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May 22, 1997New England Journal of Medicine

Use of Cardiac Procedures and Outcomes in Elderly Patients with Myocardial Infarction in the United States and Canada

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Why the study?

Does the higher use of invasive cardiac procedures in the United States compared to Canada improve long-term survival in elderly patients with acute myocardial infarction?

Population

233,702 elderly patients with a new acute myocardial infarction in 1991

Comparison

United States healthcare system management vs Canadian healthcare system management

Design

Cohort

Follow-up

1 year

Authors

JTJack V. TuHeart Failure & TransplantCPChris L. PashosOldham CouncilCNC. David NaylorAmarillo College

Discussion

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Implication

Similar mortality despite markedly higher US procedural rates; leaves open whether routine invasive management improves outcomes in elderly AMI.

Structured PICO

Does the higher use of invasive cardiac procedures in the United States compared to Canada improve long-term survival in elderly patients with acute myocardial infarction?

P
Population
233,702 elderly patients with a new acute myocardial infarction in 1991 (224,258 Medicare beneficiaries in the United States and 9,444 patients in Ontario, Canada)
I
Intervention
United States healthcare system management (associated with higher rates of invasive cardiac procedures)
C
Comparator
Canadian (Ontario) healthcare system management (associated with lower rates of invasive cardiac procedures)
O
Outcome
30-day and 1-year mortality rates, and use of invasive cardiac procedures (coronary angiography, PTCA, CABG)hard clinical

Strikingly higher rates of invasive cardiac procedures in the US compared to Canada for elderly patients with acute myocardial infarction do not result in better 1-year survival.

Cite This Study

Tu et al. (1997) studied this question.

synapsesocial.com/papers/6a10926fe1a472cb5efd252chttps://doi.org/10.1056/nejm199705223362106
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A Comparison of Management Patterns after Acute Myocardial Infarction in Canada and the United States1993 · 313 citations
  2. 2Changes in Mortality after Myocardial Revascularization in the Elderly: The National Medicare Experience1994 · 154 citations
  3. 3Adjunctive Drug Therapy of Acute Myocardial Infarction — Evidence from Clinical Trials1996 · 261 citations
  4. 4Predictors of 30-Day Mortality in the Era of Reperfusion for Acute Myocardial Infarction1995 · 1,093 citations
  5. 5Use of Medical Resources and Quality of Life after Acute Myocardial Infarction in Canada and the United States1994 · 348 citations