Opening a PCI Facility Improves Heart Attack Outcomes, Especially for Black Patients

In the aftermath of a heart attack, Black patients are less likely than White patients to receive percutaneous coronary intervention (PCI), a procedure that improves blood flow in the heart. They also have higher one-year mortality rates following heart attacks. In Do PCI Facility Openings Differentially Affect AMI Patients by Individual Race and Community Segregation? (NBER Working Paper 31626), Renee Y. Hsia and Yu-Chu Shen demonstrate that the opening of a new PCI-capable facility in a community reduces racial disparities in both PCI treatment and mortality.

The researchers analyze data on all Medicare fee-for-service patients aged 65 or older who were treated in a hospital for a heart attack between 2006 and 2017. They disaggregate outcomes by patient race and by the level of residential segregation in a patient’s community.  They calculate an index of residential segregation based on the 2010 Census for each hospital service area; communities in the top third of the index are classified as “segregated.”

Sixteen percent of heart attack patients live in a community where a new PCI-capable facility within a 15-minute drive opened during the study period. The researchers compare changes over time in outcomes for heart attack patients in these communities to changes for comparable patients in other communities.   

The effects of a facility opening were largest for Black residents in relatively integrated communities. An opening increases the likelihood of PCI treatment during hospitalization by 6.6 percentage points (12 percent) for Black residents in relatively integrated communities, but only 2.2 percentage points (4 percent) for Whites in more segregated communities.

Improvements in mortality following a PCI facility opening follow a similar pattern. Black patients in more integrated communities experience the greatest benefits: a 1.3 percentage point (11 percent) decline in 30-day mortality and a 1.9 percentage point (6 percent) decline in 1-year mortality. By comparison, the benefits to Whites in relatively segregated communities are indistinguishable from zero.

The results cannot be fully explained by a lack of local access to PCI-capable facilities prior to the opening of a new facility. Even in communities that were already in the top quartile of PCI capacity at the beginning of the study period, the opening of a new facility increases rates of in-hospital PCI for all Black patients. These findings suggest that changes in the “built environment” — such as the opening of new PCI-capable facilities — can affect racial disparities in treatment and outcomes.

— Robin McKnight

The researchers acknowledge funding from a Pilot Project Award from the NBER Center for Aging and Health Research, funded by the National Institute on Aging (P30AG012810); the National Institute on Minority Health and Health Disparities (R01MD017482); and the National Heart, Lung, and Blood Institute (R01HL114822 and R01HL134182).