Regional inequality in myocardial infarction treatment cannot be blamed on effectiveness of individual cardiologists

It is disappointing that variation across England in patient outcomes after myocardial infarction is being attributed solely to the effectiveness of cardiologists, when a single specialist is unlikely to be the cause.12Systemic limitations in healthcare cannot be ignored. Myocardial infarction is treated medically or invasively (mostly by percutaneous coronary intervention (PCI)), or both. Not all admitting hospitals have onsite PCI centres even if they have competent and effective cardiologists. If PCI is indicated, inter-hospital transfer is required, which significantly worsens long term mortality compared with direct admission to a PCI centre.3 To blame individual cardiologists’ effectiveness in a limited system that is out of their control is misleading and unfair.The study also concludes that “the most effective doctors are treating patients in more affluent, urban areas.”2 Might these populations be contributing to why these doctors are considered to be more effective? These patients are likely to be healthier, have better…
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