An observational study of demographic, clinical and angiographic characteristics of patients post myocardial infarction at Vancouver Hospital and at Seattle area hospitals
Creators: name: Fox, Rebecca
Publisher: name: University of British Columbia
Year: 2009

description: Both the American and the Canadian health care systems are faced with the challenge of determining the most cost-effective care. As such, research results which demonstrate evidence of long term outcomes will effect health policy especially related to widespread and/or costly events and procedures such as myocardial infarction (MI) and revascularization. In addition, patients with chronic disease pose very difficult economic and ethical decisions within global budgets over choices of treatments for the sickest patients as opposed to those who might derive greater long term benefit. Previous comparisons between the U.S. and Canada have shown that demographic and clinical characteristics of MI patients are similar. Although rates of catheterization and revascularization are reported, the characteristics of those selected for these procedures have not been widely examined. Conclusions have been drawn on the relationship between the level of care and resulting poorer functional outcomes of Canadians versus Americans based on these rates of procedures. A comparison between Vancouver and Seattle MI database patients who undergo cardiac catheterization provided an opportunity to determine whether regionalization of technology and capping of expenditures has prompted Canadian clinicians to select a different group of patients for these procedures as compared to those selected in Seattle. Method Demographic, clinical and hospital stay data was extracted from the Seattle and Vancouver databases and merged with procedural data for all patients who had angiography within 90 days of MI at University of Washington (including those from Group Health Central and Northwest Hospitals) and Vancouver Hospital during the period 1988-1994. A total of 545 Seattle and 293 Vancouver patients comprised the sample. Descriptive statistics, 95% confidence intervals and p values were obtained to detect differences in patient charactersitics, complications, treatment and angiographic variables. A comparison of prognostic factors for severity of coronary artery disease between the University of Washington and Vancouver Hospital patients was done using a logistic regression model. Results Seattle and Vancouver post-MI patients who had angiography were demonstrated to have important similar characteristics (such as age, sex, severity of MI, bypass procedures and total MI treatment). Seattle patients were more commonly treated with direct and rescue angioplasty procedures as compared to thrombolytic therapy at Vancouver Hospital. The mean length of hospital stay and days to procedures were significantly shorter for Seattle patients as compared to those in Vancouver. In addition, V H patients had procedures more commonly on readmission as compared to Seattle patients whose procedures were performed during initial hospitalization. The primary comparison between University of Washington and Vancouver Hospitals demonstrated that clinicians selected similar patients for procedures. Furthermore, following angiography, Vancouver patients had more angioplasty and equivalent bypass surgery performed as compared to Seattle. Both groups of patients demonstrated indications for angiography and significant coronary artery disease. Regionalization of catheterization facilities and funding from global budgets have contributed to a longer waiting time for procedures in Canada and, in some cases, a restricted number of procedures performed.