Document Detail

The effect of place of residence on access to invasive cardiac services following acute myocardial infarction.
MedLine Citation:
PMID:  19340343     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The Canadian health care system is mandated to provide reasonable access to health care for all Canadians regardless of age, sex, race, socioeconomic status or place of residence. In the present study, the impact of place of residence in Nova Scotia on access to cardiac catheterization and long-term outcomes following an acute myocardial infarction (MI) were examined. METHODS: All patients with an acute MI who were hospitalized between April 1998 and December 2001 were identified. Place of residence was defined by postal code and separated into three categories: metropolitan area (MA); nonmetropolitan urban area (UA); and rural area (RA). Rates of and waiting times for cardiac catheterization were determined, as were risk-adjusted long-term rates of mortality and readmission to the hospital. RESULTS: A total of 7351 patients were hospitalized with an acute MI during the study period. Rates of cardiac catheterization differed across the three groups (MA 45.6%, UA 37.3%, RA 37.3%; P<0.0001), as did mean waiting times (MA 15.0 days, UA 32.1 days, RA 28.7 days) (P<0.0001). After adjusting for differences among patients, residence in either UA or RA emerged as an independent predictor of lower rates of cardiac catheterization (UA: hazard ratio [HR] 0.77, P<0.0001; RA: HR 0.75, P<0.0001), greater waiting times (UA: an additional 14.1 days, P<0.0001; RA: an additional 10.8 days, P<0.0001) and increased long-term rates of readmission (UA: HR 1.24, P=0.0001; RA: HR 1.12, P=0.04). CONCLUSION: In patients admitted with an acute MI, residence outside of an MA was associated with diminished rates of cardiac catheterization, longer waiting times and increased rates of readmission. Despite universal health care coverage, Canadians are subject to significant geographical barriers to cardiac catheterization with associated poorer outcomes.
Ansar Hassan; Neil J Pearce; Jim Mathers; Paul J Veugelers; Gregory M Hirsch; Jafna L Cox;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  25     ISSN:  1916-7075     ISO Abbreviation:  Can J Cardiol     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-02     Completed Date:  2009-04-28     Revised Date:  2010-09-22    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  207-12     Citation Subset:  IM    
Department of Surgery, Dalhousie University, Halifax, Canada.
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MeSH Terms
Health Services Accessibility / statistics & numerical data*
Heart Catheterization / utilization*
Middle Aged
Myocardial Infarction / therapy*
Nova Scotia
Outcome Assessment (Health Care)
Patient Readmission / statistics & numerical data
Residence Characteristics
Rural Health Services / statistics & numerical data*
Urban Health Services / statistics & numerical data*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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