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Cardiac procedures after an acute myocardial infarction across nine Canadian provinces

Pilote L, Merrett P, Karp I, Alter D, Austin PC, Cox J, Johansen H, Ghali W, Tu JV. Can J Cardiol. 2004; 20(5):491-500.

Background — 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.

Objective — To describe variation in the use of invasive cardiac procedures and waiting times for these procedures across nine Canadian provinces.

Methods — 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.

Results — 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 provinces and Ontario. In addition to interprovincial variation, there was also significant regional variation in the rates of revascularization and waiting times. Rates of percutaneous coronary intervention increased over the study period, whereas rates of bypass surgery remained relatively stable.

Conclusions — Significant variation in the use of cardiac procedures after AMI exists across Canada and this April represent potential inequalities in the treatment of AMI across Canada.

Keywords: Coronary disease/Myocardial infarction Access to health care Health care delivery