ArticleHeart (British Cardiac Society)2002
Utilisation of coronary angiography after acute myocardial infarction in Ontario over time: have referral patterns changed?
Article in Heart (British Cardiac Society), 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Review
- Age difference explains gender difference in cardiac intervention rates after acute myocardial infarction.Healthcare policy = Politiques de sante · 2010Article
- Impact of clinical urgency, physician supply and procedural capacity on regional variations in wait times for coronary angiography.BMC health services research · 2010Article
- Routine coronary angiographic follow-up and subsequent revascularization in patients with acute myocardial infarction.Heart and vessels · 2008Article
- The relationship between physician supply, cardiovascular health service use and cardiac disease burden in Ontario: supply-need mismatch.The Canadian journal of cardiology · 2008Article
- Determining optimal population rates of cardiac catheterization: a phantom alternative?CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2005Article
- Primary Angioplasty for the Treatment of Acute ST-Segment Elevated Myocardial Infarction: An Evidence-Based Analysis.Ontario health technology assessment series · 2004Article
Corrections and comments
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Authors and funding
4 authors.
Funding
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Abstract
objectiveTo examine how physicians in Ontario, Canada, have altered their referral patterns for coronary angiography after acute myocardial infarction (AMI) over time.
designRetrospective analysis of multilinked administrative data.
settingProvince of Ontario, Canada. PATIENTS: 146 365 Ontario AMI patients hospitalised between 1 April 1992 and 31 March 1999.
main outcome measuresUtilisation trends of coronary angiography among all patients, as well as within six subgroups: elderly (versus young), women (versus men), high (versus low) risk of 30 day mortality, high (versus low) socioeconomic status, cardiology (versus non-cardiology) attending physician specialty, and hospitals with (versus without) onsite revascularisation capacity. Cox proportional hazard models were adjusted for variations in patient, physician, and hospital characteristics over time.
resultsAngiography rates in Ontario increased from 23.2% in 1992 to 35.5% in 1999 (p < 0.0001). Increases in utilisation of coronary angiography were most pronounced among the elderly (12.4-24.3% v 39.3-54.4% for non-elderly patients, p < 0.0001), the affluent (24.6-38.7% v 22.0-32.3% for less affluent patients, p = 0.01), and those tended to by cardiologists (32.0-47.1% v 20.3-30.1% for non-cardiology attending specialties, p < 0.0001) after adjusting for changes in baseline patient, physician, and hospital characteristics over time.
conclusionsDespite universal health care availability, not all patients benefited equally from increases in service capacity for coronary angiography after AMI in Ontario. Wider implementation of data monitoring and explicit management systems may be required to ensure that appropriate utilisation of cardiac services is allocated to patients who are most in need.
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