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Background: The current survival trends in patients with acute myocardial infarction (AMI) are not known. A population-based study using administrative data to examine the short and long term survival of patients after AMI in Alberta between 1994 and 1999 was conducted., Methods: AMI patients were identified from hospital discharge data. Temporal changes in the adjusted (age, sex, AMI anatomical location and comorbidities) fatality rate were analyzed in 19,928 AMI patients., Results: The age- and sex-adjusted incidence of hospitalization for AMI in Alberta significantly declined from 169.6 per 100,000 population in 1994 to 160.8 per 100,000 in 1999 (P=0.03). The risk-adjusted in-hospital case fatality rate from all causes was 11.4% (95% CI 10.6% to 12.3%) in 1994 versus 9.2% (8.4% to 10.1%) in 1999; the 30-day case fatality rate was 12.6% (11.7% to 13.6%) in 1994 versus 10.1% (9.1% to 11.0%) in 1999; and the one-year case fatality rate was 19.0% (17.8% to 20.1%) in 1994 versus 14.9% (13.8% to 16.0%) in 1999. The percentage of hospitalized AMI patients who underwent coronary angiography within one year after admission rose from 48.2% in 1994 to 52.4% in 1999; percutaneous transluminal coronary angioplasty increased from 25.5% to 35.0% and coronary artery bypass surgery increased from 9.7% to 12.6%. Prescriptions for pharmacological drugs at discharge increased from 1994 to 1999 among patients aged 65 and older: from 29.5% in 1994 to 41.0% in 1999 for beta-blockers, from 5.2% to 18.7% for lipid lowering agents and from 14.0% to 20.5% for angiotensin-converting enzyme inhibitors., Interpretation: There was a modest improvement in patient survival after AMI between 1994 and 1999. The improvements may be associated with increasing use of revascularization and pharmacological therapy provided in the management of AMI.

Background: Although outcomes after coronary artery bypass grafting (CABG) have been studied extensively across Canada, using both clinical and administrative databases, studies examining outcomes after valve surgery in Canada have been restricted to regional investigations using clinical data sources of limited scope. The objective of the present study was to report on observed and risk-adjusted in-hospital mortality rates after aortic valve replacement (AVR) and mitral valve replacement (MVR) across Canada between 1994/95 and 1999/2000 using administrative data., Methods: All cases of AVR and MVR (with and without concomitant CABG) performed between 1994/95 and 1999/2000 were identified using hospital discharge abstract data obtained from the Canadian Institute for Health Information. Rates of in-hospital mortality were risk-adjusted using logistic regression modelling techniques to account for variations in sociodemographic, comorbidity, and disease-specific indicators of average severity of illness across years and provinces. Risk-adjusted outcomes were unavailable for the province of Quebec., Results: The overall in-hospital mortality rate, excluding Quebec, between 1994/95 and 1999/2000 after isolated AVR with or without CABG was 3.7% and isolated MVR with or without CABG was 5.7%. Although risk-adjusted in-hospital mortality rates by year were unchanged between 1994/95 and 1999/2000, significant interprovincial variation did exist, ranging from 2.6% to 6.8% for AVR with or without CABG and 2.5% to 13.0% for MVR with or without CABG., Conclusion: In-hospital mortality rates after valve surgery have remained stable over time. However, significant variation in outcomes was noted between provinces. The results of this study provide the first comprehensive account of valve surgery outcomes across Canada.

Background: The authors have previously reported on Canada-wide outcomes of coronary artery bypass graft (CABG) surgery for 1992/93 through 1995/96., Objective: To provide an updated Canada-wide CABG surgery outcome report with outcome data organized by province and by year for 1992/93 through 2000/01., Methods: Hospital discharge abstract data were obtained from the Canadian Institute for Health Information and were used to identify all patients who underwent isolated CABG surgery in eight provinces from fiscal year 1992/93 through 2000/01. Crude data from Quebec hospitals were available for calendar years 1998 and 1999. Logistic regression modelling was used to calculate risk-adjusted in-hospital mortality rates by year and province., Results: Patients undergoing CABG surgery in the later years studied were on average older and had more comorbidities than did patients undergoing this surgery in earlier years. Despite increasing case complexity, risk-adjusted mortality rates decreased significantly from 3.5% (95% CI 3.2% to 3.8%) to 2.0% (95% CI 1.8% to 2.3%). Risk-adjusted mortality rates varied between provinces. Provincial risk-adjusted mortality rates ranged from 2.0% to 3.3%. However, all provinces studied had either persistently low mortality rates (Nova Scotia) or declining mortality rates across years studied, such that all provinces achieved risk-adjusted mortality rates of 2.7% or lower in 2000/01., Conclusions: This evaluation of Canadian CABG surgery outcomes demonstrates a pattern of either steadily improving or persistently favourable provincial in-hospital mortality rates after isolated CABG surgery. These favourable provincial outcome trends have been achieved despite an accompanying increase in the average case complexity of patients undergoing CABG in Canada.