Back to Search
Start Over
Temporal trends in the use of percutaneous coronary intervention and coronary artery bypass surgery in New York State and Ontario.
- Source :
-
Circulation [Circulation] 2010 Jun 22; Vol. 121 (24), pp. 2635-44. Date of Electronic Publication: 2010 Jun 07. - Publication Year :
- 2010
-
Abstract
- Background: Healthcare reform initiatives in the United States have rekindled debate about the role of government regulation in the healthcare system. Although New York State (NYS) historically has had twice as many coronary revascularizations performed as Ontario, the relative evolution of coronary revascularization patterns in both jurisdictions over time is unknown.<br />Methods and Results: We conducted an observational study comparing the temporal trends of cardiac invasive procedures use in NYS and Ontario using population-based data from 1997 to 2006 stratified by procedure indication. For nonacute myocardial infarction patients, the age- and sex-adjusted rate of percutaneous coronary intervention (PCI) was 2.3 times (95% confidence interval, 2.2 to 2.5) greater in NYS than in Ontario in 2004 to 2006. In contrast, population-based rates of coronary artery bypass grafting among nonacute myocardial infarction patients were not significantly different. For acute myocardial infarction patients, differences in coronary revascularization rates between NYS and Ontario narrowed substantially over time. In 2004 to 2006, the relative ratio was 1.3 times higher for PCI (95% confidence interval, 1.2 to 1.5) and 1.4 times higher (95% confidence interval, 1.1 to 1.8) for coronary artery bypass grafting in NYS relative to Ontario. However, a larger relative gap (relative ratio, 2.0; 95% confidence interval, 1.7 to 2.3) was observed among acute myocardial infarction patients undergoing emergency PCIs in NYS compared with Ontario.<br />Conclusions: The market-oriented financing approach in NYS is associated with markedly higher rates of PCI procedures for both discretionary indications (eg, PCI in nonacute myocardial infarction patients) and emergent indications (eg, primary PCI) compared with the government-funded single-payer system in Ontario.
- Subjects :
- Angioplasty, Balloon, Coronary economics
Angioplasty, Balloon, Coronary statistics & numerical data
Canada epidemiology
Coronary Artery Bypass economics
Coronary Artery Bypass statistics & numerical data
Coronary Artery Disease economics
Coronary Artery Disease epidemiology
Delivery of Health Care
Female
Health Care Costs
Health Care Reform
Health Care Sector
Humans
Male
Myocardial Infarction economics
Myocardial Infarction epidemiology
Myocardial Revascularization economics
Myocardial Revascularization statistics & numerical data
Myocardial Revascularization trends
New York epidemiology
Registries
Retrospective Studies
Single-Payer System
Waiting Lists
Angioplasty, Balloon, Coronary trends
Coronary Artery Bypass trends
Coronary Artery Disease therapy
Myocardial Infarction therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1524-4539
- Volume :
- 121
- Issue :
- 24
- Database :
- MEDLINE
- Journal :
- Circulation
- Publication Type :
- Academic Journal
- Accession number :
- 20529997
- Full Text :
- https://doi.org/10.1161/CIRCULATIONAHA.109.926881