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Health Outcome and Follow-up Care Differences Between First Nation and Non-First Nation Coronary Angiogram Patients:
Annette Schultz1, Lindsey Dahl1, Elizabeth McGibbon2
1College of Nursing Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
First Nations people face higher cardiovascular mortality and poorer post-angiography care compared to non-First Nations individuals. Addressing Indigenous health determinants is crucial for improving outcomes in ischemic heart disease.
Area of Science:
- Cardiology
- Indigenous Health
- Health Services Research
Background:
- First Nations (FN) populations experience disproportionately high rates of ischemic heart disease (IHD) morbidity and mortality.
- Access to diagnostic angiography is a key intervention for IHD management.
- Disparities in cardiovascular outcomes and follow-up care between FN and non-FN patients post-angiography warrant investigation.
Purpose of the Study:
- To compare outcomes and follow-up care after index angiography between First Nations and non-First Nations patients.
- To identify disparities in cardiovascular mortality, revascularization rates, and physician follow-up.
- To inform strategies for improving cardiovascular care for Indigenous populations.
Main Methods:
- A population-based cohort study identified all index angiography patients in Manitoba from April 1, 2000, to March 31, 2009.
- Patients were categorized into acute myocardial infarction (AMI) or non-AMI groups based on angiogram timing relative to AMI.
- Cox proportional hazard models were used to assess associations between FN status and outcomes.
Main Results:
- First Nations patients exhibited higher cardiovascular mortality in both non-AMI (HR=1.50) and AMI (HR=1.57) groups.
- FN patients in the non-AMI group had increased likelihood of subsequent AMI hospitalization (HR=2.26) and were less likely to receive percutaneous coronary intervention (HR=0.85) but more likely to undergo coronary artery bypass graft (HR=1.26).
- FN patients in both groups showed reduced likelihood of specialist physician visits within 3 months and 1 year post-angiography.
Conclusions:
- Significant disparities exist in cardiovascular health outcomes and follow-up care between First Nations and non-First Nations patients undergoing angiography.
- These findings underscore the need to address Indigenous determinants of health to improve cardiovascular care and outcomes.
- Targeted interventions are required to reduce disparities in post-angiography management and specialist follow-up for First Nations individuals.
Background:
First Nations (FN) people experience high rates of ischemic heart disease (IHD) morbidity and mortality. Increasing access to angiography may lead to improved outcomes. We compared various outcomes and follow-up care post-index angiography between FN and non-FN patients.
Methods:
All index angiography patients in Manitoba were identified between April 1, 2000 and March 31, 2009 and categorized into acute myocardial infarction (AMI) or non-AMI groups based on whether their angiogram occurred within 7 days of an AMI. Cox proportional hazard models estimated associations between FN status and outcomes related to mortality, subsequent hospitalizations, revascularizations, and physician visits.
Results:
Cardiovascular mortality was higher among FN patients in the non-AMI group (hazard ratio [HR] = 1.50, 95% confidence interval [CI], 1.17-1.94) and in the AMI group (HR = 1.57, 95% CI, 1.05-2.35). FN patients were also more likely to have a subsequent hospitalization for AMI (HR = 2.26, 95% CI, 1.79-2.85) in the non-AMI group. FN patients in the non-AMI group were less likely to receive percutaneous coronary intervention (HR = 0.85, 95% CI, 0.73-0.99) and more likely to undergo coronary artery bypass graft (HR = 1.26, 95% CI, 1.10-1.45). FN patients in both groups were less likely to visit a cardiologist/cardiac surgeon, internal medicine specialist, or family physician within 3 months and 1 year of angiography.
Conclusions:
Cardiovascular health and follow-up care outcomes of FN and non-FN patients who undergo angiography are not the same. Addressing Indigenous determinants of health are necessary to improve cardiovascular outcomes.
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