Western Canada heart attack patients receiving quicker access to cardiac procedures

Heart attack patients in Alberta and British Columbia receive more cardiac procedures and have shorter waiting times for them than patients in the Maritimes or Ontario, a new study from the Canadian Cardiovascular Outcomes Research Team (CCORT) has found.

Researchers examined the rates and waiting times for the revascularization procedures angioplasty and bypass surgery. Both procedures use different methods to restore blood flow through arteries after a heart attack. The study group included patients from each of nine Canadian provinces (PEI, Nova Scotia, New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia) who suffered a heart attack between 1998 and 2000.

Results:

• The highest use of revascularization at one year after hospitalization for heart attack was seen in Alberta (36%) and B.C. (32%), and the lowest rate of use was in PEI (6%). Ontario tended to have rates similar to those seen in the Maritimes for angioplasty use, with only 13% of patients receiving the procedure one year after their heart attack.
• The average wait for revascularization following heart attack was the longest in Nova Scotia (29 days), and the shortest in Alberta (8 days) and B.C. (9 days). Ontario was again similar to the Maritimes with a waiting time of 24 days.
• Significant regional variation was also found within the provinces themselves for revascularization rates and waiting times.

“The good news here is that, overall, waiting times for these cardiac procedures have gone down over the study period and the use of angioplasty has gone up,” said lead author, McGill University Health Centre (MUHC) Research Institute researcher, and CCORT investigator Dr. Louise Pilote.

“However, our study also highlights some serious potential inequities in the treatment of heart attack patients across the country,” said senior author, CCORT team leader, and ICES senior scientist Dr. Jack Tu. “Although we can’t identify the optimal rates of revascularization procedure use through this research, these discrepancies must be addressed in future research, and in planning and policy development.”

“The Heart and Stroke Foundation supports this work because it not only answers valuable questions about access to care, but hopefully will lead to the exploration of reasons for this regional variation,” said Dr. Beth Abramson, cardiologist and spokesperson for the Foundation.

The study, “Cardiac procedures after an acute myocardial infarction across nine Canadian provinces”, is in the April 16, 2004 issue of the Canadian Journal of Cardiology.

The Canadian Cardiovascular Outcomes Research Team (CCORT) was established in 2001, funded by five-year operating grants from the Canadian Institutes for Health Research (CIHR) Interdisciplinary Health Research Team (IHRT) program and the Heart and Stroke Foundation of Canada (HSF). CCORT consists of over 30 investigators from five Canadian provinces (Nova Scotia, Quebec, Ontario, Alberta, and British Columbia) conducting a series of innovative studies to measure and improve the quality of cardiac care provided to Canadians. The CCORT national coordinating centre is headquartered at the Institute for Clinical Evaluative Sciences (ICES) in Toronto.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners and practitioners to make decisions about care delivery and to develop policy.

Author affiliations: Dr. Louise Pilote, Patrick Merrett, Dr. Igor Karp – McGill University Health Centre at the Montreal General Hospital; Dr. David Alter, Dr. Peter Austin, and Dr. Jack Tu – Institute for Clinical Evaluative Sciences (ICES); Dr. Jafna Cox – Dalhousie University; Dr. Helen Johansen – Statistics Canada; Dr. William Ghali – University of Calgary; Dr. Peter Austin – Department of Public Health Sciences, University of Toronto.

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