Use of Cardiac Procedures and Outcomes in Elderly Patients with Myocardial Infarction in the United States and Canada
Jack V. Tu, M.D., Ph.D., Chris L. Pashos, Ph.D., C. David Naylor, M.D., D.Phil., Erluo Chen, M.B., M.P.H., Sharon-Lise Normand, Ph.D., Joseph P. Newhouse, Ph.D., and Barbara J. McNeil, M.D., Ph.D.
Background Acute myocardial infarction is a leading cause ofmorbidity and mortality in the United States and Canada. Weperformed a population-based study to compare the use of cardiacprocedures and outcomes after acute myocardial infarction inelderly patients in the two countries.
Methods We compared the use of invasive cardiac procedures andthe mortality rates among 224,258 elderly Medicare beneficiariesin the United States and 9444 elderly patients in Ontario, Canada,each of whom had a new acute myocardial infarction in 1991.
Results The U.S. patients were significantly more likely thanthe Canadian patients to undergo coronary angiography (34.9percent vs. 6.7 percent, P< 0.001), percutaneous transluminalcoronary angioplasty (11.7 percent vs. 1.5 percent, P<0.001),and coronary-artery bypass surgery (10.6 percent vs. 1.4 percent,P<0.001) during the first 30 days after the index infarction.These differences in the use of cardiac procedures narrowedbut persisted through 180 days of follow-up. The 30-day mortalityrates were slightly but significantly lower for the U.S. patientsthan for the Canadian patients (21.4 percent vs. 22.3 percent,P = 0.03). However, the one-year mortality rates were virtuallyidentical (34.3 percent in the United States vs. 34.4 percentin Ontario, P = 0.94).
Conclusions Short-term mortality after an acute myocardial infarctionwas slightly lower in the United States than in Ontario, butthese differences did not persist through one year of follow-up.The strikingly higher rates of use of cardiac procedures inthe United States, as compared with Canada, do not appear toresult in better long-term survival rates for elderly U.S. patientswith acute myocardial infarction.
Source Information
From the Institute for Clinical Evaluative Sciences in Ontario, North York, Ont., Canada (J.V.T., C.D.N., E.C.); the Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Toronto (J.V.T., C.D.N.); Abt Associates, Cambridge, Mass. (C.L.P.); the Departments of Biostatistics (S.-L.N.) and Health Policy and Management (J.P.N.), Harvard School of Public Health, Boston; the Kennedy School of Government, Cambridge, Mass. (J.P.N.); and the Department of Health Care Policy, Harvard Medical School, Boston (J.V.T., C.L.P., S.-L.N., J.P.N., B.J.M.). The opinions and conclusions in this study are those of the authors, and no official endorsement by the Ontario Ministry of Health is intended or should be inferred.
Address reprint requests to Dr. Tu at the Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Ave., North York, ON M4N 3M5, Canada.
Krumholz, H. M.
(2008). Outcomes Research: Generating Evidence for Best Practice and Policies. Circulation
118: 309-318
[Full Text]
Jackevicius, C. A., Li, P., Tu, J. V.
(2008). Prevalence, Predictors, and Outcomes of Primary Nonadherence After Acute Myocardial Infarction. Circulation
117: 1028-1036
[Abstract][Full Text]
Ko, D. T., Wang, Y., Alter, D. A., Curtis, J. P., Rathore, S. S., Stukel, T. A., Masoudi, F. A., Ross, J. S., Foody, J. M., Krumholz, H. M.
(2008). Regional Variation in Cardiac Catheterization Appropriateness and Baseline Risk After Acute Myocardial Infarction.. J Am Coll Cardiol
51: 716-723
[Abstract][Full Text]
Kavsak, P. A., Ko, D. T., Newman, A. M., Palomaki, G. E., Lustig, V., MacRae, A. R., Jaffe, A. S.
(2007). Risk Stratification for Heart Failure and Death in an Acute Coronary Syndrome Population Using Inflammatory Cytokines and N-Terminal Pro-Brain Natriuretic Peptide. Clin. Chem.
53: 2112-2118
[Abstract][Full Text]
Birnie, D. H. MB ChB MD, Sambell, C. BSc, Johansen, H. PhD, Williams, K. MS, Lemery, R. MD, Green, M. S. MD, Gollob, M. H. MD, Lee, D. S. MD PhD, Tang, A. S.L. MD
(2007). Use of implantable cardioverter defibrillators in Canadian and US survivors of out-of-hospital cardiac arrest. CMAJ
177: 41-46
[Abstract][Full Text]
Merhige, M. E., Breen, W. J., Shelton, V., Houston, T., D'Arcy, B. J., Perna, A. F.
