Quality of care and outcomes of older heart failure patients: is the United States doing a better job than Canada?

Despite similar culture, economy and geography, the United States and Canada have very different methods of financing and delivering healthcare. The U.S.' market-oriented system with limited governmental control is in sharp contrast to Canada's single-payer system covering the majority of physician and hospital services and prescription medications for seniors (Iglehart 2003; Detsky and Naylor 2003). Per capita healthcare costs are considerably lower in Canada than in the U.S., but Canadian budgetary constraints have resulted in limited access to specialized care such as invasive cardiac procedures and physician specialists. In contrast, the supply of specialized healthcare is greater in the U.S., but there are many challenges there including a lack of healthcare access for many uninsured patients and a lack of prescription drugs for the elderly and chronically ill. Little is known about the care and outcomes for chronic conditions with substantial public health impact. Heart failure (HF) is an important condition to study because it affects millions of Canadians and Americans, and the long-term outcomes of HF patients are extremely poor, with one-year mortality rates after hospitalization estimated to be 25% to 40% (American Heart Association 2005). Evaluating the patterns of care and outcomes of HF patients treated in both countries may provide insights about the relative performance of these two health systems.