Key result
More frequent preventive ambulatory care is linked to lower MACE, explaining ~16% of regional event variation.
Why the study?
Does increased provision of preventive ambulatory health care services reduce the incidence of major cardiovascular events in adults without prior cardiovascular hospitalizations?
Cohort (n=5,500,000)
Yes
Does increased provision of preventive ambulatory health care services reduce the incidence of major cardiovascular events in adults without prior cardiovascular hospitalizations?
Increased provision of preventive ambulatory health care services is associated with lower regional incidence of major cardiovascular events, highlighting the importance of equitable access to preventive care.
Does not support practice change; leaves open whether expanded preventive services causally reduce events.
BACKGROUND: Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates. METHODS: We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for cardiovascular disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major cardiovascular event (myocardial infarction, stroke or cardiovascular-related death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province’s 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in cardiovascular event rates. RESULTS: Cardiovascular event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years. Compared with residents of high-rate LHINs, those of low-rate health regions received physician services more often (e.g., 4.2 v. 3.5 mean annual family physician visits, p value for LHIN-level trend = 0.01) and were screened for risk factors more often. Low-rate LHINs were also more likely to achieve treatment targets for hypercholes-terolemia (51.8% v. 49.6% of patients, p = 0.03) and controlled hypertension (67.4% v. 53.3%, p = 0.04). Differences in patient and health system factors accounted for 74.5% of the variation in events between LHINs, of which 15.5% was attributable to health system factors alone. INTERPRETATION: Preventive ambulatory health care services were provided more frequently in health regions with lower cardiovascular event rates. Health system interventions to improve equitable access to preventive care might improve cardiovascular outcomes.
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Tu et al. (2017) conducted a cohort in Cardiovascular disease prevention (n=5,500,000). Preventive ambulatory health care services vs. Lower provision of preventive care was evaluated on Major cardiovascular event (myocardial infarction, stroke or cardiovascular-related death). Preventive ambulatory health care services were provided more frequently in regions with lower cardiovascular event rates, with health system factors accounting for 15.5% of the variation in events.
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