(2007). Impact of Myocardial Perfusion Imaging with PET and 82Rb on Downstream Invasive Procedure Utilization, Costs, and Outcomes in Coronary Disease Management. JNM
48: 1069-1076
[Abstract][Full Text]
Yan, A. T., Yan, R. T., Tan, M., Fung, A., Cohen, E. A., Fitchett, D. H., Langer, A., Goodman, S. G., for the Canadian Acute Coronary Syndromes 1 and 2,
(2007). Management Patterns in Relation to Risk Stratification Among Patients With Non-ST Elevation Acute Coronary Syndromes. Arch Intern Med
167: 1009-1016
[Abstract][Full Text]
Kaul, P., Peterson, E.D.
(2007). The Cardiovascular World Is Definitely Not Flat. Circulation
115: 158-160
[Full Text]
Ko, D. T., Krumholz, H. M., Wang, Y., Foody, J. M., Masoudi, F. A., Havranek, E. P., You, J. J., Alter, D. A., Stukel, T. A., Newman, A. M., Tu, J. V.
(2007). Regional Differences in Process of Care and Outcomes for Older Acute Myocardial Infarction Patients in the United States and Ontario, Canada. Circulation
115: 196-203
[Abstract][Full Text]
Eisenberg, M. J.
(2006). The Perspective of a Canadian Practitioner in America--Reply. Arch Intern Med
166: 1421-1422
[Full Text]
Kaul, P., Chang, W.-C., Lincoff, A. M., Aylward, P., Betriu, A., Bode, C., Califf, R. M., Ohman, E. M., Guetta, V., Steg, P. G., Van de Werf, F., Armstrong, P. W.
(2006). Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction: insights from the GUSTO-V trial. Eur Heart J
27: 1198-1206
[Abstract][Full Text]
Ko, D. T., Tu, J. V., Masoudi, F. A., Wang, Y., Havranek, E. P., Rathore, S. S., Newman, A. M., Donovan, L. R., Lee, D. S., Foody, J. M., Krumholz, H. M.
(2005). Quality of Care and Outcomes of Older Patients With Heart Failure Hospitalized in the United States and Canada. Arch Intern Med
165: 2486-2492
[Abstract][Full Text]
Graham, M. M., Ghali, W. A., Faris, P. D., Galbraith, P. D., Tu, J. V., Norris, C. M., Zentner, A., Knudtson, M. L., for the APPROACH Investigators,
(2005). Population rates of cardiac catheterization and yield of high-risk coronary artery disease. CMAJ
173: 35-39
[Abstract][Full Text]
Chang, W.-C., Midodzi, W. K, Westerhout, C. M, Boersma, E., Cooper, J., Barnathan, E. S, Simoons, M. L, Wallentin, L., Ohman, E M., Armstrong, P. W, for the GUSTO-IV ACS Investigators,
(2005). Are international differences in the outcomes of acute coronary syndromes apparent or real? A multilevel analysis. J. Epidemiol. Community Health
59: 427-433
[Abstract][Full Text]
Stukel, T. A., Lucas, F. L., Wennberg, D. E.
(2005). Long-term Outcomes of Regional Variations in Intensity of Invasive vs Medical Management of Medicare Patients With Acute Myocardial Infarction. JAMA
293: 1329-1337
[Abstract][Full Text]
Al-Omran, M., Verma, S., Lindsay, T. F., Weisel, R. D., Sternbach, Y.
(2004). Clinical Decision Making for Endovascular Repair of Abdominal Aortic Aneurysm. Circulation
110: e517-e523
[Full Text]
Kaul, P., Armstrong, P. W., Chang, W.-C., Naylor, C. D., Granger, C. B., Lee, K. L., Peterson, E. D., Califf, R. M., Topol, E. J., Mark, D. B.
(2004). Long-Term Mortality of Patients With Acute Myocardial Infarction in the United States and Canada: Comparison of Patients Enrolled in Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO)-I. Circulation
110: 1754-1760
[Abstract][Full Text]
Halon, D. A., Adawi, S., Dobrecky-Mery, I., Lewis, B. S.
