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Previous Volume 331:1130-1135 October 27, 1994 Number 17 Next

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ABSTRACT

Background Much attention has been directed to the use of medical resources and to patients' outcomes in Canada as compared with the United States. We compared U.S. and Canadian patients with respect to their use of medical resources and their quality of life during the year after acute myocardial infarction.

Methods A total of 2600 U.S. and 400 Canadian patients were randomly selected from the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) trial. Base-line data from their initial hospitalizations were analyzed, and the patients were then interviewed by telephone 30 days, 6 months, and 1 year after myocardial infarction to determine their use of medical care and quality of life.

Results The Canadian patients typically stayed in the hospital one day longer (P = 0.009) than the U.S. patients but had a much lower rate of cardiac catheterization (25 percent vs. 72 percent, P<0.001), coronary angioplasty (11 percent vs. 29 percent, P<0.001), and coronary bypass surgery (3 percent vs. 14 percent, P<0.001). At one year 24 percent of the Canadian and 53 percent of the U.S. patients had undergone angioplasty or bypass surgery at least once (P<0.001). The Canadians had more visits to physicians during the follow-up year (P<0.001), but fewer visits to specialists (P<0.001). At 30 days, functional status was equivalent in the patients from the two countries. However, after one year the U.S. patients had substantially more improvement than the Canadian patients (P<0.001). The prevalence of chest pain and dyspnea at one year was higher among the Canadian patients (34 percent vs. 21 percent and 45 percent vs. 29 percent, respectively; P<0.001).

Conclusions The Canadian patients had more cardiac symptoms and worse functional status one year after acute myocardial infarction than the U.S. patients. The Canadian patients also underwent fewer invasive cardiac procedures and had fewer visits to specialist physicians. These results suggest, but do not prove, that the more aggressive pattern of care in the United States may have been responsible for the better quality of life.

Source Information

From the Economic and Quality of Life Research Group (D.B.M., J.D.K., C.L.N., N.E.C.-C.) and the Clinical Trials Coordinating Center (R.M.C., C.B.G., K.L.L.), the Division of Cardiology (D.B.M., R.M.C., C.B.G.), the Department of Medicine and the Division of Biometry, Department of Community and Family Medicine (K.L.L.), Duke University Medical Center, Durham, N.C.; the Department of Medicine, University of Toronto (C.D.N., W.S.), and the Institute for Clinical Evaluative Sciences (C.D.N.), Toronto; the Department of Medicine, University of Alberta, Edmonton (P.W.A.); the Division of Health Services Research, Department of Health Research and Policy, Stanford University Medical Center, Stanford, Calif. (M.A.H.); and the Department of Cardiology, Cleveland Clinic, Cleveland (E.J.T., L.P.).

Address reprint requests to Dr. Mark at P.O. Box 3485, Duke University Medical Center, Durham, NC 27708-3485.

Full Text of this Article

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Quality of Life after Myocardial Infarction: Canada versus the United States
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Extract | Full Text  
N Engl J Med 1995; 332:469-472, Feb 16, 1995. Correspondence

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