Abstract MP68: Strategic Placement of New Cathlab in the Largest Archipelago Country: Geospatial Analysis of Cathlab Coverage in Indonesia
Authors: Farizal Rizky Muharram, Chaq El Chaq Zamzam Multazam, Wigaviola Socha Purnamaasri Harmadha
Journal: Circulation (2024)

Background: Acute coronary syndrome (ACS) is a special disease because treatment is significantly based on the time required to receive treatment. The standard gold treatment for ACS is Percutaneous Coronary Intervention (PCI), which would need Cathlab. The number of cathlabs increased significantly in Indonesia from 112 cathlabs in 2017 to 310 cathlabs in 2022. However, most cathlabs were built in areas that already had cathlabs. Despite the massive increase in the cathlab, it only slightly reduces the maldistribution (the GINI ratio decreases from 0.54 to 0.48). In response to the problem, the Ministry of Health (MoH) plans to build a cathlab in all 514 districts in Indonesia. Purpose: The idea of increasing the distribution of cathlab is extraordinary. But a new question arises: do we need to build cathlab in 514 District? Will the decision to make cathlabs in each district be effective and efficient? Methods: The cathlab location data was collected through a direct survey and site data mining. The total population and road network data are taken from an open-source geospatial system. Data were then analysed using GIS nearest-neighbor analysis to find the travel time to the nearest cathlab facility at the sub-district level. The results were then mapped on the Choropleth map. Location-Allocation Analysis was used to find the best location to build a new lab. The condition of each province was assessed using two indicators, time travel and volume. Time travel is the time a specific population needs to access the nearest cathlab. Faster time travel increases the likelihood of better outcomes. The population volume measures the number of required cathlabs by the population. The European Association of PCI recommends having one cathlab for a 500,000-650,000 people. Results: Our study found that Indonesia has a population of 330 Cathlab or 1.2 Cath per 1 million. Using geospatial analysis, these 330 categories can cover 47.5% (129 million) of the population below 1 hour and 68.1% (185 million) of the people below 2 hours. Using location-allocation analysis, we found 130 potential hospitals to get the cathlab located strategically, which will increase the coverage to 85% of the population below 2 hours of travel time. However, doubling the new cathlab to 265 cathlab only increases the range to 87%. Conclusions: Increasing the number of catheters without considering population coverage will only increase inefficiencies. The study results show that the efficient number of cathlab increases is obtained at 85% coverage with an increase of 130 cathlabs. This is due to the nature of the archipelagic country that is hindered by remote islands, high-altitude areas without roads, and some isolated areas between mountains. Different methods are needed to treat the remaining 15% of the population. Fibrinolytics have the advantage of having a low fixed cost and can still be performed in a hospital with limited facilities.