Regional variations in primary percutaneous coronary intervention for acute myocardial infarction patients: A trajectory analysis using the national claims database in Japan

Abstract

v.AbstractBACKGROUNDPrevious studies have demonstrated geographical disparities regarding the quality of care for acute myocardial infarction (AMI). The aim of this study was two-folds: first, to calculate the proportion of patients with AMI who received primary percutaneous coronary interventions (pPCIs) by secondary medical areas (SMAs), which provide general inpatient care, as a quality indicator (QI) of the process of AMI practice. Second, to identify patterns in their trajectories and to investigate the factors related to regional differences in their trajectories.METHODSWe included patients hospitalized with AMI between April 2014 and March 2020 from the national health insurance claims database in Japan and calculated the proportion of pPCIs across 335 SMAs and fiscal years. Using these proportions, we conducted group-based trajectory modeling to identify groups that shared similar trajectories of the proportions. In addition, we investigated area-level factors that were associated with the different trajectories.RESULTSThe median (interquartile range) proportions of pPCIs by SMAs were 63.5% (52.9% to 70.5%) in FY 2014 and 69.6% (63.3% to 74.2%) in FY 2020. Four groups, named low to low (LL; n =, low to middle (LM; n = 16), middle to middle (MM; n = 68), and high to high (HH; n = 208), were identified from our trajectory analysis. The HH and MM groups had higher population densities and higher numbers of physicians and cardiologists per capita than the LL and LM groups. The LL and LM groups had similar numbers of physicians per capita, but the number of cardiologists per capita in the LM group increased over the years of the study compared with the LL group.CONCLUSIONThe trajectory of the proportion of PCIs for AMI patients identified groups of SMAs. Among the four groups, the LM group showed an increasing trend in the proportions of pPCIs, whereas the three other groups showed relatively stable trends.vi.Summary boxesWhat is already known on this topicThe quality of health care for acute myocardial infarction (AMI) patients varies across regions.Door-to-balloon time is associated with patient outcomes, and one of the most easily measurable indicators is the provision of rapid treatment for AMI patients.What this study addsThe study demonstrated that there were not only cross-sectional regional differences in the proportion of PCIs for AMI patients but also differences in these trajectories.The cross-sectional regional differences in the proportion of pPCIs were maintained in many SMAs, but there were a few SMAs that increased yearly.