Interprovincial Differences in Canadian Coronary Care Unit Resource Use and Outcomes

Area of Science:

• Cardiology
• Health Services Research
• Public Health

Background:

• International data show significant variation in coronary care unit (CCU) admission rates for acute coronary syndrome (ACS) and heart failure (HF).
• Limited information exists regarding interprovincial disparities in CCU utilization and patient outcomes within Canada.

Purpose of the Study:

• To examine interprovincial differences in CCU admission rates for hospitalized ACS and HF patients in Canada.
• To assess the use of CCU-restricted therapies and the association between CCU admission rates and in-hospital mortality across Canadian provinces.

Main Methods:

• Analysis of Canadian Institute of Health Information data for patients hospitalized with ACS or HF (2007-2013).
• Comparison of CCU admission rates, receipt of critical care therapies within 48 hours, and risk-adjusted in-hospital mortality across provinces.

Main Results:

• CCU admission rate was 33% nationally, with significant provincial variation (17%-50%).
• 59% of CCU patients did not receive critical care therapies within 2 days; this also varied by province (48%-84%).
• In-hospital mortality varied provincially (5%-13%), but the correlation between CCU admission rates and mortality was low (r=-0.30).

Conclusions:

• Substantial interprovincial variation exists in CCU admission rates and care delivery for ACS and HF patients in Canada.
• There is a need for national CCU admission criteria to standardize care, optimize resource allocation, and improve patient outcomes.