{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T20:58:52Z","timestamp":1793307532754,"version":"4.5.0"},"reference-count":43,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"unspecified","delay-in-days":33,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Lembaga Pengelola Dana Pendidikan (LPDP) Indonesia"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,1,14]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>International guidelines recommend percutaneous coronary intervention within 120\u2009min for high-risk acute coronary syndrome. In Indonesia, a sprawling archipelago with a rising cardiovascular burden, the ministry of health is expanding catheterisation laboratory (cath lab) infrastructure. This study aims to evaluate the current distribution, population coverage and \u2018effective access\u2019 to cath labs to inform equitable infrastructure planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional geospatial analysis using a primary hospital survey (January\u2013June 2024) to identify 335 functional cath labs. Travel times were estimated from the midpoints of all inhabited subdistricts (kecamatan) to the nearest facility using road network modelling. Primary outcomes included cath lab density per million population and the proportion of the population within successive 30\u2009min travel thresholds. Secondary outcomes assessed \u2018effective coverage\u2019 by adjusting for National Health Insurance (BPJS) credentialing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nationally, cath lab density is 1.23 per million population, with a median travel time of 54\u2009min. While 73.0% of the total population can reach a facility within 120\u2009min, stark disparities exist: 95% of urban residents have 2-hour access compared with 66.9% in rural areas. Regionally, Java (92.3%) and Bali (91.5%) show high coverage, while Papua and Maluku face critical gaps, with &gt;80% of the population requiring more than 3\u2009hours of travel. 46.3% of cath labs are covered by BPJS, and only 5.1% offer documented 24\/7 service. When accounting for insurance status, national 2-hour coverage drops from 73.0% to 63.5%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although geographical access appears moderate at a national level, Indonesia\u2019s cardiovascular infrastructure is highly inequitable and operationally constrained. Many provinces meet density benchmarks but lack geographical coverage or financial\/operational readiness. Beyond Indonesia, this approach offers a practical tool for other low- and middle-income countries to align scarce cardiac care resources with population need.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003702","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T16:25:20Z","timestamp":1770135920000},"page":"e003702","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Modelling the coverage gap in percutaneous coronary intervention in LMIC: a geospatial analysis of cath lab coverage in Indonesia"],"prefix":"10.1136","volume":"13","author":[{"given":"Iwan","family":"Dakota","sequence":"first","affiliation":[{"name":"Rumah Sakit Jantung Harapan Kita, Jakarta, Indonesia"},{"name":"Cardiology, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5353-8603","authenticated-orcid":false,"given":"Farizal Rizky","family":"Muharram","sequence":"additional","affiliation":[{"name":"Health System Center, ARC Institute Indonesia, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaq El Chaq Zamzam","family":"Multazam","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, ARC Institute Indonesia, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6123-4343","authenticated-orcid":false,"given":"Wigaviola Socha Purnamaasri","family":"Harmadha","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, ARC Institute Indonesia, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrianto","family":"Andrianto","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Dr Soetomo Regional General Hospital, Surabaya, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8649-8158","authenticated-orcid":false,"given":"Doni","family":"Firman","sequence":"additional","affiliation":[{"name":"Rumah Sakit Jantung Harapan Kita, Jakarta, Indonesia"},{"name":"Department of Cardiology and Vascular Medicine, University of Indonesia, Depok, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya Marinda","family":"Montain","sequence":"additional","affiliation":[{"name":"Rumah Sakit Jantung Harapan Kita, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hananto","family":"Andriantoro","sequence":"additional","affiliation":[{"name":"Rumah Sakit Jantung Harapan Kita, Jakarta, Indonesia"},{"name":"Cardiology, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"2026020308251790000_13.1.e003702.1","doi-asserted-by":"crossref","unstructured":"Lawton JS , Tamis-Holland JE , Bangalore S . Correction to: 2021 ACC\/AHA\/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022;145. doi:10.1161\/CIR.0000000000001060","DOI":"10.1161\/CIR.0000000000001060"},{"key":"2026020308251790000_13.1.e003702.2","doi-asserted-by":"crossref","unstructured":"Neumann FJ , Sousa-Uva M , Ahlsson A , et al . ESC\/EACTS Guidelines on myocardial revascularization. Eur Heart J 2018;40. doi:10.1093\/eurheartj\/ehy855","DOI":"10.1093\/eurheartj\/ehy855"},{"key":"2026020308251790000_13.1.e003702.