When someone suffers a heart attack, rapid access to specialist treatment can mean the difference between life and death. However, building more hospitals with advanced medical equipment does not automatically lead to better outcomes.

New research from the University of California, San Francisco, suggests that the location of specialist services matters more than simply increasing their number.

Published in JAMA Network Open in October 2026, the study examined nearly 600,000 heart attack hospitalisations and revealed striking differences between communities with good medical access and those without it.

What Did The Researchers Investigate?

The researchers analysed 590,282 hospitalisations for heart attacks in California between 2011 and 2022. They focused on access to percutaneous coronary intervention (PCI), a procedure used to restore blood flow through narrowed or blocked coronary arteries.

PCI commonly involves inserting a catheter into an artery and using a small balloon to open the blockage. A stent may then be placed to help keep the artery open.

The procedure requires specialised equipment and trained medical professionals, making it expensive for hospitals to provide. Researchers compared what happened when a new PCI-capable facility opened within a 30-minute drive of patients' communities.

Where New Facilities Saved Lives

The greatest benefits appeared in areas where patients previously lacked timely access to specialist treatment.

After a new facility opened, admission to a hospital capable of performing PCI increased by 53% in relative terms. The likelihood of receiving the procedure rose by 16%. Most importantly, mortality within 30 days fell by 20%, while mortality within one year declined by 15%. These findings suggest that reducing geographical barriers to emergency cardiac treatment can be associated with substantial improvements in survival.

Why More Hospitals Did Not Always Help

The picture was different in communities that already had a PCI-capable hospital within a 30-minute drive. Opening another facility increased admissions to specialist hospitals by only 2%, while the use of PCI rose by 3%. Researchers found no statistically significant improvement in survival rates.

This distinction raises an important question about healthcare spending. An additional specialist centre may increase the number of procedures performed without necessarily improving patients' chances of recovery.

Rural Communities Face Greater Challenges

Limited access was particularly common in rural California. Among 52,756 patients from rural communities, 81% initially lived more than 30 minutes from a hospital capable of performing PCI.

For people experiencing a heart attack, long journeys can delay potentially lifesaving treatment. These findings underline the importance of identifying underserved areas before investing in expensive medical infrastructure.

What Does This Mean For Healthcare?

Hospitals must consider staffing, equipment costs and demand when deciding where to establish specialist services. However, financial considerations do not always align with the needs of communities facing the greatest barriers to treatment.

Senior researcher Renee Y. Hsia emphasised that healthcare investments should be directed towards locations where they can deliver the greatest benefits.

The study suggests that policymakers should assess existing access before approving additional specialist facilities.

What Are The Study's Limitations?

The research identified associations between facility openings, treatment rates and survival. It cannot establish that opening a hospital directly caused every observed improvement. Its findings also concern a specific cardiac procedure in California and may not apply equally to other treatments or healthcare systems. Nevertheless, the results provide an important lesson for medical planning.

Expanding healthcare can save lives, but the greatest improvements may come from bringing essential services to communities that have been waiting too long for them.