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Absence of bias against smokers in access to coronary revascularization after cardiac catheterization.

https://arctichealth.org/en/permalink/ahliterature176495
Source
Int J Qual Health Care. 2005 Feb;17(1):37-42
Publication Type
Article
Date
Feb-2005
Author
Jacques Cornuz
Peter D Faris
P Diane Galbraith
Merril L Knudtson
William A Ghali
Author Affiliation
Department of Medicine, University of Lausanne, Lausanne, Switzerland.
Source
Int J Qual Health Care. 2005 Feb;17(1):37-42
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Alberta - epidemiology
Angioplasty, Balloon, Coronary - utilization
Attitude of Health Personnel
Cardiac Catheterization - utilization
Cohort Studies
Coronary Artery Bypass - utilization
Coronary Disease - diagnosis - therapy
Female
Humans
Male
Middle Aged
Myocardial Revascularization - utilization
Prejudice
Prospective Studies
Smoking - epidemiology
Abstract
Many consider smoking to be a personal choice for which individuals should be held accountable. We assessed whether there is any evidence of bias against smokers in cardiac care decision-making by determining whether smokers were as likely as non-smokers to undergo revascularization procedures after cardiac catheterization.
Prospective cohort study. Subjects and setting. All patients undergoing cardiac catheterization in Alberta, Canada.
Patients were categorized as current smokers, former smokers, or never smokers, and then compared for their risk-adjusted likelihood of undergoing revascularization procedures (percutaneous coronary intervention or coronary artery bypass grafting) after cardiac catheterization.
Among 20406 patients undergoing catheterization, 25.4% were current smokers at the time of catheterization, 36.6% were former smokers, and 38.0% had never smoked. When compared with never smokers (reference group), the hazard ratio for undergoing any revascularization procedure after catheterization was 0.98 (95% CI 0.93-1.03) for current smokers and 0.98 (0.94-1.03) for former smokers. The hazard ratio for undergoing coronary artery bypass grafting was 1.09 (1.00-1.19) for current smokers and 1.00 (0.93-1.08) for former smokers. For percutaneous coronary intervention, the hazard ratios were 0.93 (0.87-0.99) for current smokers and 1.00 (0.94-1.06) for former smokers.
Despite potential for discrimination on the basis of smoking status, current and former smokers undergoing cardiac catheterization in Alberta, Canada were as likely to undergo revascularization procedures as catheterization patients who had never smoked.
PubMed ID
15668309 View in PubMed
Less detail

Access to myocardial revascularization procedures: closing the gap with time?

https://arctichealth.org/en/permalink/ahliterature170348
Source
BMC Public Health. 2006;6:60
Publication Type
Article
Date
2006
Author
Alain Vanasse
Théophile Niyonsenga
Josiane Courteau
Abbas Hemiari
Author Affiliation
Family Medicine Department, Faculty of Medicine, Université de Sherbrooke, Sherbrooke (QC), J1H 5N4, Canada. alain.vanasse@usherbrooke.ca
Source
BMC Public Health. 2006;6:60
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angioplasty, Balloon, Coronary - utilization
Cardiac Care Facilities - supply & distribution
Cohort Studies
Coronary Artery Bypass - utilization
Female
Geography
Health Services Accessibility - statistics & numerical data
Humans
Incidence
Male
Middle Aged
Myocardial Infarction - epidemiology - surgery
Myocardial Revascularization - utilization
Patient Discharge
Quebec - epidemiology
Registries
Time Factors
Abstract
Early access to revascularization procedures is known to be related to a more favorable outcome in myocardial infarction (MI) patients, but access to specialized care varies widely amongst the population. We aim to test if the early gap found in the revascularization rates, according to distance between patients' location and the closest specialized cardiology center (SCC), remains on a long term basis.
We conducted a population-based cohort study using data from the Quebec's hospital discharge register (MED-ECHO). The study population includes all patients 25 years and older living in the province of Quebec, who were hospitalized for a MI in 1999 with a follow up time of one year after the index hospitalization. The main variable is revascularization (percutaneous transluminal coronary angioplasty or a coronary artery bypass graft). The population is divided in four groups depending how close they are from a SCC ( or = 105 km). Revascularization rates are adjusted for age and sex.
The study population includes 11,802 individuals, 66% are men. The one-year incidence rate of MI is 244 individuals per 100,000 inhabitants. At index hospitalization, a significant gap is found between patients living close ( or = 32 km). During the first year, a gap reduction can be observed but only for patients living at an intermediate distance from the specialized center (64-105 km).
The gap observed in revascularization rates at the index hospitalization for MI is in favour of patients living closer (
Notes
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PubMed ID
16524458 View in PubMed
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Cardiac procedures after an acute myocardial infarction across nine Canadian provinces.

