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Study says 1/3 of Canadians might not get optimal heart attack treatment

By: Shannon Montgomery, THE CANADIAN PRESS

4/02/2010 6:40 PM | Comments: 0

CALGARY - Just over one-third of Canadians live too far away from a specialized hospital to get the best available treatment for a heart attack, suggests a new study.

But its authors argue that number is pretty good for a vast, sparsely populated country where many people live away from major urban areas.

The University of Calgary researchers looked at how many Canadians 40 years and older live within an hour of a hospital that's equipped to perform an emergency angioplasty, a specialized procedure in which surgeons open a blocked blood vessel to the heart.

More than 70 per cent of people in Ontario can access the treatment within an hour, while only 15.8 per cent in New Brunswick are within an hour of the province's only hospital capable of providing the treatment. Some areas, such as Prince Edward Island and the three territories, don't have a facility that performs the procedure.

Senior author Dr. William Ghali says the fact that 63.9 per cent of Canadians can get access to the sophisticated treatment within an hour is pretty good considering the country's spread-out population.

"One way to view the number is to view it negatively and say, 'oh, isn't it bad that 35 per cent can't get there within an hour'," he said.

"My take is actual more of a positive one, that it's quite positive that two-thirds of the population can get access within an hour."

The traditional treatment for a heart attack has been clot-busting drugs, but Ghali has said it's been recognized that rapid access to an angioplasty leads to better outcomes.

Similar studies in the United States have shown that about 80 per cent of its population has similar access to the treatment, said Ghali. That country is more densely populated, but also has more specialized treatment available in community hospitals.

"For example, a place like Red Deer ... or Lethbridge might actually have angioplasty services in the American health-care system."

But Ghali cautioned his study isn't suggesting that's the way to go; rather, he it's information that government and people can consider when figuring out the best way to spend health-care dollars.

It's extremely costly to set up specialized treatment centres, but that's not the only concern.

"Hospitals that do a lot of a procedure tend to have better results than hospitals that do it very occasionally. The strong argument against setting up these facilities in small centres is that you can get substandard care in places that aren't doing it enough," Ghali said.

"There are trade-offs that we don't have the answers to. But this work is the first step in the dialogue."

John Cairns, a cardiologist and professor at the University of British Columbia, said he wasn't surprised by the numbers found by the study.

"The third that are not able to get this, that's just the reality of living outside of a major centre. You can't have neurosurgery, you can't have advanced transplantation, you can't have everything if you live in an isolated area," he said.

"So it's a balancing of what's affordable and what's possible."

Cairns said that most new procedures tend to start out very specialized and slowly become more common in smaller hospitals.

Ghali also pointed out that rural areas can follow the "drip and ship" method in which a patient is given clot-busting drugs and sent to the nearly major centre even if it's more than an hour away.

Alka Patel, a PhD candidate who led the study, said she'd like to look into whether the availability of helicopter ambulances and other air transportation makes a difference in access.

Another question is whether there is a correlation between the number of people living close to a major centre and the number of deaths from heart attacks.

She said she's encouraged by the results so far.

"In a country like ours, it's hard to say everyone's going to have access for a service like this. It shows that with what we have we're doing pretty well."

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