Improvements in prevention and cardiac care mean fewer heart attacks and fewer deaths



    Tenth annual Health Indicators report highlights progress in the health
    of Canadians and the health system over a decade, as well as where
    improvements can be made

    OTTAWA, June 11 /CNW Telbec/ - A new report tracking selected indicators
of health system performance over 10 years in Canada shows significant
improvements in the prevention and management of heart disease, with fewer
Canadians having a heart attack, one of the leading causes of death in this
country. Data from the Canadian Institute for Health Information (CIHI) shows
the rate of patients admitted to hospital for heart attack in Canada (outside
Quebec) dropped 13% between 2003-2004 and 2007-2008, after population growth
and aging were taken into account. Over the same time period, deaths in
hospital within 30 days of admission for acute myocardial infarction (AMI), or
heart attack, were down 11%, and unplanned readmissions to hospital after a
heart attack declined by 31%. Health Indicators 2009 marks the 10th
anniversary of CIHI's annual report. Produced with Statistics Canada, the
report provides more than 40 comparable measures of health and the health
system by health region, province and territory.
    "Heart attacks remain one of the leading causes of death in Canada, so it
is encouraging to see the progress being made on this front," says Helen
Angus, Vice President, Research at CIHI. "Measuring improvements in prevention
and cardiac care gives public health professionals, researchers, clinicians
and administrators a picture of what innovations are making a difference as
they seek to further improve outcomes for patients."
    Two types of cardiac revascularization procedures are used to treat
coronary heart disease: angioplasty and coronary artery bypass graft (CABG)
surgery. Over the past decade, the number of angioplasties performed more than
doubled, with a peak rate of 177 angioplasties per 100,000 population reached
in 2005-2006. At the same time, the rate of CABG, a more invasive procedure,
decreased by 18%. A combination of factors, including advances in cardiac care
(for example, more heart attack patients receive revascularization shortly
after their heart attacks than in the past), may partly explain the decrease
in AMI in-hospital mortality rates.

    Rates of stroke down, but no improvement seen in the rate of
    stroke-related deaths in hospital

    CIHI's data also shows a significant decrease in the rates of stroke over
the last five years, declining 14% between 2003-2004 and 2007-2008, after
population growth and aging are taken into account. However, the risk of dying
in hospital within 30 days of admission for a stroke did not improve over this
period, with mortality rates remaining at 18%, or just about double the risk
of dying in hospital from a heart attack. Stroke patients attended by a
neurologist or neurosurgeon were 40% less likely to die in hospital than
patients not treated by a specialist, after differences in patient
characteristics were taken into account. Only a quarter of stroke patients had
a neurology or neurosurgery specialist responsible for their care in
2007-2008.
    "While the finding that stroke rates are declining is encouraging, deaths
within 30 days of admission to hospital due to stroke have remained relatively
constant," says Dr. Indra Pulcins, Director, Indicators and Performance
Measurement at CIHI. "This is a signal that we may need to continue to look at
how stroke care is managed. Large variations across the country also show
there is an opportunity to improve care, and the provinces are already working
on various strategies proven to improve outcomes."
    For the first time, this year's Health Indicators report also looks at
rates of new heart attacks and strokes by neighbourhood income levels across
Canada (outside of Quebec). The heart attack rate for Canadians in the least
affluent neighbourhoods was 66% higher than for those in the most affluent
neighbourhoods. For strokes, those in less affluent neighbourhoods were 54%
more likely to be hospitalized than those in the most affluent neighbourhoods.
The gaps between the most affluent and least affluent groups widened over the
past five years.

    Rates of potentially preventable hospitalizations decreasing; no change
    in asthma readmissions

    Hospital stays are costly for the health system and disruptive for
patients and their families, so it is important to track which ones are
potentially avoidable. Injuries are a major cause of hospitalization and
premature death in Canada, despite the fact that many can be prevented. CIHI
data shows that hospitalization rates for traumatic injury in Canada decreased
9% between 2001-2002 and 2007-2008, after population growth and aging were
taken into account. For those younger than 65, the three most common reasons
for injury hospitalization in 2007-2008 were falls (39%), transport collisions
(23%) and assault (9%). For those 65 or older, the majority of
hospitalizations followed a fall.
    Hospitalization rates for chronic conditions that could potentially be
managed or treated in the community, such as diabetes or hypertension,
decreased by 29% between 2001-2002 and 2007-2008.
    Patients admitted to hospital for asthma treatments likely have poorly
controlled asthma which may be due, in part, to potential gaps in care in the
community. CIHI's data found there was no significant change in the rate of
readmission to hospital after an initial stay between 2003-2004 and 2007-2008.