https://arctichealth.org/en/permalink/ahliterature180468
Source
Can J Cardiol. 2004 Apr;20(5):491-500
Publication Type
Article
Date
Apr-2004
Author
Louise Pilote
Patrick Merrett
Igor Karp
David Alter
Peter C Austin
Jafna Cox
Helen Johansen
William Ghali
Jack V Tu
Author Affiliation
McGill University Health Centre at the Montreal General Hospital, Montreal, Quebec, Canada. louise.pilote@mcgill.ca
Source
Can J Cardiol. 2004 Apr;20(5):491-500
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Angioplasty, Balloon, Coronary - utilization
Canada - epidemiology
Coronary Artery Bypass - utilization
Female
Health Services Needs and Demand - statistics & numerical data
Humans
Longitudinal Studies
Male
Medical Records
Middle Aged
Myocardial Infarction - epidemiology - etiology - therapy
Retrospective Studies
Sex Distribution
Waiting Lists
Abstract
Geographical variations in the use of invasive cardiac procedures have been documented. It remains unclear to what extent these variations exist across the Canadian provinces.
To describe variation in the use of invasive cardiac procedures and waiting times for these procedures across nine Canadian provinces.
Using longitudinal, de-identified patient data from the Canadian Institute for Health Information, records of patients who had suffered an acute myocardial infarction (AMI) in each of nine Canadian provinces between 1997/1998 and 1999/2000 were selected. Rates and median waiting times for percutaneous coronary intervention and coronary artery bypass graft surgery were calculated by age, sex and health region.
There was a large variation in the use of and waiting times for invasive cardiac procedures across the Canadian provinces studied. In general, cardiac procedure rates in Western provinces were higher than in Eastern provinces, most notably higher than in the Maritime provinces and Ontario. In addition to interprovincial variation, there was also significant regional variation in the rates of revascularization and waiting times. Rates of percutaneous coronary intervention increased over the study period, whereas rates of bypass surgery remained relatively stable.
Significant variation in the use of cardiac procedures after AMI exists across Canada and this April represent potential inequalities in the treatment of AMI across Canada.
PubMed ID
15100750 View in PubMed
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Cardiac procedures among American Indians and Alaska Natives compared to non-Hispanic whites hospitalized with ischemic heart disease in California.

https://arctichealth.org/en/permalink/ahliterature145781
Source
J Gen Intern Med. 2010 May;25(5):430-4
Publication Type
Article
Date
May-2010
Author
Stacey Jolly
Chi Kao
Andrew B Bindman
Carol Korenbrot
Author Affiliation
Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA. jollys@ccf.org
Source
J Gen Intern Med. 2010 May;25(5):430-4
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Alaska - ethnology
Angioplasty, Balloon, Coronary - utilization
California - ethnology
Cardiac Catheterization - utilization
Cardiac Surgical Procedures - utilization
Coronary Artery Bypass - utilization
Cross-Sectional Studies
European Continental Ancestry Group - ethnology
Female
Hispanic Americans - ethnology
Hospitalization
Humans
Indians, North American - ethnology
Male
Middle Aged
Myocardial Ischemia - ethnology - therapy
Population Groups - ethnology
Abstract
American Indians/Alaska Natives (AIAN) experience a high burden of cardiovascular disease with rates for fatal and nonfatal heart disease approximately twofold higher than the U.S. population.
To determine if disparities exist in cardiac procedure rates among AIAN compared to non-Hispanic whites hospitalized in California for ischemic heart disease defined as acute myocardial infarction or unstable angina.
Cross-sectional study. EVENTS: A total of 796 ischemic heart disease hospitalizations among AIAN and 90971 among non-Hispanic whites in 37 of 58 counties in California from 1998-2002.
Cardiac catheterization, percutaneous cardiac intervention, and coronary artery bypass graft surgery procedure rates from hospitalization administrative data.
AIAN did not have lower cardiac procedure rates for cardiac catheterization and percutaneous cardiac intervention compared to non-Hispanic whites (unadjusted OR 1.00, 95% CI 0.87-1.16 and OR 1.04, 95% CI 0.90-1.20, respectively). Adjustment for age, sex, comorbidities, and payer source did not alter the results (adjusted OR 0.95, 95% CI 0.82-1.10 and OR 0.98, 95% CI 0.85-1.14, respectively). We found higher odds (unadjusted OR 1.36, 95% CI 1.09-1.70) for receipt of coronary artery bypass graft surgery among AIAN hospitalized for ischemic heart disease compared to non-Hispanic whites which after adjustment attenuated some and was no longer statistically significant (adjusted OR 1.26, 95% CI 1.00-1.58).
AIAN were not less likely to receive cardiac procedures as non-Hispanic whites during hospitalizations for ischemic heart disease. Additional research is needed to determine whether differences in specialty referral patterns, patients' treatment preferences, or outpatient management may explain some of the health disparities due to cardiovascular disease that is found among AIAN.
Notes
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PubMed ID
20107917 View in PubMed
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Changing treatment patterns for coronary artery revascularization in Canada: the projected impact of drug eluting stents.

