Health Care in Canada 2006: a seventh annual report: CIHI

In-hospital mortality rates within 30 days of admission with a new heart attack or stroke differ significantly among regions

June 7, 2006-Canadians admitted to hospital with a new heart attack are less likely to die in hospital within 30 days than in the past, according to a new report released today by the Canadian Institute for Health Information (CIHI). The short-term (30-day) in-hospital death rate dropped from 13.4% in 1999–2000 to 11.1% in 2004–2005. Patients admitted to hospital with a new stroke were more likely to die within 30 days than those with a heart attack—18.8% died in hospital within 30 days in 2004–2005, a rate that was relatively stable over the preceding five years.

These new findings are reported in Health Care in Canada 2006, CIHI’s seventh annual publication on the state of the health system. For the first time, this year’s report provides trends for two key health indicators: short-term mortality rates following admission with a new heart attack and short-term mortality rates following admission with a new stroke. It also examines how these death rates vary across the country and explores factors that may be associated with better or worse odds of survival, including age, sex and the types of care that patients receive.

CIHI data also show that fewer people are being admitted to hospital with heart attacks and strokes. After adjustment was made for population growth and aging, the rate of hospitalization for patients with a new heart attack fell about 19% between 1999–2000 and 2004–2005. By the end of this period, 187 people out of every 100,000 were admitted to a hospital with a new heart attack each year. The rate for stroke hospitalizations in 2004–2005 (127 per 100,000 population) was about 23% lower than five years before.

“Cardiovascular disease, which includes heart attacks and strokes, continues to be among the leading causes of death and emergency hospital admissions in Canada,” says CIHI President and CEO Glenda Yeates. “It is encouraging to see that the odds of surviving a heart attack are improving. But looking across the country, death rates vary considerably from region to region, which suggests that there is an opportunity for further improvement.”

Due to historical differences in data collection, trend data exclude Newfoundland and Labrador (heart attack rates only), Quebec and British Columbia. Results for B.C. are available for the most recent years and are included in the regional comparisons.

Regional differences in 30-day heart attack and stroke death rates

Overall, about one in ten people admitted with a new heart attack (11.1%) died in hospital within 30 days between 2002–2003 and 2004–2005. However, after differences in age, sex and other illnesses were accounted for, death rates in some larger health regions (population of over 75,000) were more than double those in others. Regional death rates ranged from 7.6% to 16.3%.

Of the 54 regions for which data are available, 11 had rates statistically significantly higher than the overall average, and 5 had lower rates.

Similarly, the overall in-hospital death rate within 30 days following admission with a new stroke was 19.1%, with regional rates ranging from 14.7% to 29.2%. Of the 57 regions for which data are available, 15 had rates statistically significantly higher than the overall average, and 7 had lower rates. To make the results as comparable as possible, analyses include only newheart attacks and strokes. Individuals who had been hospitalized with the same condition in the past year were excluded from the analyses.

Types of care influence survival rates

Timely intervention, as well as appropriate care and support, are just some of the factors that have an impact on a patient’s chances of survival following a heart attack or stroke. For example, previous studies have shown better cardiac outcomes for patients treated by specialists and in centres that treat more patients, are located in urban areas and have on-site facilities to perform revascularization (procedures used to restore blood flow to the heart). Often, these factors are linked. Urban hospitals tend to treat more patients, have on-site revascularization and have more specialists on staff.

CIHI analysis found that 36% of heart attack patients were mainly cared for by a cardiac specialist in 2004–2005. These patients were less likely to die in hospital within 30 days than those primarily cared for by other types of physicians. Likewise, the 26% of stroke patients who had a neurologist or neurosurgeon as their main attending physician also tended to have better outcomes. This remained true, even after a number of other hospital and patient characteristics were taken into account.

“Many factors are at play in determining whether a patient survives a heart attack or stroke, and often these factors are intertwined,” says Jennifer Zelmer, CIHI’s Vice President of Research and Analysis. “Each patient’s experience is unique, but as new knowledge emerges, understanding how factors overlap will be key to informing decisions about what types of care work best for whom and in what circumstances.”

Different outcomes for different patients—women at higher risk

CIHI analysis found that women admitted with a new heart attack or stroke were more likely to die in hospital within 30 days than men. In the case of heart attack, after age and other health conditions were taken into account, the risk of dying was 16% greater. For stroke, it was 11% greater.

For stroke, a patient’s odds of dying also depend on the type of stroke. The 30-day in-hospital mortality rate for patients admitted with an ischemic stroke (the most common type of stroke, caused by disrupted blood flow to the brain) has remained relatively stable in recent years, at around 13%. Hemorrhagic strokes (caused by the rupture of a blood vessel inside the skull) are less common, though more deadly. However, the death rate for those with this type of stroke has dropped in recent years, falling from 37.7% in 1999–2000 to 32.8% in 2004–2005.

“CIHI was the first to publish comparable short-term mortality rates for heart and stroke patients for regions across the country,” says CIHI Board Chair Graham W. S. Scott, C.M., Q.C. “There is still much work to be done to fully understand why people in some regions are more likely to survive than in others. Now that we know how death rates are changing over time, we can see clearly that some hospitals and health regions have used this data to improve care for Canadians.”

Other highlights this year:

  • Joint replacements, cardiac surgery and other rates vary across the country. Updated data show at least a two-fold difference in rates of surgery, hospitalization due to injury and readmission from region to region. Health Indicators 2006, a companion report to Health Care in Canada 2006, includes 23 key measures on health care and outcomes for 75 health regions across Canada, representing 95% of Canada’s population. These indicators allow different jurisdictions to compare their performance and identify potential opportunities for improvement.
  • Overall health spending in Canada has increased, reaching an estimated $142 billion in 2005, or $4,411 per person.
  • Over 1.5 million people across the country work in health and social services. That’s about 1 in 10 employed Canadians. Nursing and medicine are the two largest health professions.

Health Care in Canada 2006: a seventh annual report

Health Care in Canada 2006, produced by CIHI with assistance from Statistics Canada, offers current and updated information at local, regional, national and international levels from many sources, including new CIHI studies and Statistics Canada data.

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.