Regional features of the availability of emergency and specialized, including high-tech, healthcare for acute coronary syndrome using the example of the Kursk and Kurgan regions

Aim. To study regional features of the impact of the availability of emergency and specialized, including high-tech, healthcare for patients with acute coronary syndrome (ACS) on mortality using the example of the Kursk and Kurgan Regions.

Material and methods. Data from the "Monitoring of Measures to Reduce Mortality from Coronary Artery Disease" for 2016-2021 were used. Cointegration of time series characterizing mortality from ACS and parameters of health care availability was used. The elasticity coefficient was used to assess the strength of factors’ influence.

Results. In Kursk Oblast, mortality in ST-segment elevation ACS (STE-ACS) was reduced by the proportion of those hospitalized in the first 12 hours (E=0,93%; R2=0,80) and in the first 2 hours (E=0,86%; R2=0,87), as well as thrombolysis (E=4,9%; R2=0,98) and percutaneous coronary interventions (PCI) in patients admitted before 12 hours (E=0,65%; R2=0,94). Mortality in non-STE-ACS (NSTE-ACS) was reduced by increasing the proportion of PCI procedures (E=0,43%; R2=0,60). In the Kurgan Oblast, mortality in STE-ACS was reduced by the proportion of those hospitalized in the first 12 hours (E=1,9%; R2=0,76) and in the first 2 hours (E=0,65%; R2=0,65), as well as prehospital thrombolysis (E=0,44%; R2=0,56) and thrombolysis in general (E=1,15%; R2=0,96). In NSTE-ACS, mortality was also reduced by the proportion of PCI (E=1,1%; R2=0,75).

Conclusion. The study demonstrates regional differences in the impact of the availability of emergency and specialized, including high-tech, healthcare for patients with ACS. In the Kursk Oblast, systemic thrombolysis plays a key role in reducing mortality, while in the Kurgan Oblast, it is a reduction in hospitalization time. In both regions, to reduce mortality in NSTE-ACS, the availability of PCI should be increased. Thus, cointegration analysis should be used to assess the effectiveness of regional healthcare systems.

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