https://arctichealth.org/en/permalink/ahliterature177007
Source
BMC Cardiovasc Disord. 2004;4:23
Publication Type
Article
Date
2004
Author
Michael T Halpern
Michael Lacey
Mary Ann Clark
Miguel A Valentin
Author Affiliation
Exponent, Alexandria, VA, USA. mhalpern@exponent.com
Source
BMC Cardiovasc Disord. 2004;4:23
Date
2004
Language
English
Publication Type
Article
Keywords
Adult
Angioplasty, Balloon, Coronary - utilization
Canada
Cardiology
Coronary Artery Bypass - utilization
Coronary Artery Disease - economics - therapy
Device Approval
Humans
Male
Myocardial Revascularization - economics - utilization
Physician's Practice Patterns
Questionnaires
Stents - economics - utilization
Abstract
To evaluate current treatment patterns for coronary artery revascularization in Canada and explore the potential impact of drug eluting stents (DES) on these treatment patterns.
Eleven cardiologists at multiple Canadian academic centers completed a questionnaire on coronary artery revascularization rates and treatment patterns.
Participating physicians indicated slightly higher rates of PTCA, CABG, and stent implantation than reported in CCN publications. Participants estimated that 24% of all patients currently receiving bare metal stents (BMS) would receive DES in the first year following DES approval in Canada, although there was a large range of estimates around this value (5% to 65%). By the fifth year following DES approval, it was estimated that 85% of BMS patients would instead receive DES. Among diabetic patients, estimates ranged from 43% in the first year following approval to 91% in the fifth year. For all patients currently receiving CABG, mean use of DES instead was estimated at 12% in the first year to 42% at five years; rates among diabetic patients currently undergoing CABG were 17% in the first year to 49% in the fifth year.
These results suggest a continued increase in revascularization procedures in Canada. Based on the panel's responses, it is likely that a trend away from CABG towards PTCA will continue in Canada, and will be augmented by the availability of DES as a treatment option. The availability of DES as a treatment option in Canada may change the threshold at which revascularization procedures are considered.
Notes
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PubMed ID
15596004 View in PubMed
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Characterizing the spectrum of in-stent restenosis: implications for contemporary treatment.

https://arctichealth.org/en/permalink/ahliterature166202
Source
Can J Cardiol. 2006 Dec;22(14):1223-9
Publication Type
Article
Date
Dec-2006
Author
Gordon E Pate
May Lee
Karin Humphries
Eric Cohen
Robert Lowe
Rebecca S Fox
Robert Teskey
Christopher E Buller
Author Affiliation
Division of Cardiology, University of British Columbia, Vancouver.
Source
Can J Cardiol. 2006 Dec;22(14):1223-9
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Angioplasty, Balloon, Coronary - utilization
Brachytherapy - utilization
Canada - epidemiology
Coronary Angiography
Coronary Artery Bypass - utilization
Coronary Restenosis - epidemiology - radiography - therapy
Coronary Vessels - pathology
Female
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - epidemiology - radiography - therapy
Prospective Studies
Registries
Stents - adverse effects
Abstract
Reports addressing treatment of in-stent restenosis (ISR) are principally derived from clinical trials.
To characterize the spectrum of ISR in an unselected population, and to explore clinical and angiographic factors determining management.
During a prespecified six-month period before the introduction of drug-eluting stents, consecutive cases of ISR that were identified during clinically driven cardiac catheterization at five hospitals offering all approved treatment modalities for ISR were prospectively registered.
ISR was identified in 363 patients; 301 (84%) had one ISR lesion and 62 (16%) had multiple lesions. Unstable clinical presentations accounted for 51%, including 15% with ST-elevation myocardial infarction. The median interval (25th, 75th percentiles) from stent insertion to angiographic diagnosis of ISR was eight months (Q1,Q3: 4,15), with a median stented length of 18 mm (Q1,Q3: 15,28). The majority of lesions (60%) displayed a diffuse ISR pattern (Mehran types 2 and 3). ISR type was independent of time to re-presentation, diabetes, arterial territory and total stent length. Treatment included percutaneous coronary intervention (PCI) alone (n=139 [38%]), PCI with brachytherapy (n=105 [29%]), medical therapy (n=60 [17%]) and coronary artery bypass graft surgery (n=59 [16%]). Medical therapy was associated with small vessel size and recurrent ISR, and coronary artery bypass graft surgery was associated with multiple lesions, as well as diffuse, occlusive and recurrent ISR. For patients treated percutaneously, PCI treatment alone was more common for focal restenosis and after ST-elevation myocardial infarction, and brachytherapy was the more common treatment for diffuse and recurrent ISR, and stable angina.
These data provide a benchmark description of the spectrum of ISR with which the impact of drug-eluting stents may be compared and better understood.
Notes
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PubMed ID
17151772 View in PubMed
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Comparative assessment of ECG dynamics in myocardial infarction according to reperfusion therapy approach (primary and facilitated coronary angioplasty) and timing of the procedure.

