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Likelihood of coronary angiography among First Nations patients with acute myocardial infarction
Lauren C Bresee1, Merril L Knudtson1, Jianguo Zhang1
1Department of Medicine (Bresee, Knudtson, Zhang, Ahmed, Ghali, Manns, Fabreau, Hemmelgarn), Libin Cardiovascular Institute of Alberta (Knudtson, Ahmed, Ghali, Quan, Manns, Hemmelgarn), Institute for Public Health (Crowshoe, Ghali, Quan, Manns, Hemmelgarn) and Department of Family Medicine (Crowshoe), University of Calgary, Calgary, Alta.; Department of Medicine (Tonelli), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Ghali, Quan, Manns, Hemmelgarn), University of Calgary, Calgary, Alta.; Brigham and Women's Hospital (Fabreau) and Department of Health Care Policy (Fabreau), Harvard Medical School, Boston, Mass.
Insights
First Nations patients with acute myocardial infarction (MI) were less likely to receive timely coronary angiography. This disparity was linked to worse long-term survival, highlighting a need for improved access to cardiac procedures.
Area of Science:
- Cardiovascular Medicine
- Health Disparities
- Indigenous Health
Background:
- Cardiovascular disease (CVD) poses a significant health burden for First Nations populations.
- The relationship between CVD morbidity and access to diagnostic procedures like coronary angiography remains under-examined.
Purpose of the Study:
- To investigate disparities in the utilization of coronary angiography following acute myocardial infarction (MI) between First Nations and non-First Nations patients.
- To assess the impact of these disparities on patient outcomes.
Main Methods:
- Retrospective analysis of adult patients experiencing incident acute MI between 1997 and 2008 in Alberta, Canada.
- Utilized the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database.
- Adjusted for key confounders to compare the likelihood of angiography, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) between ethnic groups.
Main Results:
- First Nations patients (2.2% of 46,764 total) had a lower likelihood of receiving angiography within 24 hours of acute MI (adjusted OR 0.73).
- While procedural rates (PCI, CABG) were similar for those receiving angiography, First Nations individuals faced worse survival with medical management alone or PCI.
- Survival rates were comparable between groups only for those who underwent CABG.
Conclusions:
- First Nations individuals experiencing acute MI are less likely to undergo coronary angiography and exhibit poorer long-term survival compared to non-First Nations patients.
- Improving access to timely coronary angiography for First Nations people is crucial for enhancing cardiovascular health outcomes.
Background:
Morbidity due to cardiovascular disease is high among First Nations people. The extent to which this may be related to the likelihood of coronary angiography is unclear. We examined the likelihood of coronary angiography after acute myocardial infarction (MI) among First Nations and non-First Nations patients.
Methods:
Our study included adults with incident acute MI between 1997 and 2008 in Alberta. We determined the likelihood of angiography among First Nations and non-First Nations patients, adjusted for important confounders, using the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database.
Results:
Of the 46,764 people with acute MI, 1043 (2.2%) were First Nations. First Nations patients were less likely to receive angiography within 1 day after acute MI (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI] 0.62-0.87). Among First Nations and non-First Nations patients who underwent angiography (64.9%), there was no difference in the likelihood of percutaneous coronary intervention (PCI) (adjusted hazard ratio [HR] 0.92, 95% CI 0.83-1.02) or coronary artery bypass grafting (CABG) (adjusted HR 1.03, 95% CI 0.85-1.25). First Nations people had worse survival if they received medical management alone (adjusted HR 1.38, 95% CI 1.07-1.77) or if they underwent PCI (adjusted HR 1.38, 95% CI 1.06-1.80), whereas survival was similar among First Nations and non-First Nations patients who received CABG.
Interpretation:
First Nations people were less likely to undergo angiography after acute MI and experienced worse long-term survival compared with non-First Nations people. Efforts to improve access to angiography for First Nations people may improve outcomes.
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