    Hip fracture rate has decreased, but waits for hip repair surgery have
    increased over time

    Hip fractures are among one of the most common and stressful injuries
incurred by seniors. Fall prevention strategies in place across the country
may be contributing to fewer falls and a reduced rate of hip fractures.
Between 1998-1999 and 2007-2008, the rate of hip fractures sustained in the
community decreased by 21%. However, a patient's risk of fracturing a hip
while in hospital has not changed significantly since 2003-2004. Almost 1 in
1,000 seniors admitted to an acute care facility in Canada break a hip while
in hospital, approximately 600 per year.
    CIHI data also shows that longer waits for hip fracture surgery are
associated with higher mortality rates. Hip fracture patients who received
surgery on the day of admission or the next day were 18% less likely to die in
hospital within 30 days of admission than those who had their surgery later,
after differences in age and other conditions were taken into account. In
2007-2008, 62.5% of hip fracture patients had surgery on the day of admission
or the next day, compared to 67.7% in 2003-2004.
    "Indicators tell us where we're doing well and where more effort is
needed," says Eugene Wen, Manager, Health Indicators at CIHI. "While community
programs appear to be reducing the rate of hip fractures generally, more work
is clearly needed to prevent hip fractures that occur in hospitals and to
reduce surgical wait times for fracture repairs. Many health regions and
health care facilities are beginning to address this challenge. Future Health
Indicators reports will show if these efforts are paying off."

    Rates of surgical procedures associated with men's and women's
    reproductive health vary

    Giving birth is the most common reason for hospitalization in Canada, and
the way babies are delivered has an impact on the health system. Caesarean
sections, which can be associated with increased maternal illness, cost 60%
more than vaginal births. The rate of babies born by C-section increased by
nearly 25% between 2001-2002 (22.5%) and 2007-2008 (27.7%). This rate varies
substantially across the provinces and territories, but also by the age of the
mother. Although the C-section rate for mothers age 40 or older was double
(42%) the rate for mothers age 20 to 24 (21%), the rates increased for mothers
of all ages.
    The second most frequently performed surgery for women is
hysterectomy-the surgical removal of the uterus-with about 36,000 procedures
performed annually. The rate of hysterectomies performed in Canadian hospitals
decreased by 23% between 1998-1999 and 2007-2008. For men, prostatectomy-the
surgical removal of all or part of the prostate gland-was the second most
commonly performed operation, after coronary angioplasty. Both hysterectomies
and prostatectomies were mostly done for non-cancerous conditions.
    No significant improvement in the rates of unplanned readmission after
hysterectomy and prostatectomy was found between 2003-2004 and 2007-2008.
Ninety percent of readmissions after hysterectomy were for a post-operative
infection.

    About CIHI

    The Canadian Institute for Health Information (CIHI) collects and
analyzes information on health and health care in Canada and makes it publicly
available. Canada's federal, provincial and territorial governments created
CIHI as a not-for-profit, independent organization dedicated to forging a
common approach to Canadian health information. CIHI's goal: to provide
timely, accurate and comparable information. CIHI's data and reports inform
health policies, support the effective delivery of health services and raise
awareness among Canadians of the factors that contribute to good health.

    
    The report and the following figures are available from CIHI's website,
    at www.cihi.ca.

    Figure 1   Rates of Hospitalized AMI Events, Canada
               (Figure 1, page 19 in the report)

    Figure 2   Rates of 30-Day AMI In-Hospital Mortality, Canada
               (Figure 1, page 25 in the report)

    Figure 3   Annual Rates of Readmission After a Heart Attack, Canada
               (Figure 1, page 27 in  the report)

    Figure 4   Rates of Hospitalized AMI Events by Neighbourhood Income
               Quintile, Canada, 2007-2008
               (Figure 3, page 19 in the report)

    Figure 5   Rates of Hospitalized Stroke Events, Canada
               (Figure 1, page 33 in the report)

    Figure 6   Rates of Hospitalized Stroke Events by Neighbourhood Income
               Quintile, Canada, 2007-2008
               (Figure 2, page 33 in the report)
    




For further information:

For further information: Leona Hollingsworth, (416) 481-2002, ext. 5251,
Cell: (416) 459-6855, lhollingsworth@cihi.ca; Jennie Hoekstra, (613) 241-7860,
ext. 6331, Cell: (613) 725-4097, jhoekstra@cihi.ca


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