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Canadian Journal of Cardiology

Health Outcome and Follow-up Care Differences Between First Nation and Non-First Nation Coronary Angiogram Patients: A Retrospective Cohort Study

      Abstract

      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.

      Résumé

      Contexte

      Les taux de morbidité et de mortalité liés à la cardiopathie ischémique sont élevés au sein des Premières Nations (PN). Or un accès accru à l’angiographie pourrait améliorer l’évolution de l’état de santé. Nous avons comparé, chez des patients appartenant aux PN et chez des patients n’appartenant pas aux PN, les résultats de divers paramètres et les soins de suivi après une angiographie de référence.

      Méthodes

      Des patients du Manitoba ayant passé une angiographie de référence ont été répertoriés entre le 1er avril 2000 et le 31 mars 2009, et divisés en deux groupes, soit infarctus aigu du myocarde (IAM) et non-IAM, selon que l’examen angiographique avait ou non été réalisé dans les 7 jours suivant un IAM. Des modèles de régression des hasards proportionnels de Cox ont été utilisés pour l’évaluation des associations entre l’appartenance aux PN et les résultats relatifs à la mortalité, aux hospitalisations ultérieures, aux revascularisations et aux visites chez le médecin.

      Résultats

      La mortalité cardiovasculaire a été plus élevée chez les patients des PN du groupe non-IAM (rapport des risques instantanés [RRI] = 1,50; intervalle de confiance [IC] à 95 % : 1,17-1,94) et du groupe IAM (RRI = 1,57; IC à 95 % : 1,05-2,35). Chez les patients des PN, la probabilité d’hospitalisation ultérieure pour un IAM a aussi été plus élevée (RRI = 2,26; IC à 95 % : 1,79-2,85) dans le groupe non-IAM. Chez les patients des PN du groupe non-IAM, la probabilité d’intervention coronarienne percutanée a été plus faible (RRI = 0,85; IC à 95 % : 0,73-0,99) et la probabilité de pontage aortocoronarien, plus élevée (RRI = 1,26, IC à 95 % : 1,10-1,45). Dans les deux groupes de patients des PN, on a en outre observé une plus faible probabilité de visite chez un cardiologue ou un cardiochirurgien, un interniste ou un médecin de famille au cours des 3 mois et de l’année ayant suivi l’examen angiographique.

      Conclusions

      Chez les patients des PN, les résultats relatifs à la santé cardiovasculaire et aux soins de suivi ne sont pas les mêmes que chez les patients n’appartenant pas aux PN. Il est donc nécessaire d’agir sur les déterminants de la santé des populations autochtones pour améliorer les résultats cliniques cardiovasculaires.
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