A comparison of management patterns after acute myocardial infarction in Canada and the United States

Jean L. Rouleau, Lemuel A. Moyé, Marc A. Pfeffer, J. Malcolm O Arnold, Victoria Bernstein, Thomas E. Cuddy, Gilles R. Dagenais, Edward M. Geltman, Steven Goldman, David Gordon, Peggy Hamm, Marc Klein, Gervasio A. Lamas, John Mccans, Patricia Mcewan, Francis J. Menapace, John O. Parker, François Sestier, Bruce Sussex, Eugene Braunwald

Research output: Contribution to journalArticle

278 Citations (Scopus)

Abstract

Background. There are major differences in the organization of the health care systems in Canada and the United States. We hypothesized that these differences may be accompanied by differences in patient care. Methods. To test our hypothesis, we compared the treatment patterns for patients with acute myocardial infarction in 19 Canadian and 93 United States hospitals participating in the Survival and Ventricular Enlargement (SAVE) study, which tested the effectiveness of captopril in this population of patients after a myocardial infarction. Results. In Canada, 51 percent of the patients admitted to a participating coronary care unit had acute myocardial infarctions, as compared with only 35 percent in the United States (P<0.001 ). Despite the similar clinical characteristics of the 1573 U.S. patients and 658 Canadian patients participating in the study, coronary arteriography was more commonly performed in the United States than in Canada (in 68 percent vs. 35 percent, P<0.001), as were revascularization procedures before randomization (31 percent vs. 12 percent, P<0.001). During an average follow-up of 42 months, these procedures were also performed more commonly in the United States than in Canada. These differences were not associated with any apparent difference in mortality (22 percent in Canada and 23 percent in the United States) or rate of reinfarction (14 percent in Canada and 13 percent in the United States), but there was a higher incidence of activity-limiting angina in Canada than in the United States (33 percent vs. 27 percent, P<0.007). Conclusions. The threshold for the admission of patients to a coronary care unit or for the use of invasive diagnostic and therapeutic interventions in the early and late periods after an infarction is higher in Canada than in the United States. This is not associated with any apparent difference in the rate of reinfarction or survival, but is associated with a higher frequency of activity-limiting angina.

Original languageEnglish (US)
Pages (from-to)779-784
Number of pages6
JournalNew England Journal of Medicine
Volume328
Issue number11
StatePublished - Mar 18 1993
Externally publishedYes

Fingerprint

Canada
Myocardial Infarction
Coronary Care Units
State Hospitals
Survival
Patient Admission
Captopril
Random Allocation
Infarction
Patient Care
Angiography
Organizations
Delivery of Health Care
Mortality
Incidence
Therapeutics
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Rouleau, J. L., Moyé, L. A., Pfeffer, M. A., Arnold, J. M. O., Bernstein, V., Cuddy, T. E., ... Braunwald, E. (1993). A comparison of management patterns after acute myocardial infarction in Canada and the United States. New England Journal of Medicine, 328(11), 779-784.

A comparison of management patterns after acute myocardial infarction in Canada and the United States. / Rouleau, Jean L.; Moyé, Lemuel A.; Pfeffer, Marc A.; Arnold, J. Malcolm O; Bernstein, Victoria; Cuddy, Thomas E.; Dagenais, Gilles R.; Geltman, Edward M.; Goldman, Steven; Gordon, David; Hamm, Peggy; Klein, Marc; Lamas, Gervasio A.; Mccans, John; Mcewan, Patricia; Menapace, Francis J.; Parker, John O.; Sestier, François; Sussex, Bruce; Braunwald, Eugene.

In: New England Journal of Medicine, Vol. 328, No. 11, 18.03.1993, p. 779-784.

