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Shavadia JS, Stanberry L, Singh J, Thao KR, Ghasemzadeh N, Mercado N, Nayak KR, Alraies MC, Bagur R, Saw J, Bagai A, Bainey KR, Madan M, Amlani S, Garberich R, Grines CL, Garcia S, Henry TD, Dehghani P. Comparative Analysis of Patients With STEMI and COVID-19 Between Canada and the United States. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023:100970. [PMID: 37363317 PMCID: PMC10284462 DOI: 10.1016/j.jscai.2023.100970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/28/2023]
Abstract
Background Important health care differences exist between the United States (US) and Canada, which may have been exacerbated during the pandemic. We compared clinical characteristics, treatment strategies, and clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) and COVID-19 (STEMI-COVID) treated in the US and Canada. Methods The North American COVID-19 Myocardial Infarction registry is a prospective, investigator-initiated study enrolling patients with STEMI with confirmed or suspected COVID-19 in the US and Canada. The primary end point was in-hospital mortality. Additionally, we explored associations between vaccination and clinical outcomes. Results Of 853 patients with STEMI-COVID, 112 (13%) were enrolled in Canada, and compared with the US, patients in Canada were more likely to present with chest pain and less likely to have a history of heart failure, stroke/transient ischemic attack, pulmonary infiltrates or renal failure. In both countries, the primary percutaneous coronary intervention was the dominant reperfusion strategy, with no difference in door-to-balloon times; fibrinolysis was used less frequently in the US than in Canada. The adjusted in-hospital mortality was not different between the 2 countries (relative risk [RR], 1.0; 95% CI, 0.46-2.72; P = 1.0). However, the risk of in-hospital mortality was significantly higher in unvaccinated compared with vaccinated patients with STEMI-COVID (RR, 4.7; 95% CI, 1.7-11.53; P = .015). Conclusions Notable differences in morbidities and reperfusion strategies were evident between patients with STEMI-COVID in the US compared with Canada. No differences were noted for in-hospital mortality. Vaccination, regardless of region, appeared to associate with a lower risk of in-hospital mortality strongly.
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Affiliation(s)
- Jay S Shavadia
- Division of Cardiology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Jyotpal Singh
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
| | | | - Nima Ghasemzadeh
- Georgia Heart Institute, Northeast Georgia Medical Center, Gainesville, Georgia
| | | | - Keshav R Nayak
- Department of Cardiology, Scripps Mercy Hospital, San Diego, California
| | | | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Kevin R Bainey
- University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Mina Madan
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shy Amlani
- William Osler Health System, Brampton, Ontario, Canada
| | - Ross Garberich
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - Santiago Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Timothy D Henry
- The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio
| | - Payam Dehghani
- Prairie Vascular Research Inc, Regina, Saskatchewan, Canada
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Wijeysundera HC, Gaudino M, Qiu F, Olson MA, Mao J, Manoragavan R, Rong L, Tam DY, Austin PC, Fremes SE, Sedrakyan A. Regional Differences in Outcomes for Patients Undergoing Transcatheter Aortic Valve Replacement in New York State and Ontario. Can J Cardiol 2023; 39:570-577. [PMID: 36737001 PMCID: PMC11116973 DOI: 10.1016/j.cjca.2023.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/27/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become the standard of care for a wide spectrum of patients with severe aortic stenosis. However, there are wide variations in access to TAVR among jurisdictions. It is unknown if such variation is associated with differences in postprocedural outcomes. Our objective was to determine whether differences in health care delivery in jurisdictions with high vs low access of care to TAVR translate to differences in postprocedural outcomes. METHODS In this observational, retrospective cohort study, we identified all Ontario and New York State residents greater than 18 years of age who received TAVR from January 1, 2012, to December 31, 2018. Our primary outcomes were post-TAVR 30 day in-hospital mortality and all-cause readmissions. Using indirect standardization, we calculated the observed vs expected outcomes for New York patients, had they been treated in Ontario. RESULTS Our cohort consisted of 16,814 TAVR patients at 36 hospitals in New York State and 5007 TAVR patients at 11 hospitals in Ontario. In Ontario, TAVR access rates increased from ∼18.2 TAVR per million in 2012 to 87.4 TAVR per million in 2018, whereas for New York State, the rates increased from 31.9 to 220.4 TAVR per million. For 30-day mortality, 3.1% of Ontario TAVR patients had an in-hospital death, compared with 2.5% of New York patients. With adjustment, this translated to an observed-expected ratio of 0.70 (95% confidence interval [CI], 0.54-0.92) for New York patients. CONCLUSIONS Having greater access to TAVR may be associated with improved outcomes, potentially because of intervention earlier in the trajectory of the disease.
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Affiliation(s)
- Harindra C Wijeysundera
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Feng Qiu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Molly A Olson
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Jialin Mao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
| | - Ragavie Manoragavan
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Art Sedrakyan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
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Cram P, Cohen ME, Ko C, Landon BE, Hall B, Jackson TD. Surgical Outcomes in Canada and the United States: An Analysis of the ACS-NSQIP Clinical Registry. World J Surg 2022; 46:1039-1050. [PMID: 35102437 PMCID: PMC9929717 DOI: 10.1007/s00268-022-06444-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been longstanding uncertainty over whether lower healthcare spending in Canada might be associated with inferior outcomes for hospital-based care. We hypothesized that mortality and surgical complication rates would be higher for patients who underwent four common surgical procedures in Canada as compared to the US. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study of all adults who underwent hip fracture repair, colectomy, pancreatectomy, or spine surgery in 96 Canadian and 585 US hospitals participating in the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) between January 1, 2015 and December 31, 2019. We compared patients with respect to demographic characteristics and comorbidity. We then compared unadjusted and adjusted outcomes within 30-days of surgery for patients in Canada and the US including: (1) Mortality; (2) A composite constituting 1-or-more of the following complications (cardiac arrest; myocardial infarction; pneumonia; renal failure/; return to operating room; surgical site infection; sepsis; unplanned intubation). RESULTS Our hip fracture cohort consisted of 21,166 patients in Canada (22.3%) and 73,817 in the US (77.7%), for colectomy 21,279 patients in Canada (8.9%) and 218,307 (91.1%), for pancreatectomy 873 (7.8%) in Canada and 12,078 (92.2%) in the US, and for spine surgery 14,088 (5.3%) and 252,029 (94.7%). Patient sociodemographics and comorbidity were clinically similar between jurisdictions. In adjusted analyses odds of death was significantly higher in Canada for two procedures (colectomy (OR 1.22; 95% CI 1.044-1.424; P = .012) and pancreatectomy (OR 2.11; 95% CI 1.26-3.56; P = .005)) and similar for hip fracture and spine surgery. Odds of the composite outcome were significantly higher in Canada for all 4 procedures, largely driven by higher risk of cardiac events and post-operative infections. CONCLUSIONS We found evidence of higher rates of mortality and surgical complications within 30-days of surgery for patients in Canada as compared to the US.
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Affiliation(s)
- Peter Cram
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Clifford Ko
- American College of Surgeons, Chicago, IL, USA,UCLA Department of Surgery, Los Angeles, CA, USA,Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Bruce E. Landon
- Department of Health Care Policy, Harvard Medical School and Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Bruce Hall
- American College of Surgeons, Chicago, IL, USA,Department of Surgery, School of Medicine, Washington University, St Louis, MO, USA,St Louis VA Medical Center, St Louis, MO, USA,BJC Healthcare, St Louis, MO, USA
| | - Timothy D. Jackson
- Department of Surgery, University of Toronto, Toronto, Canada,Division of General Surgery, University Health Network, Toronto, ON, Canada
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