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Canadian Journal of Cardiology

Access to Thoracic Aortic Care: Challenges and Opportunities in Universal Health Coverage Systems

  • Dominique Vervoort
    Correspondence
    Corresponding author: Dr Dominique Vervoort, Institute of Health Policy, Management and Evaluation, University of Toronto,155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada. Tel.: +1-416-989-7874.
    Affiliations
    Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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  • Jennifer C.Y. Chung
    Affiliations
    Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada

    Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
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  • Maral Ouzounian
    Affiliations
    Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada

    Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
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Published:March 07, 2022DOI:https://doi.org/10.1016/j.cjca.2022.03.004
      Access to cardiovascular care requires geographical accessibility, infrastructural capacity, health care quality, financial affordability, and societal acceptability.
      • Vervoort D.
      Moving the needle: a guide to solving the global cardiac surgery puzzle for surgeons, societies, students, and researchers.
      In high-income countries with universal health coverage (UHC) models, such as Canada, geographic accessibility remains 1 of the most pressing barriers.
      • Ge E.
      • Su M.
      • Zhao R.
      • Huang Z.
      • Shan Y.
      • Wei X.
      Geographical disparities in access to hospital care in Ontario, Canada: a spatial coverage modelling approach.
      ,
      • McEvoy C.S.
      • Ross-Li D.
      • Norris E.A.
      • Ricca R.L.
      • Gow K.W.
      From far and wide: geographic distance to pediatric surgical care across Canada.
      Canada is the second-largest country by total area and fourth by land mass but 236th in terms of population density.
      World Bank
      Population density (people per sq km of land area).
      The inherent regionalization of cardiac surgery in Canada results in cardiac surgical centres concentrating in larger cities, whereas those living outside large cities are scattered across vast distances. Distance to cardiac care in Canada has been associated with worse outcomes after cardiac surgery,
      • Cote C.L.
      • Singh S.
      • Yip A.M.
      • et al.
      Increased distance from the tertiary cardiac center is associated with worse 30-day outcomes after cardiac operations.
      differential access to cardiac catheterization,
      • Boyd J.C.
      • Cox J.L.
      • Hassan A.
      • Lutchmedial S.
      • Yip A.M.
      • Légaré J.F.
      Where you live in Nova Scotia can significantly impact your access to lifesaving cardiac care: access to invasive care influences survival.
      and delayed care of acute myocardial infarction.
      • Hassan A.
      • Pearce N.J.
      • Mathers J.
      • et al.
      The effect of place of residence on access to invasive cardiac services following acute myocardial infarction.
      In this issue of the Canadian Journal of Cardiology, Cote et al.
      • Cote C.L.
      • De Waard D.
      • Tansley G.
      • et al.
      Increased travel time to the tertiary centre is associated with decreased long-term survival following ascending aortic operations.
      report that increased travel time (> 1 hour vs < 1 hour) in Nova Scotia may be associated with increased long-term mortality after ascending thoracic aortic surgery (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.13-4.28; P = 0.02). Although Nova Scotia is Canada’s second most densely populated province, its population density would rank 213th on the list of countries.
      World Bank
      Population density (people per sq km of land area).
      In addition, the poor rural road infrastructure connecting patients across Nova Scotia with Halifax, where Nova Scotia’s only cardiac surgical centre is located, imposes further barriers. The authors add to their previous work on access to cardiovascular services in Nova Scotia, helping to elucidate disparities in access to cardiovascular care in Canada.
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