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

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

June 11, 2009 – 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.