Population access to reperfusion services for ST-segment elevation myocardial infarction in Kerala, India.
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.
['Mathew|Anoop|A|', 'Abdullakutty|Jabir|J|', 'Sebastian|Placid|P|', 'Viswanathan|Sunitha|S|', 'Mathew|Cibu|C|', 'Nair|Venugopalan|V|', 'Mohanan|Padinhare P|PP|', 'George Koshy|A|A|']
D003430:Cross-Sectional Studies D004562:Electrocardiography D005260:Female D006297:Health Services Accessibility D017052:Hospital Mortality D006753:Hospital Records D006801:Humans D007194:India D008297:Male D009203:Myocardial Infarction D015425:Myocardial Reperfusion D010043:Outcome and Process Assessment, Health Care D013997:Time Factors
ST-segment elevation myocardial infarction Regionalization Health services availability