Disparity In Survival Rates In US and Canadian heart Patients

According to new research, elderly heart failure patients in United States have better short-term survival rates than Canadian patients, but lose that advantage over time.

Their study findings appear in the November 28 issue of Archives of Internal Medicine.

Heart failure is the most common cause of hospitalization for individuals aged 65 and older in both countries.

The authors compared process of care and 30-day and one-year risk-standardized mortality rates among 28,521 U.S. Medicare beneficiaries and 8,180 similarly aged patients in Ontario, Canada, who were hospitalized with heart failure from 1998 to 2001. The authors found that 61.2 % U.S. patients underwent left ventricular ejection fraction assessment during hospitalization as compared to 41.7 % patients in Canada.

The authors also report that at discharge, patients in the US were prescribed beta-blockers more frequently (28.7 % vs. 25.4 %), but angiotensin-converting enzyme inhibitors less frequently (54.3 % vs. 63.4 %).

The US patients had lower risk characteristics on admission and lower crude mortality rates at 30 days and 1 year. The death rate at 30 days was 8.9 % for U.S. patients, which was significantly lower as compared with 10.7 % for Canadian patients. But at one year, the death rates for patients in both countries were similar.

The authors conclude that heart failure patients hospitalized in the US had significantly better short-term mortality but equivalent long-term mortality compared with a sample of heart failure patients hospitalized in Canada.

The researchers propose that the initial results were perhaps because of more intensive initial treatment in US as compared to that in Canada, but the disparity disappeared in a year, perhaps because Canada's system provides better access to follow-up care and prescription drugs for the elderly.

The authors suggest further studies to explore the reasons underlying this difference in outcomes and to gain additional insights to improve the care and outcomes of heart failure patients in both countries.