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Waiting for coronary revascularization: a comparison between New York State, The Netherlands and Sweden
S J Bernstein1, H Rigter, B Brorsson
1Departments of Medicine and Health Management and Policy, University of Michigan, Ann Arbor 48109-0376, USA.
Insights
New York offers significantly shorter waiting times for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery compared to the Netherlands and Sweden. Longer waits for these procedures, especially CABG, pose risks to patient health.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Comparative Healthcare Systems
Background:
- Significant variations exist in healthcare access and delivery for coronary revascularization procedures globally.
- Waiting times for cardiac procedures can impact patient outcomes and satisfaction.
Purpose of the Study:
- To compare waiting times for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery.
- To assess the impact of waiting times on patient health outcomes.
- To compare healthcare systems in New York State, the Netherlands, and Sweden.
Main Methods:
- Retrospective review of medical records for 4487 patients undergoing PTCA or CABG.
- Data collected from hospitals in New York State, the Netherlands, and Sweden.
- Median waiting times measured from coronary angiography to procedure.
Main Results:
- New York patients experienced median waiting times of 13 days for PTCA and 17 days for CABG.
- Netherlands patients waited 35 days (PTCA) and 72 days (CABG).
- Sweden patients waited 42 days (PTCA) and 59 days (CABG).
- Waiting list mortality rates were 0.8% for CABG and 0.15% for PTCA candidates in the Netherlands and Sweden.
Conclusions:
- Substantial international disparities in waiting times for coronary revascularization were identified.
- Patients awaiting CABG faced the highest risk of adverse events due to prolonged waiting.
- Increased capacity for coronary revascularization in the Netherlands and Sweden since the study.
- International collaboration can enhance quality of care in cardiovascular procedures.
Objective:
To compare waiting times for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery in New York State, the Netherlands and Sweden and to determine whether queuing adversely affects patients' health.
Methods:
We reviewed the medical records of 4487 chronic stable angina patients who underwent PTCA or CABG in one of 15 New York State hospitals (n = 1021) or were referred for PTCA or CABG to one of ten hospitals in the Netherlands (n = 1980) or to one of seven hospitals in Sweden (n = 1486). We measured the median waiting time between coronary angiography and PTCA or CABG.
Results:
The median waiting time for PTCA in New York was 13 days compared with 35 and 42 days, respectively, in the Netherlands and Sweden (P < 0.001). For CABG, New York patients waited 17 days, while Dutch and Swedish patients waited 72 and 59 days, respectively (P < 0.001). The Swedish and Dutch waiting list mortality rate was 0.8% for CABG candidates and 0.15% for PTCA candidates.
Conclusions:
There were large variations in waiting time for coronary revascularization among these three sites. Patients waiting for CABG were at greatest risk of experiencing an adverse event. In both the Netherlands and Sweden, the capacity to perform coronary revascularization has been expanded since this study began. Further international cooperation may identify other areas where quality of care can be improved.
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