(2004). Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients. J Am Coll Cardiol
43: 346-352
[Abstract][Full Text]
Petersen, L. A., Normand, S.-L. T., Leape, L. L., McNeil, B. J.
(2003). Regionalization and the Underuse of Angiography in the Veterans Affairs Health Care System as Compared with a Fee-for-Service System. NEJM
348: 2209-2217
[Abstract][Full Text]
Urbach, D. R., Bell, C. M., Austin, P. C.
(2003). Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization. CMAJ
168: 1409-1414
[Abstract][Full Text]
Klarenbach, S. W., Jacobs, P.
(2003). International Comparison of Health Resource Utilization in Subjects With Diabetes: An analysis of Canadian and American national health surveys. Diabetes Care
26: 1116-1122
[Abstract][Full Text]
Khaykin, Y, Austin, P C, Tu, J V, Alter, D A
(2002). Utilisation of coronary angiography after acute myocardial infarction in Ontario over time: have referral patterns changed?. Heart
88: 460-466
[Abstract][Full Text]
Martin, R M, Hemingway, H, Gunnell, D, Karsch, K R, Baumbach, A, Frankel, S
(2002). Population need for coronary revascularisation: are national targets for England credible?. Heart
88: 627-633
[Abstract][Full Text]
Natarajan, M. K., Mehta, S. R., Holder, D. H., Goodhart, D. R., Gafni, A., Shilton, D., Afzal, R., Teo, K., Yusuf, S.
(2002). The risks of waiting for cardiac catheterization: a prospective study. CMAJ
167: 1233-1240
[Abstract][Full Text]
Mehta, R. H., Criger, D. A., Granger, C. B., Pieper, K. K., Califf, R. M., Topol, E. J., Bates, E. R.
(2002). Patient outcomes after fibrinolytic therapy for acute myocardial infarction at hospitals with and without coronary revascularization capability. J Am Coll Cardiol
40: 1034-1040
[Abstract][Full Text]
Dzavik, V., Rouleau, J.-L. u.
(2002). Should all patients with an acute myocardial infarction present to a hospital with revascularization capabilities?: The evidence is mounting that they need not. J Am Coll Cardiol
40: 1041-1043
[Full Text]
Alpert, J.S.
(2002). Acute coronary syndromes observed from an international perspective. Eur Heart J
23: 1139-1140
[Full Text]
Lumer, G.B, Roy, D, Talajic, M, Couturier, A, Lambert, J, Frasure-Smith, N, Thibault, B, Dubuc, M, Gagne, P, Nattel, S
(2002). Amiodarone reduces procedures and costs related to atrial fibrillation in a controlled clinical trial. Eur Heart J
23: 1050-1056
[Abstract][Full Text]
Kaul, P., Saunders, L. D., Roos, L. L., Kephart, G., Ghali, W. A., Walld, R., Warren, J.
(2002). Trends in Utilization of Coronary Artery Bypass Surgery and Associated Outcomes: Alberta, Manitoba, and Nova Scotia. American Journal of Medical Quality
17: 103-112
[Abstract]
Pilote, L., Lauzon, C., Huynh, T., Dion, D., Roux, R., Racine, N., Carignan, S., Diodati, J. G., Levesque, C., Charbonneau, F., Pouliot, J., Joseph, L., Eisenberg, M. J.
(2002). Quality of Life After Acute Myocardial Infarction Among Patients Treated at Sites With and Without On-site Availability of Angiography. Arch Intern Med
162: 553-559
[Abstract][Full Text]
Llevadot, J, Giugliano, R.P, Antman, E.M, Wilcox, R.G, Gurfinkel, E.P, Henry, T, McCabe, C.H, Charlesworth, A, Thompson, S, Nicolau, J.C, Tebbe, U, Sadowski, Z, Braunwald, E, for the InTIME II Invatigators,
(2001). Availability of on-site catheterization and clinical outcomes in patients receiving fibrinolysis for ST-elevation myocardial infarction. Eur Heart J
22: 2104-2115
[Abstract]
del Mar de la Torre, M., San Roman, J. A., Bermejo, J., Pastor, G., Alonso, J., Fernandez-Aviles, F.
