Variations by health region in treatment and survival after heart attack (original) (raw)
Related papers
Canadian Journal of Cardiology, 2010
T he treatment of acute myocardial infarction (AMI) has evolved considerably over the past 20 years, most notably with the introduction of pharmacological reperfusion therapy and, more recently, acute revascularization procedures (1-3). For the latter, a systematic review of randomized trials comparing the use of angioplasty versus intravenous thrombolytic therapy for ST segment elevation AMI concluded that primary percutaneous coronary intervention (PCI) is more efficacious in reducing short-term mortality than thrombolytic therapy (4). With respect to patients with non-ST segment elevation AMI or unstable angina, early invasive treatment strategies (ie, angiography and revascularization via PCI or coronary artery bypass graft [CABG] surgery) within seven days of admission with AMI have also been shown to have a greater sustained reduction in mortality and morbidity compared with a noninvasive, primarily medical management approach (5-9).
Specialized cardiological care may be overutilized in urban areas of Québec
2011
Background: Urban/rural differences in secondary cardiovascular disease (CVD) events have previously been observed for Québec. These differences could be attributable to differential utilization of specialized cardiological care, such as revascularization procedures and visits to cardiologists; if this were the case, policies to increase utilization in rural areas would be indicated. Design: This is a population-based cohort study. Methods: We analysed mortality and hospital re-admission in Québec within 1 year after an initial cardiovascular event in relation to urban/rural location and specialized care utilization, controlling for demography, comorbidities, and cumulative hospitalization. Results: Analysis showed higher hospital re-admissions and slightly lower CVD mortality in rural areas, as well as less use of specialized care in rural areas. However, urban/rural differentials were not attributable to differences in utilization of care. Paradoxically, comorbidities were lower among patients who saw specialists. Conclusions: Ultimately, urban/rural differences in secondary CVD outcomes were not attributable to differences in care utilization or our measures of underlying health status, and were likely due to cultural or lifestyle factors that are both hard to model and hard to change through policy. There appears to be overutilization of specialized care in urban areas, an issue which requires further study. Our results suggest that substantial caution is required when interpreting health service usage data and that critical factors in the relationship between specialized cardiological care and outcomes are still poorly understood at a population level.
Circulation, 2006
Background— Previous comparisons of acute myocardial infarction (AMI) treatment between the United States and Canada are limited because they compared selected patients from randomized trials, used administrative data that lacked clinical detail, or did not consider regional differences in AMI treatment. Methods and Results— We compared medication use, invasive cardiac procedure use, and 30-day risk-standardized mortality rates of 38 886 fee-for-service Medicare beneficiaries hospitalized with AMI in the United States and 5634 similarly aged patients in Ontario, Canada, from 1998 and 2001. Baseline characteristics and illness severity across the US regions and Ontario were not substantially different. Cardiac catheterization use in AMI patients was significantly higher in the United States compared with Ontario (38.7% versus 16.8%, P <0.001), but significant regional variations existed, in which the northeastern United States had significantly lower utilization rates (25.6%) comp...
Regional variations in ambulatory care and incidence of cardiovascular events
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2017
Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates. We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for cardiovascular disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major cardiovascular event (myocardial infarction, stroke or cardiovascular-related death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province's 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in cardiovascular event rates. Ca...
Cardiac procedures after an acute myocardial infarction across nine Canadian provinces
The Canadian journal of cardiology, 2004
Geographical variations in the use of invasive cardiac procedures have been documented. It remains unclear to what extent these variations exist across the Canadian provinces. To describe variation in the use of invasive cardiac procedures and waiting times for these procedures across nine Canadian provinces. Using longitudinal, de-identified patient data from the Canadian Institute for Health Information, records of patients who had suffered an acute myocardial infarction (AMI) in each of nine Canadian provinces between 1997/1998 and 1999/2000 were selected. Rates and median waiting times for percutaneous coronary intervention and coronary artery bypass graft surgery were calculated by age, sex and health region. There was a large variation in the use of and waiting times for invasive cardiac procedures across the Canadian provinces studied. In general, cardiac procedure rates in Western provinces were higher than in Eastern provinces, most notably higher than in the Maritime provi...
Regional disparities in mortality by heart attack: evidence from France
This paper studies the determinants of the regional disparities in the mortality of patients treated in a hospital for a heart attack in France. These determinants can be some di¤erences in patient characteristics, treatments, hospital charateristics, and local healthcare market structure. We assess their importance with an exhaustive administrative dataset over the 1998-2003 period using a strati…ed duration model. The raw disparities in the propensity to die within 15 days between the extreme regions reaches 80%. It decreases to 47% after controlling for the patient characteristics and their treatments. In fact, a variance analysis shows that innovative treatments play an important role. Remaining regional disparities are signi…cantly related to the local healthcare market structure. The more patients are locally concentrated in a few large hospitals rather than many small ones, the lower the mortality.
BMC health services research, 2006
Researchers and policy makers have focussed on the development of indicators to help monitor the success of regionalization, primary care reform and other health sector restructuring initiatives. Certain indicators are useful in examining issues of equity in service provision, especially among older populations, regardless of where they live. AHRs are used as an indicator of primary care system efficiency and thus reveal information about access to general practitioners. The purpose of this paper is to examine trends in avoidable hospitalization rates (AHRs) during a period of time characterized by several waves of health sector restructuring and regionalization in British Columbia. AHRs are examined in relation to non-avoidable and total hospitalization rates as well as by urban and rural geography across the province. Analyses draw on linked administrative health data from the province of British Columbia for 1990 through 2000 for the population aged 50 and over. Joinpoint regress...
European journal of public health, 2016
Geographic and socioeconomic barriers may hinder fair access to healthcare. This study assesses geographic and socioeconomic disparities in access to reperfusion procedures in acute myocardial infarction (AMI) patients residing in Piedmont (Italy). Coronary Care Units (CCUs) were geocoded with a geographic information system (GIS) and the shortest drive time from CCUs to patients' residence was computed and categorized as 0 to <20, 20 to <40 and ≥40 min. Using data on AMI emergency hospitalizations in 2004-2012, we employed a log-binomial regression model to evaluate the relation between drive time and use of Percutaneous Transluminal Coronary Angioplasty (PTCA) occurring within 2 days after a hospitalization for an episode of AMI, and whether this relation varied depending on the period of hospitalization. A total of 29% of all cases with a diagnosis of AMI (n = 66 097), were revascularized within 2 days from the index admission. The further AMI patients lived from CCUs, ...
CJC Open, 2021
Acute myocardial infarction (AMI) is one of the most common causes of morbidity and mortality across Canada. 1 Each year, more than 70,000 patients with AMI are admitted to Canadian hospitals. 2 Of these, approximately 5000 patients die within 30 days of hospitalization, and about 10% to 15% are readmitted within 30 days of their initial AMI. 2,3 Outcomes after AMI in Canadian hospitals have been publicly reported by the Canadian Institute for Health Information (CIHI) for close to 2 decades to identify hospitals with suboptimal outcomes and assist in creating and monitoring quality improvement efforts. 4-8 Accurately profiling hospital performance regarding patient outcomes depends on selecting appropriate patients for reporting, and implementing accurate risk-adjustment