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Outcomes of acute myocardial infarction in Canada
Jack V Tu1, Peter C Austin, Woganee A Filate
1Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada. tu@ices.on.ca
Insights
Acute myocardial infarction (AMI) in Canada has a substantial mortality rate, particularly for women and the elderly. Significant regional variations in AMI outcomes and readmission rates highlight the need for further research into care disparities.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Limited data exists on recent population-based trends in acute myocardial infarction (AMI) patient outcomes in Canada.
- Understanding these trends is crucial for improving cardiovascular care nationally.
Purpose of the Study:
- To analyze recent population-based trends in acute myocardial infarction (AMI) outcomes in Canada.
- To identify regional variations in AMI mortality and readmission rates.
Main Methods:
- Utilized Canadian Institute for Health Information databases (Discharge Abstract Database, Hospital Morbidity Database).
- Examined new AMI cases (fiscal 1997/98–1999/2000) in patients ≥20 years old.
- Analyzed hospital readmissions for subsequent AMI, angina, and congestive heart failure (CHF).
Main Results:
- Identified 139,523 new AMI cases with an overall in-hospital mortality rate of 12.3%.
- In-hospital mortality was higher for women (16.7%) than men (9.9%).
- One-year readmission rates for survivors included angina (12.5%), second AMI (7.7%), and CHF (7.5%), with significant interregional differences.
Conclusions:
- Acute myocardial infarction (AMI) carries a significant acute mortality risk in Canada, disproportionately affecting elderly and female patients.
- Substantial interregional disparities in mortality and readmission rates necessitate further investigation into contributing factors.
Background:
Little information is available on recent population-based trends in the outcomes of patients who have had an acute myocardial infarction (AMI) in Canada.
Methods:
Data were analyzed from the Discharge Abstract Database and Hospital Morbidity Database of the Canadian Institute for Health Information. All new cases of AMI in Canada between fiscal 1997/98 and fiscal 1999/2000 of patients at least 20 years old were examined. Data were also analyzed from these databases for hospital readmissions for a second AMI, angina and congestive heart failure (CHF).
Results:
There were 139,523 new AMI cases. The overall crude in-hospital AMI mortality rate in Canada was 12.3%. In-hospital mortality rate after an AMI was worse for women than for men in Canada (16.7% and 9.9%, respectively). The age- and sex-standardized in-hospital mortality rate varied from a low of 10.5% (95% CI 8.4% to 12.6%) in Prince Edward Island to a high of 13.1% (95% CI 12.8% to 13.5%) in Quebec. Among AMI survivors, 12.5% were readmitted within one year for angina, 7.7% for a second AMI and 7.5% for CHF. There were wide interregional differences in age- and sex-standardized mortality rates and one-year readmission rates.
Conclusions:
AMI is associated with a substantial acute mortality rate in Canada, especially in the elderly and female patients. Identifying the causes of interregional differences in patient outcomes should be a priority for future research.