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0105831","article-title":"Unmet needs for cardiovascular care in Indonesia","volume":"9","author":"Maharani","year":"2014","journal-title":"PLoS One"},{"key":"2026020308251790000_13.1.e003702.4","doi-asserted-by":"publisher","DOI":"10.1007\/s12928-020-00669-z"},{"key":"2026020308251790000_13.1.e003702.5","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2017-312404"},{"key":"2026020308251790000_13.1.e003702.6","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313013"},{"key":"2026020308251790000_13.1.e003702.7","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s44197-024-00187-8","article-title":"The 30 Years of Shifting in The Indonesian Cardiovascular Burden\u2014Analysis of The Global Burden of Disease Study","volume":"14","author":"Muharram","year":"2024","journal-title":"J Epidemiol Glob Health"},{"key":"2026020308251790000_13.1.e003702.8","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000025404.78001.D8"},{"key":"2026020308251790000_13.1.e003702.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003493","article-title":"Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency","volume":"5","author":"Iyer","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2026020308251790000_13.1.e003702.10","doi-asserted-by":"crossref","unstructured":"Andrianto A , Muharram FR , Multazam CECZ , et al . A geospatial study of the coverage of catheterization laboratory facilities (cath labs) and the travel time required to reach them in East Java, Indonesia. Geospat Health 2023;18. doi:10.4081\/gh.2023.1164","DOI":"10.4081\/gh.2023.1164"},{"key":"2026020308251790000_13.1.e003702.11","first-page":"1594","article-title":"Reducing geographic inequalities in access times for acute treatment of myocardial infarction in a large country: the example of Russia","volume":"47","author":"Timonin","year":"2018","journal-title":"Int J Epidemiol"},{"key":"2026020308251790000_13.1.e003702.12","doi-asserted-by":"crossref","unstructured":"Widimsky P , Fajadet J , Danchin N , et al . \u201cStent 4 Life\u201d Targeting PCI at all who will benefit the most A joint project between EAPCI, Euro-PCR, EUCOMED and the ESC Working Group on Acute Cardiac Care Why \u201cStent 4 Life\u201d?, Available: http:\/\/www.orderline.dh.gov.uk","DOI":"10.4244\/EIJV4I5A94"},{"key":"2026020308251790000_13.1.e003702.13","doi-asserted-by":"publisher","DOI":"10.1136\/heart.89.8.827"},{"key":"2026020308251790000_13.1.e003702.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.07.050"},{"key":"2026020308251790000_13.1.e003702.15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.963868"},{"key":"2026020308251790000_13.1.e003702.16","doi-asserted-by":"crossref","unstructured":"Olugbuyi O , Smith C , Kaul P , et al . Impact of Socioeconomic Status and Residence Distance on Infant Heart Disease Outcomes in Canada. JAHA 2022;11. doi:10.1161\/JAHA.122.026627","DOI":"10.1161\/JAHA.122.026627"},{"key":"2026020308251790000_13.1.e003702.17","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.596346"},{"key":"2026020308251790000_13.1.e003702.18","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.638353"},{"key":"2026020308251790000_13.1.e003702.19","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.apgeog.2012.01.007","article-title":"Measuring national accessibility to cardiac services using geographic information systems","volume":"34","author":"Coffee","year":"2012","journal-title":"Appl Geogr"},{"key":"2026020308251790000_13.1.e003702.20","doi-asserted-by":"crossref","unstructured":"Ferguson WJ , Kemp K , Kost G . Using a geographic information system to enhance patient access to point-of-care diagnostics in a limited-resource setting. Int J Health Geogr 2016;15. doi:10.1186\/s12942-016-0037-9","DOI":"10.1186\/s12942-016-0037-9"},{"key":"2026020308251790000_13.1.e003702.