Abstract
Background
Geographic factors may influence cardiovascular disease outcomes in Canada. Circulatory
diseases are a major reason for higher population mortality rates in Northern Ontario,
but it is unknown if hospitalized patients with cardiovascular disease experience
differential outcomes compared with those in the South.
Methods
We examined 30-day and 1-year mortality and readmissions for patients hospitalized
with acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF),
or stroke in Northern compared with Southern Ontario, using the Canadian Institute
for Health Information Discharge Abstract Database (2005-2016). Northern patients
were defined as those residing and hospitalized in the Northwest or Northeast Local
Health Integration Network regions. We used multiple Cox proportional hazards regression
analysis for time-to-first event and Prentice-Williams-Peterson method to evaluate
repeat and multiply admitted patients.
Results
A total of 47,745 Northern and 465,353 Southern patients hospitalized with AMI (n =
182,158), HF (n = 130,770), AF (n = 72,326), or stroke (n = 127,844) were studied.
Rates of first readmission were higher among Northern patients for AMI (adjusted hazard
ratio [HR], 1.32), HF (HR, 1.16), AF (HR, 1.21), and stroke (HR, 1.27) compared with
Southern patients (all P < 0.001). Repeat readmission rates among Northern patients for AMI (HR, 1.23), HF
(HR, 1.13), AF (HR, 1.18), and stroke (HR, 1.22) were also increased (all P < 0.001 vs Southern). Thirty-day mortality did not differ significantly between Northern
and Southern patients.
Conclusions
Readmissions were increased in those residing and hospitalized in the North. To reduce
readmissions in the North, the quality of postacute transitional care should be examined
further.
Résumé
Contexte
Des facteurs géographiques peuvent influer sur l’issue de maladies cardiovasculaires
au Canada. Les maladies du système circulatoire constituent une raison majeure du
taux de mortalité élevé dans le nord de l’Ontario, mais on ne sait pas si les patients
hospitalisés pour une maladie cardiovasculaire connaissent des issues différentes
par rapport aux personnes vivant dans le sud.
Méthodologie
Nous avons examiné les taux de mortalité et de réadmissions à 30 jours et à 1 an des
patients hospitalisés pour un infarctus aigu du myocarde (IAM), une insuffisance cardiaque
(IC), une fibrillation auriculaire (FA) ou un accident vasculaire cérébral (AVC) dans
le nord de l’Ontario comparativement à ceux observés dans le sud de la province, à
partir de la base de données sur les congés des patients de l’Institut canadien d’information
sur la santé (2005-2016). Les patients du nord étaient ceux qui résidaient et étaient
hospitalisés dans les régions nord-ouest et nord-est du réseau local d’intégration
des services de santé (RLISS). Nous avons fait appel à la méthode de régression multiple
à risque proportionnel de Cox pour calculer le temps écoulé avant le premier événement
et à la méthode Prentice-Williams-Peterson pour évaluer les patients hospitalisés
de façons répétées ou plusieurs fois.
Résultats
Un total de 47 745 patients du nord et 465 353 patients du sud hospitalisés pour un
IAM (n = 182 158), une IC (n = 130 770), une FA (n = 72 326) ou un AVC (n = 127 844)
ont été inclus dans l’étude. Les taux de première réadmission ont été plus élevés
chez les patients du nord pour l'IAM aigu (rapport des risques instantanés corrigé
[RRI], 1,32), l'IC (RRI, 1,16), la FA (RRI, 1,21) et l’AVC (RR, 1,27) comparativement
aux patients du sud (p < 0,001 dans tous les cas). Les taux de réadmissions répétées des patients du nord
pour l'IAM (RRI, 1,23), l'IC (RRI, 1,13), la FA (RRI, 1,18) et l’AVC (RRI, 1,22) étaient
également élevés (p < 0,001 vs sud dans tous les cas). La mortalité à trente jours n’était pas considérablement
différente entre le nord et le sud.
Conclusions
Les réadmissions étaient accrues chez les patients résidants et hospitalisés dans
le nord. Pour réduire les réadmissions dans le nord, la qualité des soins transitionnels
après un épisode aigu devrait être examinée davantage.
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Article info
Publication history
Accepted:
January 11,
2019
Received:
August 20,
2018
Footnotes
See page 350 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