Research output: Contribution to journalArticle

Rouleau, JL, Moyé, LA, Pfeffer, MA, Arnold, JMO, Bernstein, V, Cuddy, TE, Dagenais, GR, Geltman, EM, Goldman, S, Gordon, D, Hamm, P, Klein, M, Lamas, GA, Mccans, J, Mcewan, P, Menapace, FJ, Parker, JO, Sestier, F, Sussex, B & Braunwald, E 1993, 'A comparison of management patterns after acute myocardial infarction in Canada and the United States', New England Journal of Medicine, vol. 328, no. 11, pp. 779-784.
Rouleau JL, Moyé LA, Pfeffer MA, Arnold JMO, Bernstein V, Cuddy TE et al. A comparison of management patterns after acute myocardial infarction in Canada and the United States. New England Journal of Medicine. 1993 Mar 18;328(11):779-784.
Rouleau, Jean L. ; Moyé, Lemuel A. ; Pfeffer, Marc A. ; Arnold, J. Malcolm O ; Bernstein, Victoria ; Cuddy, Thomas E. ; Dagenais, Gilles R. ; Geltman, Edward M. ; Goldman, Steven ; Gordon, David ; Hamm, Peggy ; Klein, Marc ; Lamas, Gervasio A. ; Mccans, John ; Mcewan, Patricia ; Menapace, Francis J. ; Parker, John O. ; Sestier, François ; Sussex, Bruce ; Braunwald, Eugene. / A comparison of management patterns after acute myocardial infarction in Canada and the United States. In: New England Journal of Medicine. 1993 ; Vol. 328, No. 11. pp. 779-784.
@article{aa18763b9f344d0d9b790998f7a5f171,
title = "A comparison of management patterns after acute myocardial infarction in Canada and the United States",
abstract = "Background. There are major differences in the organization of the health care systems in Canada and the United States. We hypothesized that these differences may be accompanied by differences in patient care. Methods. To test our hypothesis, we compared the treatment patterns for patients with acute myocardial infarction in 19 Canadian and 93 United States hospitals participating in the Survival and Ventricular Enlargement (SAVE) study, which tested the effectiveness of captopril in this population of patients after a myocardial infarction. Results. In Canada, 51 percent of the patients admitted to a participating coronary care unit had acute myocardial infarctions, as compared with only 35 percent in the United States (P<0.001 ). Despite the similar clinical characteristics of the 1573 U.S. patients and 658 Canadian patients participating in the study, coronary arteriography was more commonly performed in the United States than in Canada (in 68 percent vs. 35 percent, P<0.001), as were revascularization procedures before randomization (31 percent vs. 12 percent, P<0.001). During an average follow-up of 42 months, these procedures were also performed more commonly in the United States than in Canada. These differences were not associated with any apparent difference in mortality (22 percent in Canada and 23 percent in the United States) or rate of reinfarction (14 percent in Canada and 13 percent in the United States), but there was a higher incidence of activity-limiting angina in Canada than in the United States (33 percent vs. 27 percent, P<0.007). Conclusions. The threshold for the admission of patients to a coronary care unit or for the use of invasive diagnostic and therapeutic interventions in the early and late periods after an infarction is higher in Canada than in the United States. This is not associated with any apparent difference in the rate of reinfarction or survival, but is associated with a higher frequency of activity-limiting angina.",
author = "Rouleau, {Jean L.} and Moy{\'e}, {Lemuel A.} and Pfeffer, {Marc A.} and Arnold, {J. Malcolm O} and Victoria Bernstein and Cuddy, {Thomas E.} and Dagenais, {Gilles R.} and Geltman, {Edward M.} and Steven Goldman and David Gordon and Peggy Hamm and Marc Klein and Lamas, {Gervasio A.} and John Mccans and Patricia Mcewan and Menapace, {Francis J.} and Parker, {John O.} and Fran{\cc}ois Sestier and Bruce Sussex and Eugene Braunwald",
year = "1993",
month = "3",
day = "18",
language = "English (US)",
volume = "328",
pages = "779--784",
journal = "New England Journal of Medicine",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "11",

}

TY - JOUR

T1 - A comparison of management patterns after acute myocardial infarction in Canada and the United States

AU - Rouleau, Jean L.

AU - Moyé, Lemuel A.

AU - Pfeffer, Marc A.

