Quality of Acute Myocardial Infarction Care in Canada: A 10-Year Review of 30-Day In-Hospital Mortality and 30-Day Hospital Readmission

Can J Cardiol. 2017 Oct;33(10):1319-1326. doi: 10.1016/j.cjca.2017.06.014. Epub 2017 Jul 8.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Canada / epidemiology
  • Female
  • Follow-Up Studies
  • Hospital Mortality / trends
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / mortality
  • Myocardial Infarction / surgery*
  • Myocardial Revascularization / standards*
  • Odds Ratio
  • Patient Readmission / trends*
  • Quality of Health Care*
  • Retrospective Studies
  • Time Factors