(2001). Prognostic Power of Dobutamine Echocardiography After Uncomplicated Acute Myocardial Infarction in the Elderly. Chest
120: 1200-1205
[Abstract][Full Text]
Giugliano, R.P, Llevadot, J, Wilcox, R.G, Gurfinkel, E.P, McCabe, C.H, Charlesworth, A, Thompson, S.L, Antman, E.M, Braunwald, E, for the In TIME II Investigators,
(2001). Geographic variation in patient and hospital characteristics, management, and clinical outcomes in ST-elevation myocardial infarction treated with fibrinolysis. Results from InTIME-II. Eur Heart J
22: 1702-1715
[Abstract]
Alter, D. A., Naylor, C. D., Austin, P. C., Tu, J. V.
(2001). Long-term MI Outcomes at Hospitals With or Without On-site Revascularization. JAMA
285: 2101-2108
[Abstract][Full Text]
Tu, J. V., Austin, P. C., Walld, R., Roos, L., Agras, J., McDonald, K. M.
(2001). Development and validation of the ontario acute myocardial infarction mortality prediction rules. J Am Coll Cardiol
37: 992-997
[Abstract][Full Text]
van Amerongen, D., Mariotto, A., Kaplan, M. G., Guadagnoli, E.
(2001). Appropriateness of Coronary Angiography after Myocardial Infarction among Medicare Beneficiaries. NEJM
344: 774-775
[Full Text]
Salacinski, H. J., Goldner, S., Giudiceandrea, A., Hamilton, G., Seifalian, A. M., Edwards, A., Carson, R. J.
(2001). The Mechanical Behavior of Vascular Grafts: A Review. J Biomater Appl
15: 241-278
[Abstract]
Fu, Y., Chang, W.-C., Mark, D., Califf, R. M., Mackenzie, B., Granger, C. B., Topol, E. J., Hlatky, M., Armstrong, P. W.
(2000). Canadian-American Differences in the Management of Acute Coronary Syndromes in the GUSTO IIb Trial : One-Year Follow-Up of Patients Without ST-Segment Elevation. Circulation
102: 1375-1381
[Abstract][Full Text]
Bucher, H. C, Hengstler, P., Schindler, C., Guyatt, G. H
(2000). Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials. BMJ
321: 73-77
[Abstract][Full Text]
Pilote, L., Lavoie, F., Ho, V., Eisenberg, M. J.
(2000). Changes in the treatment and outcomes of acute myocardial infarction in Quebec, 1988-1995. CMAJ
163: 31-36
[Abstract][Full Text]
Abramson, B. L., Mosca, L., Grundy, S. M., Judelson, D., King, K., Limacher, M., Oparil, S., Pasternak, R., Pearson, T. A., Redberg, R. F., Smith, S. C., Winston, M., Zinberg, S.
(2000). Hormone Replacement Therapy and Cardiac Prevention Response. Circulation
101
: e223-e224
[Full Text]
Naylor, C. D., Szalai, J. P., Katic, M.
(2000). Benchmarking the vital risk of waiting for coronary artery bypass surgery in Ontario. CMAJ
162: 775-779
[Abstract][Full Text]
Druss, B. G., Bradford, D. W., Rosenheck, R. A., Radford, M. J., Krumholz, H. M.
(2000). Mental Disorders and Use of Cardiovascular Procedures After Myocardial Infarction. JAMA
283: 506-511
[Abstract][Full Text]
Kuntz, K. M., Tsevat, J., Weinstein, M. C., Goldman, L.
(1999). Expert Panel vs Decision-Analysis Recommendations for Postdischarge Coronary Angiography After Myocardial Infarction. JAMA
282: 2246-2251
[Abstract][Full Text]
Maor, Y., Cohen, Y., Olmer, L., Mozes, B.
(1999). Factors Associated With Health Indicators in Patients Undergoing Coronary Artery Bypass Surgery*. Chest
116: 1570-1574
[Abstract][Full Text]
Temianka, D., Miller, T. E., Sage, W. M.
(1999). Disclosure of Physicians' Financial Incentives. JAMA
282: 1814-1814
[Full Text]
Tu, J. V., Naylor, C. D., Austin, P.
(1999). Temporal changes in the outcomes of acute myocardial infarction in Ontario, 1992-1996. CMAJ
161: 1257-1261
[Abstract][Full Text]
Alter, D. A., Naylor, C. D., Austin, P., Tu, J. V.
(1999). Effects of Socioeconomic Status on Access to Invasive Cardiac Procedures and on Mortality after Acute Myocardial Infarction. NEJM
341: 1359-1367
[Abstract][Full Text]
Tsang, T. S. M., Barnes, M. E., Hayes, S. N., Freeman, W. K., Dearani, J. A., Butler, S. L. O., Seward, J. B.