AU - Arnold, J. Malcolm O

AU - Bernstein, Victoria

AU - Cuddy, Thomas E.

AU - Dagenais, Gilles R.

AU - Geltman, Edward M.

AU - Goldman, Steven

AU - Gordon, David

AU - Hamm, Peggy

AU - Klein, Marc

AU - Lamas, Gervasio A.

AU - Mccans, John

AU - Mcewan, Patricia

AU - Menapace, Francis J.

AU - Parker, John O.

AU - Sestier, François

AU - Sussex, Bruce

AU - Braunwald, Eugene

PY - 1993/3/18

Y1 - 1993/3/18

N2 - Background. There are major differences in the organization of the health care systems in Canada and the United States. We hypothesized that these differences may be accompanied by differences in patient care. Methods. To test our hypothesis, we compared the treatment patterns for patients with acute myocardial infarction in 19 Canadian and 93 United States hospitals participating in the Survival and Ventricular Enlargement (SAVE) study, which tested the effectiveness of captopril in this population of patients after a myocardial infarction. Results. In Canada, 51 percent of the patients admitted to a participating coronary care unit had acute myocardial infarctions, as compared with only 35 percent in the United States (P<0.001 ). Despite the similar clinical characteristics of the 1573 U.S. patients and 658 Canadian patients participating in the study, coronary arteriography was more commonly performed in the United States than in Canada (in 68 percent vs. 35 percent, P<0.001), as were revascularization procedures before randomization (31 percent vs. 12 percent, P<0.001). During an average follow-up of 42 months, these procedures were also performed more commonly in the United States than in Canada. These differences were not associated with any apparent difference in mortality (22 percent in Canada and 23 percent in the United States) or rate of reinfarction (14 percent in Canada and 13 percent in the United States), but there was a higher incidence of activity-limiting angina in Canada than in the United States (33 percent vs. 27 percent, P<0.007). Conclusions. The threshold for the admission of patients to a coronary care unit or for the use of invasive diagnostic and therapeutic interventions in the early and late periods after an infarction is higher in Canada than in the United States. This is not associated with any apparent difference in the rate of reinfarction or survival, but is associated with a higher frequency of activity-limiting angina.

AB - Background. There are major differences in the organization of the health care systems in Canada and the United States. We hypothesized that these differences may be accompanied by differences in patient care. Methods. To test our hypothesis, we compared the treatment patterns for patients with acute myocardial infarction in 19 Canadian and 93 United States hospitals participating in the Survival and Ventricular Enlargement (SAVE) study, which tested the effectiveness of captopril in this population of patients after a myocardial infarction. Results. In Canada, 51 percent of the patients admitted to a participating coronary care unit had acute myocardial infarctions, as compared with only 35 percent in the United States (P<0.001 ). Despite the similar clinical characteristics of the 1573 U.S. patients and 658 Canadian patients participating in the study, coronary arteriography was more commonly performed in the United States than in Canada (in 68 percent vs. 35 percent, P<0.001), as were revascularization procedures before randomization (31 percent vs. 12 percent, P<0.001). During an average follow-up of 42 months, these procedures were also performed more commonly in the United States than in Canada. These differences were not associated with any apparent difference in mortality (22 percent in Canada and 23 percent in the United States) or rate of reinfarction (14 percent in Canada and 13 percent in the United States), but there was a higher incidence of activity-limiting angina in Canada than in the United States (33 percent vs. 27 percent, P<0.007). Conclusions. The threshold for the admission of patients to a coronary care unit or for the use of invasive diagnostic and therapeutic interventions in the early and late periods after an infarction is higher in Canada than in the United States. This is not associated with any apparent difference in the rate of reinfarction or survival, but is associated with a higher frequency of activity-limiting angina.

UR - http://www.scopus.com/inward/record.url?scp=0027467343&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027467343&partnerID=8YFLogxK

M3 - Article

C2 - 8123063

AN - SCOPUS:0027467343

VL - 328

SP - 779

EP - 784

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 11

ER -