https://arctichealth.org/en/permalink/ahliterature162199
Source
Anadolu Kardiyol Derg. 2007 Jul;7 Suppl 1:171-4
Publication Type
Article
Date
Jul-2007
Author
G V Ryabykina
A V Sozykin
S V Dobrovolskaya
Author Affiliation
Russian Cardiology Research Center, Moscow, Russia. anrogoza@cardio.ru
Source
Anadolu Kardiyol Derg. 2007 Jul;7 Suppl 1:171-4
Date
Jul-2007
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Balloon, Coronary - utilization
Electrocardiography
Humans
Middle Aged
Myocardial Infarction - epidemiology - physiopathology - therapy
Outcome Assessment (Health Care)
Russia - epidemiology
Thrombolytic Therapy - utilization
Time Factors
Abstract
The aim of this study was to compare electrocardiogram (ECG)-12 dynamics depending on the methods of facilitated and primary angioplasty in patients with acute coronary syndrome. The ECG changes in 81 patients - 73 patients with acute myocardial infarction and 8 patients with unstable angina pectoris - were studied.
The ECG analysis before reperfusion therapy and after angioplasty included: dynamics of summary elevation (Sigma ST+) and depression (Sigma ST-) of ST segment and changes of summary value of R waves (Sigma R) in 12 leads. The results were estimated with consideration for the length of the period from the beginning of pain syndrome till treatment and topics of the infraction-related artery.
According to our data, there was no difference between facilitated and primary transluminal coronary angioplasty in their effect on focal myocardial variation dynamics and the size of peri-infarction zone.
A reliable decrease in elevation and depression of ST segment was observed in reperfusion therapy not later than 6 hours after the beginning of pain syndrome. When reperfusion therapy is begun later, dynamics of summary values of ST segment elevation and depression before and after treatment are not reliable.
PubMed ID
17584716 View in PubMed
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Cross-provincial use of cardiac services: the importance of data-sharing for clinical registries and outcomes research.

https://arctichealth.org/en/permalink/ahliterature175673
Source
Can J Cardiol. 2005 Mar;21(3):267-72
Publication Type
Article
Date
Mar-2005
Author
Karin H Humphries
Ronald G Carere
Mona Izadnegahdar
P Diane Galbraith
Merril L Knudtson
William A Ghali
Author Affiliation
St Paul's Hospital, Vancouver, Canada. khumphries@providencehealth.bc.ca
Source
Can J Cardiol. 2005 Mar;21(3):267-72
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Aged
Alberta
Angioplasty, Balloon, Coronary - utilization
Bias (epidemiology)
British Columbia
Cardiac Catheterization - utilization
Community Health Planning
Cooperative Behavior
Coronary Artery Bypass - utilization
Data Collection - methods
Data Interpretation, Statistical
Databases, Factual - utilization
Female
Health Care Surveys
Health Services Accessibility - statistics & numerical data
Hospitalization - statistics & numerical data
Humans
Insurance Claim Reporting
Male
Medical Record Linkage - methods
Middle Aged
Outcome Assessment (Health Care) - methods
Registries
Sex Distribution
Abstract
The structure of the Canadian health care system lends itself to health services and health outcomes research. It is possible to track hospital admissions and discharges, physician billings and prescriptions using administrative databases. In addition, several provinces have developed registries that provide detailed clinical and procedural information. Using the unique personal health numbers assigned to all Canadian residents, linkage between administrative databases and population-based clinical registries provides important information regarding the use of health services and health outcomes.
To determine the extent of cross-border (British Columbia-Alberta border) use of cardiac services by British Columbia residents.
Population rates of cardiac procedures were calculated using two prospective clinical registries (British Columbia Cardiac Registries and Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease [APPROACH]), as well as administrative databases (the British Columbia Ministry of Health's hospitalization and Medical Services Plan databases).
Analyses using only British Columbia data suggest low cardiac procedure rates for patients living in eastern British Columbia. By accessing APPROACH data, it was determined that more than 80% of British Columbia cardiac patients living along the British Columbia-Alberta border access procedural services in Alberta.
While residents of eastern British Columbia appear to have reduced access to cardiac services when data from British Columbia are analyzed in isolation, they are actually accessing care in Alberta. Analyses based solely on single province data sources will underestimate cardiac procedures rates.
PubMed ID
15776116 View in PubMed
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28 records – page 1 of 3.