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Introduction Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We completed a cost-effectiveness analysis based on a decision-analytic model to assess smokers hospitalised in Ontario, Canada for AMI, UA, HF, and COPD, their risk of continuing to smoke and the effects of quitting on re-hospitalisation and mortality over a 1-year period. We calculated short-term and long-term cost-effectiveness ratios. Our primary outcome was 1-year cost per quality-adjusted life year (QALY) gained. Results From the hospital payer's perspective, delivery of the OMSC can be considered cost effective with 1-year cost per QALY gained of $C1386, and lifetime cost per QALY gained of $C68. In the first year, we calculated that provision of the OMSC to 15 326 smokers would generate 4689 quitters, and would prevent 116 rehospitalisations, 923 hospital days, and 119 deaths. Results were robust within numerous sensitivity analyses. Discussion The OMSC appears to be cost-effective from the hospital payer perspective. Important consideration is the relatively low intervention cost compared to the reduction in costs related to readmissions for illnesses associated with continued smoking. [ABSTRACT FROM AUTHOR]

Objective: To examine how physicians in Ontario, Canada, have altered their referral patterns for coronary angiography after acute myocardial infarction (AMI) over time.Design: Retrospective analysis of multilinked administrative data.Setting: Province of Ontario, Canada.Patients: 146 365 Ontario AMI patients hospitalised between 1 April 1992 and 31 March 1999.Main Outcome Measures: Utilisation trends of coronary angiography among all patients, as well as within six subgroups: elderly (versus young), women (versus men), high (versus low) risk of 30 day mortality, high (versus low) socioeconomic status, cardiology (versus non-cardiology) attending physician specialty, and hospitals with (versus without) onsite revascularisation capacity. Cox proportional hazard models were adjusted for variations in patient, physician, and hospital characteristics over time.Results: Angiography rates in Ontario increased from 23.2% in 1992 to 35.5% in 1999 (p < 0.0001). Increases in utilisation of coronary angiography were most pronounced among the elderly (12.4-24.3% v 39.3-54.4% for non-elderly patients, p < 0.0001), the affluent (24.6-38.7% v 22.0-32.3% for less affluent patients, p = 0.01), and those tended to by cardiologists (32.0-47.1% v 20.3-30.1% for non-cardiology attending specialties, p < 0.0001) after adjusting for changes in baseline patient, physician, and hospital characteristics over time.Conclusions: Despite universal health care availability, not all patients benefited equally from increases in service capacity for coronary angiography after AMI in Ontario. Wider implementation of data monitoring and explicit management systems may be required to ensure that appropriate utilisation of cardiac services is allocated to patients who are most in need. [ABSTRACT FROM AUTHOR]

Examines the course of rehabilitation in patients with complicated acute myocardial infarction after primary ventricular fibrillation in Kingston, Ontario. Resumption of work, sexual activity and driving; Examination of the mortality rate; Consideration of age, occupation, time of ventricular fibrillation and site of infarct.

Editorial. Focuses on the issue of early discharge after myocardial infarction. Benefits of general practitioners' home visits after discharge of patients; Review of drugs currently taken; Advice to patients about physical activity and how to increase it.

The article provides brief information on a study regarding the efficacy of concomitant use of proton pump inhibitor (PPI) with clopidogrel on patients who have history of myocardial infarction (MI). After a population-based, nested, and case-control study of 13,636 older patients in Ontario, it found out that concomitant use of proton pump inhibitors with clopidogrel may increase the risk of readmission after discharge for acute MI.

The article discusses a study which assessed the influence of rosiglitazone and pioglitazone administration on the risks of heart failure, myocardial infarction and death in patients with diabetes. The study included diabetic patients, aged 66 years and above in Ontario, who were treated with either rosiglitazone or pioglitazone from April 1, 2002 and March 31, 2008. Study authors found that hospitalization for acute myocardial infarction or congestive heart failure and mortality are higher in rosiglitazone patients than pioglitazone.