| Summary: | 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. === Medicine, Faculty of === Population and Public Health (SPPH), School of === Graduate
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