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-018-3006-0","article-title":"Geographic assessment of access to health care in patients with cardiovascular disease in South Africa","volume":"18","author":"Kapwata","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"2026020308251790000_13.1.e003702.22","doi-asserted-by":"crossref","unstructured":"Koul S , Andell P , Martinsson A , et al . Delay From First Medical Contact to Primary PCI and All\u2010Cause Mortality: A Nationwide Study of Patients With ST\u2010Elevation Myocardial Infarction. JAHA 2014;3. doi:10.1161\/JAHA.113.000486","DOI":"10.1161\/JAHA.113.000486"},{"key":"2026020308251790000_13.1.e003702.23","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1139"},{"key":"2026020308251790000_13.1.e003702.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12942-023-00328-5","article-title":"Characterization of prehospital time delay in primary percutaneous coronary intervention for acute myocardial infarction: analysis of geographical infrastructure-dependent and -independent components","volume":"22","author":"Oyatani","year":"2023","journal-title":"Int J Health Geogr"},{"key":"2026020308251790000_13.1.e003702.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2011.02.012"},{"key":"2026020308251790000_13.1.e003702.26","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2020-316621"},{"key":"2026020308251790000_13.1.e003702.27","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001025"},{"key":"2026020308251790000_13.1.e003702.28","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0259979","article-title":"Pre hospital delay and its associated factors in acute myocardial infarction in a developing country","volume":"16","author":"Chowdhury","year":"2021","journal-title":"PLoS ONE"},{"key":"2026020308251790000_13.1.e003702.29","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000121424.76486.20"},{"key":"2026020308251790000_13.1.e003702.30","doi-asserted-by":"crossref","unstructured":"Danchin N , Durand E , Blanchard D . n.d. Pre-hospital thrombolysis in perspective. Eur Heart J 29:2835\u201342. doi:10.1093\/eurheartj\/ehn462","DOI":"10.1093\/eurheartj\/ehn462"},{"key":"2026020308251790000_13.1.e003702.31","first-page":"439","article-title":"Reperfusion Options for ST Elevation Myocardial Infarction Patients with Expected Delays to Percutaneous Coronary Intervention","volume":"5","author":"Larson","year":"2016","journal-title":"Interv Cardiol Clin"},{"key":"2026020308251790000_13.1.e003702.32","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-301009"},{"key":"2026020308251790000_13.1.e003702.33","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2007.133041"},{"key":"2026020308251790000_13.1.e003702.34","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi673"},{"key":"2026020308251790000_13.1.e003702.35","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.184048"},{"key":"2026020308251790000_13.1.e003702.36","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313398"},{"key":"2026020308251790000_13.1.e003702.37","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-026362","article-title":"Protocol of the China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP): a 10-year project to improve quality of care by building up a regional STEMI care network","volume":"9","author":"Zhang","year":"2019","journal-title":"BMJ Open"},{"key":"2026020308251790000_13.1.e003702.38","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy394"},{"key":"2026020308251790000_13.1.e003702.39","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-019-55299-0","article-title":"Adherence to guideline recommendations for coronary angiography in a poor South-East Asian setting: Impact on short- and medium-term clinical outcomes","volume":"9","author":"Qanitha","year":"2019","journal-title":"Sci Rep"},{"key":"2026020308251790000_13.1.e003702.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2017.03.040"},{"key":"2026020308251790000_13.1.e003702.41","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2015-000240","article-title":"Organisation of reperfusion therapy for STEMI in a developing country","volume":"2","author":"Dharma","year":"2015","journal-title":"Open Heart"},{"key":"2026020308251790000_13.1.e003702.42","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/j.ihj.2015.08.027","article-title":"Two-year follow-up data from the STEPP-AMI study: A prospective, observational, multicenter study comparing tenecteplase-facilitated PCI versus primary PCI in Indian patients with STEMI","volume":"68","author":"Victor","year":"2016","journal-title":"Indian Heart J"},{"key":"2026020308251790000_13.1.e003702.43","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.112.965111"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003702","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T16:25:23Z","timestamp":1770135923000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003702"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2,3]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2025-003702"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003702","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}