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Can J Cardiol. 2017 Oct;33(10):1319-1326. doi: 10.1016/j.cjca.2017.06.014. Epub 2017 Jul 8.

Quality of Acute Myocardial Infarction Care in Canada: A 10-Year Review of 30-Day In-Hospital Mortality and 30-Day Hospital Readmission.

Author information

1
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
2
Department of Medicine, University of Alberta, Edmonton, Alberta; Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
3
School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada.
4
Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Ontario, Canada.
5
Department of Medicine, University of Alberta, Edmonton, Alberta; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada. Electronic address: pkaul@ualberta.ca.

Abstract

BACKGROUND:

The recently released Canadian cardiac care quality indicators include 30-day in-hospital mortality and readmission rates after percutaneous coronary intervention (PCI) and isolated coronary artery bypass grafting (CABG). We examined long-term trends and provincial variations in these outcomes among acute myocardial infarction (AMI) patients.

METHODS:

We included patients aged 18 years and older who were hospitalized with a primary diagnosis of AMI between 2004 and 2013 in all Canadian provinces except Quebec. We calculated 30-day in-hospital death and readmission rates after PCI as well as isolated CABG. We used logistic regressions to evaluate baseline-adjusted temporal trends and provincial variations in mortality and readmission.

RESULTS:

Among 341,001 AMI episodes in 323,862 unique patients, 43.1% and 7% received PCI and CABG, respectively. Mortality after PCI (2.8%) remained stable (odds ratio [OR], 1.01; P = 0.399), whereas mortality after isolated CABG (2.5%) decreased over time (OR, 0.96; P = 0.017). Readmission after PCI (8.8%) increased (OR, 1.06; P < 0.001), whereas readmission after isolated CABG (11.4%) remained stable over time (OR, 0.99; P = 0.116). Compared with Alberta, mortality and readmission after PCI were highest in Saskatchewan (mortality: OR, 1.32; P = 0.001; readmission: OR, 1.24; P < 0.001), whereas mortality after isolated CABG was highest in Newfoundland and Labrador (OR, 2.05; P = 0.010) and readmission after isolated CABG was highest in New Brunswick (OR, 1.49; P = 0.001).

CONCLUSIONS:

There was no change in mortality, and a slight increase in readmission rates after PCI, and modest improvements in mortality and readmission rates after CABG among AMI patients during the study period. Significant interprovincial variations remained. A stronger focus on pan-Canadian coordination in AMI care and a set of standard benchmarks for AMI-specific PCI- and CABG-related quality indicators are needed.

PMID:
28941611
DOI:
10.1016/j.cjca.2017.06.014
[Indexed for MEDLINE]

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