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Cardiac intervention rates for older patients with acute myocardial infarction in the United States and Ontario, 2003-2013: a retrospective cohort study.
- Source :
-
CMAJ open [CMAJ Open] 2020 Jun 11; Vol. 8 (2), pp. E437-E447. Date of Electronic Publication: 2020 Jun 11 (Print Publication: 2020). - Publication Year :
- 2020
-
Abstract
- Background: Previous work showed lower cardiac intervention rates for patients with acute myocardial infarction (AMI) in Ontario than in the United States. We assessed whether Ontario's efforts to improve access to rapid percutaneous coronary intervention (PCI) for AMI were associated with improved timeliness of care and whether this closed the gap between the 2 jurisdictions.<br />Methods: In this retrospective cohort study, we followed adults aged 66-99 years in the US and Ontario for 30 days after admission for incident AMI between 2003 and 2013 using health administrative data from both countries. We calculated the proportion of patients who received cardiac catheterization, PCI and coronary artery bypass grafting on the day of and within 30 days of admission overall and according to AMI type (ST-segment elevation AMI [STEMI] v. non-STEMI) and risk group (low, medium or high predicted risk of 30-d mortality).<br />Results: We followed 414 216 patients in the US and 112 484 in Ontario. The large disparities in cardiac intervention rates observed in 2003 mostly disappeared over time. By 2013, the proportion of patients who received same-day PCI was only slightly higher in the US than in Ontario (22.3% v. 19.2%), whereas the converse was true for 30-day PCI (44.0% v. 41.3%). In 2013, patients with STEMI in the US and Ontario received PCI at nearly identical rates on the day of admission (66.3% v. 63.8%); however, more patients at high risk with STEMI in the US than in Ontario received PCI, both on the day of admission (55.5% v. 44.7%) and by 30 days (60.5% v. 55.0%).<br />Interpretation: Despite differences in resources and organization of delivery systems, by 2013, timely receipt of PCI by Ontario patients with AMI lagged only slightly behind that by US patients. A higher supply of PCI centres in the US may have facilitated earlier intervention among patients at high risk with STEMI.<br />Competing Interests: Competing interests: None declared.<br /> (Copyright 2020, Joule Inc. or its licensors.)
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Cardiac Catheterization methods
Cardiac Catheterization statistics & numerical data
Comorbidity
Disease Management
Female
Geriatric Assessment
Humans
Male
Mortality
Myocardial Infarction etiology
Myocardial Infarction therapy
Ontario epidemiology
Percutaneous Coronary Intervention methods
Prevalence
Public Health Surveillance
ST Elevation Myocardial Infarction
United States epidemiology
Myocardial Infarction epidemiology
Percutaneous Coronary Intervention statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 2291-0026
- Volume :
- 8
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- CMAJ open
- Publication Type :
- Academic Journal
- Accession number :
- 32527795
- Full Text :
- https://doi.org/10.9778/cmajo.20190190