Patient access to cardiology services—rather than cardiologists’ effectiveness—varies widely by region

The report from the Institute for Fiscal Studies attributes different outcomes of treatment for myocardial infarction in England to the variable quality of cardiologists.12 Quality is assessed by outcomes from ST segment elevation myocardial infarction (STEMI) compared with colleagues in the same hospital and compared with outcomes for non-STEMI. The study considers past stroke and STEMI and the Charlson index of comorbidity, and also refers to socioeconomic factors, but it does not take into account the effect of travel to hospital from the location where symptoms were first experienced.This is important because the invasive techniques for treating STEMI are not available in all hospitals. The study describes a decreasing quality of cardiology, from “professional urban” to “countryside,” based not on the characteristics of the hospital location but on those of the patient’s residence.Cardiology centres in urban teaching hospitals provide an interventional cardiology service, readily accessed by those living and working…
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