Heart attack survival may depend on where you live

Americans' odds of surviving a heart attack seem to partially depend on which state they live in, according to researchers.

Their study of hospital data from 11 states found wide variation in both treatment of heart attacks and patients' short-term death rates. Overall, heart attack patients in New York, South Carolina, Maryland and California were most likely to die in the hospital, with mortality rates in each state hovering around 11 percent.

Patients in Arizona, Colorado, Oregon and Washington state, where in-hospital death rates were roughly 8 to 9 percent, were the least likely to die.

Dr. Shadi S. Saleh and colleagues at the State University of New York at Albany report the findings in the American Journal of Cardiology.

The reasons for the differences among states are not completely clear, but the study did find some variations in care according to geography. In particular, the states showed a wide range in the percentage of patients receiving angioplasty, a procedure in which a balloon-tipped catheter is threaded into a blocked artery to clear a passage for blood flow.

Heart attack patients who underwent angioplasty, Saleh's team found, had a much lower death rate - 1.8 percent, versus 10.4 percent among all patients in the study.

So differences in angioplasty rates, according to the researchers, may help explain the discrepancies in death rates across the states. Colorado had the highest rate of angioplasty, at 36 percent, while Maryland had the lowest, at less than 17 percent.

The findings are based on 1999 figures from a national database containing hospital discharge information. The researchers focused on 11 states representing different U.S. regions: Arizona, California, Colorado, Florida, Iowa, Maryland, New York, Oregon, South Carolina, Washington and Wisconsin.

Besides the variations in death rates and angioplasty, the study found that states differed greatly when it came to rates of patient transfers from one hospital to another. In New York, for example, nearly 21 percent of patients were transferred, versus roughly 11 percent in Iowa.

The reasons for such differences, according to the researchers, may have to do with states' varying "certificate-of-need" policies; in New York, for example, only certain hospitals are certified to perform cardiac procedures.

In addition, transfers may be relatively uncommon in largely rural states like Iowa, since many heart attack patients may not be stable enough to make the trip to another hospital.

Further research, the study authors conclude, should look more closely at the differences in heart attack treatment among U.S. states, including the degree to which hospitals are conforming to national guidelines on cardiac care.

SOURCE: American Journal of Cardiology, November 2005.