# Disruptions in ST-Elevation Myocardial Infarction Transfer Networks and Cardiovascular Health of Rural Americans

> **NIH NIH R01** · UNIVERSITY OF MINNESOTA · 2024 · $393,470

## Abstract

PROJECT ABSTRACT
Rural Americans face disproportionate cardiovascular disease burden, yet they must travel farther to reach
hospitals that can provide effective, guideline-concordant treatment for acute myocardial infarction (AMI).
Transfer networks play a crucial role in care for rural ST-Elevation Myocardial Infarction (STEMI), the most
severe form of AMI, moving patients from rural hospitals to hospitals that can perform primary Percutaneous
Coronary Intervention (PCI), the preferred treatment for STEMI. Of the 925 hospitals have closed or been
acquired in rural areas since 2007, 75% may have been part of a STEMI transfer network. Although closures
and acquisitions of hospitals may disrupt STEMI transfer network, the impact on STEMI patients has not been
explored. Existing research on hospital closures finds conflicting results on AMI mortality. Failure to account for
networks disadvantages previous research in 3 ways. 1) Time to PCI depends on the geographic location and
the transfer relationships of hospitals within STEMI transfer networks. 2) Disruptions can cause spillover
effects to patients not directly affected by closures and acquisitions but in the same transfer network. 3) The
characteristics of network affect time to PCI after disruption. Although not previously explored, disruptions in
rural STEMI networks could worsen rural-urban disparities in AMI mortality rates and reverse reductions in
rural cardiovascular mortality over the past four decades. This project will draw upon novel data resources
collected by the research team including validated data on hospital closure status and timing and validated
data on hospital-level PCI capabilities. Leveraging the expertise of the research team in innovative network
analysis techniques, invasive cardiology, emergency medicine, rural health, Medicare claims data, and
biostatistics we will estimate STEMI transfer networks using Medicare claims data from 2007-2021 and link
networks to hospital closure and acquisition data collected and validated by the research team. We will
leverage connections to stakeholders in STEMI systems of care and rural health as well as expertise in survey
design and implementation to develop a survey of EMS agencies to collect information on the emergency
medical services involvement in STEMI networks. We propose the following aims: 1) estimate the association
of STEMI network disruption with through0network time to PCI; 2) estimate the association of STEMI network
disruption with STEMI treatment and mortality; 3) identify network-level factors associated with changes in
patient mortality after STEMI network disruption; and 4) quantify the role of STEMI transfer network disruption
in rural-urban STEMI disparities. We will disseminate information on STEMI networks and their characteristics
via a web-based app. Our findings will identify a previously unknown access barrier for rural patients and can
inform policymakers and clinicians about how to improve the health ...

## Key facts

- **NIH application ID:** 10846812
- **Project number:** 5R01HL153179-04
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** Sayeh Sander Nikpay
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $393,470
- **Award type:** 5
- **Project period:** 2021-05-15 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10846812

## Citation

> US National Institutes of Health, RePORTER application 10846812, Disruptions in ST-Elevation Myocardial Infarction Transfer Networks and Cardiovascular Health of Rural Americans (5R01HL153179-04). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10846812. Licensed CC0.

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