heart failure, many hospitals seek to extend their cardiac service lines. By building cardiac catheterization labs, the thinking goes, they can treat patients with ST-segment myocardial infarction (STEMI) by offering primary percutaneous coronary intervention (PCI). Compared with fibrinolytic therapy (FT), PCI is better at reducing mortality when administered in a timely fashion.
But because PCI is only available in hospitals with cath labs, FT remains the standard of care in most U.S. hospitals. It would appear that the thing to do is to start building cath labs.
Is that a financially viable approach for regional hospitals? A study originally published in the September issue of Circulation: Cardiovascular Quality and Outcomes set out to determinethe effectiveness of regional strategies for delivering PCI.
The authors of "Comparative Effectiveness of STEMI Regionalization Strategies" suggest that it is not necessarily cost-effective for a regional hospital to have a cath lab, so long as proper strategies for the emergency transport of STEMI patients to PCI-capable hospitals are in place. The study cites data from a separate paper, which found that "80% of the U.S. population lives within a one-hour drive of a PCI facility, but fewer than 80% of eligible patients with STEMI actually receive PCI."
Researchers say that the most cost-effective solution is to devise a two-pronged strategy to enhance PCI access within a region: build capacity using hospital-based strategies, and leverage access by using an emergency medical service strategy.
This risk/benefit analysis applied to the STEMI/PCI question is objective and the study's conclusions are logical. But who will be able to convince hospital CEOs that they should pass up the opportunity to build out a service line in favor of collaborating with other, often competing hospitals and EMS services, to hammer out a logistical plan that may ultimately result in fewer (STEMI) patients coming through the doors? That's a tough sell.