The effect of place of residence on access to invasive cardiac services following acute myocardial infarction

Ansar Hassan, Neil J. Pearce, Jim Mathers, Paul J. Veugelers, Gregory M. Hirsch, Jafna L. Cox

Producción científica: Contribución a una revistaArtículorevisión exhaustiva

29 Citas (Scopus)

Resumen

Background: The Canadian health care system is mandated to provide reasonable access to health care for all Canadians regardless of age, sex, race, socioeconomic status or place of residence. In the present study, the impact of place of residence in Nova Scotia on access to cardiac catheterization and long-term outcomes following an acute myocardial infarction MI were examined. Methods: All patients with an acute MI who were hospitalized between April 1998 and December 2001 were identified. Place of residence was defined by postal code and separated into three categories: metropolitan area (MA); nonmetropolitan urban area (UA); and rural area (RA). Rates of and waiting times for cardiac catheterization were determined, as were risk-adjusted long-term rates of mortality and readmission to the hospital. Results: A total of 7351 patients were hospitalized with an acute MI during the study period. Rates of cardiac catheterization differed across the three groups (MA 45.6%, UA 37.3%, RA 37.3%; P<0.0001), as did mean waiting times (MA 15.0 days, UA 32.1 days, RA 28.7 days) (P<0.0001). After adjusting for differences among patients, residence in either UA or RA emerged as an independent predictor of lower rates of cardiac catheterization (UA: hazard ratio [HR] 0.77, P<0.0001; RA: HR 0.75, P<0.0001), greater waiting times (UA: an additional 14.1 days, P<0.0001; RA: an additional 10.8 days, P<0.0001) and increased long-term rates of readmission (UA: HR 1.24, P=0.0001; RA: HR 1.12, P-0-04). Conclusion: In patients admitted with an acute MI, residence outside of an MA was associated with diminished rates of cardiac catheterization, longer waiting times and increased rates of readmission. Despite universal health care coverage, Canadians are subject to significant geographical barriers to cardiac catheterization with associated poorer outcomes.

Idioma originalEnglish
Páginas (desde-hasta)207-212
Número de páginas6
PublicaciónCanadian Journal of Cardiology
Volumen25
N.º4
DOI
EstadoPublished - 2009

Nota bibliográfica

Funding Information:
FUNDING: Dr Hassan is a PhD student funded by the Canadian Cardiovascular Outcomes Research Team and the Nova Scotia Health Research Foundation.

ASJC Scopus Subject Areas

  • Cardiology and Cardiovascular Medicine

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