(1999). Clinical and Echocardiographic Characteristics of Significant Pericardial Effusions Following Cardiothoracic Surgery and Outcomes of Echo-Guided Pericardiocentesis for Management: Mayo Clinic Experience, 1979-1998. Chest
116: 322-331
[Abstract][Full Text]
Batchelor, W. B., Peterson, E. D., Mark, D. B., Knight, J. D., Granger, C. B., Armstrong, P. W., Califf, R. M.
(1999). A comparison of U.S. and Canadian cardiac catheterization practices in detecting severe coronary artery disease after myocardial infarction: efficiency, yield and long-term implications. J Am Coll Cardiol
34: 12-19
[Abstract][Full Text]
Gottlieb, S., Boyko, V., Harpaz, D., Hod, H., Cohen, M., Mandelzweig, L., Khoury, Z., Stern, S., Behar, S., for the Israeli Thrombolytic Survey Group,
(1999). Long-term (three-year) prognosis of patients treated with reperfusion or conservatively after acute myocardial infarction. J Am Coll Cardiol
34: 70-82
[Abstract][Full Text]
Scanlon, P. J., Faxon, D. P., Audet, A.-M., Carabello, B., Dehmer, G. J., Eagle, K. A., Legako, R. D., Leon, D. F., Murray, J. A., Nissen, S. E., Pepine, C. J., Watson, R. M., Ritchie, J. L., Gibbons, R. J., Cheitlin, M. D., Eagle, K. A., Gardner, T. J., Garson, A. Jr, Russell, R. O. Jr, Ryan, T. J., Smith, S. C. Jr
(1999). ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol
33: 1756-1824
[Full Text]
Niklason, L. E., Gao, J., Abbott, W. M., Hirschi, K. K., Houser, S., Marini, R., Langer, R.
(1999). Functional Arteries Grown in Vitro. Science
284: 489-493
[Abstract][Full Text]
Krumholz, H. M., Chen, J., Murillo, J. E., Cohen, D. J., Radford, M. J.
(1998). Admission to Hospitals With On-Site Cardiac Catheterization Facilities : Impact on Long-Term Costs and Outcomes. Circulation
98: 2010-2016
[Abstract][Full Text]
Tsang, T. S. M., Freeman, W. K., Barnes, M. E., Reeder, G. S., Packer, D. L., Seward, J. B.
(1998). Rescue echocardiographically guided pericardiocentesis for cardiac perforation complicating catheter-based procedures: The Mayo Clinic experience. J Am Coll Cardiol
32: 1345-1350
[Abstract][Full Text]
De Gregorio, J., Kobayashi, Y., Albiero, R., Reimers, B., Di Mario, C., Finci, L., Colombo, A.
(1998). Coronary artery stenting in the elderly: short-term outcome and long-term angiographic and clinical follow-up. J Am Coll Cardiol
32: 577-583
[Abstract][Full Text]
Donohoe, M. T.
(1998). Comparing Generalist and Specialty Care: Discrepancies, Deficiencies, and Excesses. Arch Intern Med
158: 1596-1608
[Abstract][Full Text]
Enas, E. A., Forrester, J. S., Shah, P. K.
(1998). Testing the Efficacy of Lipid-Lowering Therapy Versus Revascularization: The Time Has Come, or Is It Past Due? • Response. Circulation
97: 2584-2586
[Full Text]
Bell, C. M., Crystal, M., Detsky, A. S., Redelmeier, D. A.
(1998). Shopping Around for Hospital Services: A Comparison of the United States and Canada. JAMA
279: 1015-1017
[Abstract][Full Text]
BROPHY, J M, SLEIGHT, P
(1998). Enthusiasm, reality, and cost-effectiveness analysis. Heart
79: 9-10
[Full Text]
Green, J., Wharton, T. P., Tu, J. V.
(1997). Use of Cardiac Procedures in the United States and Canada. NEJM
337: 1008-1009
[Full Text]
(1997). Cardiac Procedure Volume in the U.S. vs. Canada. Journal Watch Cardiology
1997: 6-6
[Full Text]
Krumholz, H. M.
(1997). Cardiac Procedures, Outcomes, and Accountability. NEJM
336: 1521-1523
[Full Text]
A correction has been published: N Engl J Med 1997;337(2):139.
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