Access to cardiovascular care requires geographical accessibility, infrastructural
capacity, health care quality, financial affordability, and societal acceptability.
1
In high-income countries with universal health coverage (UHC) models, such as Canada,
geographic accessibility remains 1 of the most pressing barriers.
- Vervoort D.
Moving the needle: a guide to solving the global cardiac surgery puzzle for surgeons,
societies, students, and researchers.
Published online February. 2020; 20https://doi.org/10.25373/CTSNET.11872425
2
,3
Canada is the second-largest country by total area and fourth by land mass but 236th
in terms of population density.
4
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,
World Bank
Population density (people per sq km of land area).
Population density (people per sq km of land area).
https://data.worldbank.org/indicator/EN.POP.DNST
Date accessed: February 17, 2022
5
differential access to cardiac catheterization,
6
and delayed care of acute myocardial infarction.
7
In this issue of the Canadian Journal of Cardiology, Cote et al.
8
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.
4
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.World Bank
Population density (people per sq km of land area).
Population density (people per sq km of land area).
https://data.worldbank.org/indicator/EN.POP.DNST
Date accessed: February 17, 2022
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Moving the needle: a guide to solving the global cardiac surgery puzzle for surgeons, societies, students, and researchers.Published online February. 2020; 20https://doi.org/10.25373/CTSNET.11872425
- Geographical disparities in access to hospital care in Ontario, Canada: a spatial coverage modelling approach.BMJ Open. 2021; 11e041474
- From far and wide: geographic distance to pediatric surgical care across Canada.J Pediatr Surg. 2020; 55: 908-912
- Population density (people per sq km of land area).(Published 2022. Available at:)https://data.worldbank.org/indicator/EN.POP.DNSTDate accessed: February 17, 2022
- Increased distance from the tertiary cardiac center is associated with worse 30-day outcomes after cardiac operations.Ann Thorac Surg. 2015; 100: 2213-2218
- Where you live in Nova Scotia can significantly impact your access to lifesaving cardiac care: access to invasive care influences survival.Can J Cardiol. 2018; 34: 202-208
- The effect of place of residence on access to invasive cardiac services following acute myocardial infarction.Can J Cardiol. 2009; 25: 207-212
- Increased travel time to the tertiary centre is associated with decreased long-term survival following ascending aortic operations.Can J Cardiol. 2022; 38: 801-807
- National outcomes in acute aortic dissection: influence of surgeon and institutional volume on operative mortality.Ann Thorac Surg. 2013; 95: 1563-1569
- Interfacility transfer of Medicare beneficiaries with acute type A aortic dissection and regionalization of care in the United States.Circulation. 2019; 140: 1239-1250
- The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.JAMA. 2000; 283: 897-903
- Correlates of delayed recognition and treatment of acute type A aortic dissection: the International Registry of Acute Aortic Dissection (IRAD).Circulation. 2011; 124: 1911-1918
- Comparison of characteristics and outcomes for type A aortic dissection surgery by Māori, Pasifika or other ethnicities.N Z Med J. 2020; 133: 33-40
- Differential presentation in acuity and outcomes based on socioeconomic status in patients who undergo thoracoabdominal aortic aneurysm repair.J Thorac Cardiovasc Surg. 2022; 163 (1990-1998.e1)
- Sex-related differences in patients undergoing thoracic aortic surgery.Circulation. 2019; 139: 1177-1184
- Sex differences in thoracic aortic disease: a review of the literature and a call to action.J Thorac Cardiovasc Surg. 2020; 160: 656-660
- Susceptibility to acute thoracic aortic dissections in patients dying outside the hospital: an autopsy study.Am Heart J. 2011; 162: 474-479
- Open versus endovascular repair of thoracic aortic aneurysms: a Nationwide Inpatient Sample study.Vasc Endovascular Surg. 2014; 48: 383-387
- Surveillance imaging following acute type a aortic dissection.J Am Coll Cardiol. 2021; 78: 1863-1871
- Readmissions after complex aneurysm repair are frequent, costly, and primarily at nonindex hospitals.J Vasc Surg. 2014; 60: 1429-1437
- Racial disparities associated with reinterventions after elective endovascular aortic aneurysm repair.J Surg Res. 2021; 268: 381-388
- Historical and continued colonial impacts on heart health of Indigenous Peoples in Canada: what’s reconciliation got to do with it?.CJC Open. 2021; 3: S149-S164
- Socioeconomic and geographic disparities in access to endovascular abdominal aortic aneurysm repair.Ann Vasc Surg. 2013; 27: 1061-1067
- Incidence, secular trends, and outcomes of cardiac surgery in Aboriginal peoples.Can J Cardiol. 2013; 29: 1629-1636
- Canadian Cardiovascular Society Access to Care Working Group on Cardiac Rehabilitation. Universal access: but when? Treating the right patient at the right time: access to cardiac rehabilitation.Can J Cardiol. 2006; 22: 905-911
- Universal access: but when? Treating the right patient at the right time: access to electrophysiology services in Canada.Can J Cardiol. 2006; 22: 741-746
- Treating the right patient at the right time: access to echocardiography in Canada.Can J Cardiol. 2006; 22: 1029-1033
- Canadian Cardiovascular Society Access to Care Working Group. Treating the right patient at the right time: access to cardiac catheterization, percutaneous coronary intervention and cardiac surgery.Can J Cardiol. 2006; 22: 679-683
- Ontario Investing $5.2 million to bring cardiovascular surgery services to Northwestern Ontario.(Published 2021. Available at:)
- Cardiovascular surgery project: two sites, one program.(Published 2022. Available at:)https://tbrhsc.net/programs-services/cardiovascular-sciences-program/cardiovascular-surgery-project/Date accessed: February 13, 2022
- Virtual care with digital technologies for rural Canadians living with cardiovascular disease.CJC Open. 2021; 4: 133-147
Article info
Publication history
Published online: March 07, 2022
Accepted:
March 3,
2022
Received:
February 24,
2022
Footnotes
See article by Cote et al., pages 801–807 of this issue.
See page 728 for disclosure information.
Identification
Copyright
© 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Increased Travel Time to the Tertiary Centre Is Associated With Decreased Long-term Survival Following Ascending Aortic OperationsCanadian Journal of CardiologyVol. 38Issue 6
