Publication
Quality of Acute Myocardial Infarction Care in Canada: A 10-Year Review of 30-Day In-Hospital Mortality and 30-Day Hospital Readmission.
Publisher:
Elsevier BV
Date:
10-2017
DOI:
10.1016/J.CJCA.2017.06.014
Abstract: The recently released Canadian cardiac care quality indicators include 30-day in-hospital mortality and readmission rates after percutaneous coronary intervention (PCI) and isolated coronary artery bypass grafting (CABG). We examined long-term trends and provincial variations in these outcomes among acute myocardial infarction (AMI) patients. We included patients aged 18 years and older who were hospitalized with a primary diagnosis of AMI between 2004 and 2013 in all Canadian provinces except Quebec. We calculated 30-day in-hospital death and readmission rates after PCI as well as isolated CABG. We used logistic regressions to evaluate baseline-adjusted temporal trends and provincial variations in mortality and readmission. Among 341,001 AMI episodes in 323,862 unique patients, 43.1% and 7% received PCI and CABG, respectively. Mortality after PCI (2.8%) remained stable (odds ratio [OR], 1.01 P = 0.399), whereas mortality after isolated CABG (2.5%) decreased over time (OR, 0.96 P = 0.017). Readmission after PCI (8.8%) increased (OR, 1.06 P < 0.001), whereas readmission after isolated CABG (11.4%) remained stable over time (OR, 0.99 P = 0.116). Compared with Alberta, mortality and readmission after PCI were highest in Saskatchewan (mortality: OR, 1.32 P = 0.001 readmission: OR, 1.24 P < 0.001), whereas mortality after isolated CABG was highest in Newfoundland and Labrador (OR, 2.05 P = 0.010) and readmission after isolated CABG was highest in New Brunswick (OR, 1.49 P = 0.001). There was no change in mortality, and a slight increase in readmission rates after PCI, and modest improvements in mortality and readmission rates after CABG among AMI patients during the study period. Significant interprovincial variations remained. A stronger focus on pan-Canadian coordination in AMI care and a set of standard benchmarks for AMI-specific PCI- and CABG-related quality indicators are needed.