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heart attacks

Almost two-thirds of Canadian adults have access to a medical facility that can do emergency angioplasty within one hour of their home, a new study shows.

While swift surgery is the best treatment for a common form of heart attack, researchers cautioned that, realistically, it probably can't be provided to everyone in a vast country like Canada.

"You can take the glass-half-empty view that this is not good. But I take the glass-half-full view that 64 per cent over all is a pretty encouraging number," said William Ghali, a professor in the Centre for Health and Policy Studies at the University of Calgary and senior author of the study, in an interview.

The research, published in the medical journal Open Medicine, shows that while access to speedy treatment is pretty good over all for a sprawling, sparsely populated country, there are stark regional disparities.

For example, only 15.8 per cent of New Brunswick residents could, theoretically, be transported promptly to a hospital that performs angioplasty, also known as primary percutaneous coronary intervention or PCI.

By contrast, the figure is 72.6 per cent in Ontario.

In the United States, more than 80 per cent of adults could get to a PCI within 60 minutes, compared with Canada's 64 per cent, the study says.

Alka Patel, a U of C doctoral student and lead author of the study, said that while the findings seem to point to a shortage, they "should not lead to blind enthusiasm" for building more PCI facilities. There is a "trade-off between equity and efficiency," and the logistics of building new facilities are complex, she said.

A common deadly form of heart attack is ST segment elevation myocardial infarction (STEMI).

The recommended treatment is angioplasty, a simple operation in which a balloon catheter is inserted into an artery in the groin, then snaked up to restore blood flow to the heart.

Surgeons commonly say that "time is heart muscle," meaning that the faster the procedure is done, the less the heart will be damaged. STEMI patients who undergo angioplasty also have much lower rates of another heart attack or a stroke.

However, not all STEMI patients are offered the procedure, and the principal reason is that they cannot be transported to hospital promptly, Dr. Ghali said.

This situation had led to the development of regional care models, in which transportation and treatment of STEMI patients could be expedited, but the study points to major holes in that system.

Dr. Ghali said angioplasty can never be offered equitably in a country as large as Canada. But he noted that, even in rural and remote areas, there are good alternatives such as "drip and ship," in which heart attack patients are treated with clot-busting drugs, then taken to a larger centre for angioplasty.

Research has shown that the time between the onset of a heart attack and the reopening of an artery - known as door-to-balloon time - should not exceed 90 minutes.

In the new study, researchers assumed that if transportation of patients was prompt, access to surgery would be also.

There are 40 hospitals in Canada that perform PCI surgery; 14 are in Ontario and 13 in Quebec. None of the northern territories nor the province of Prince Edward Island have a PCI facility.

The researchers used census population data and road network analysis to calculate travel times.

In Canada there is one PCI facility for every 595,000 adults; in the United States there is one for every 176,000 adults.