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CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1992 Mar 15;146(6):851–859.

Coronary artery bypass grafting in Canada: What is its rate of use? Which rate is right?

C D Naylor 1, A M Ugnat 1, D Weinkauf 1, G M Anderson 1, A Wielgosz 1
PMCID: PMC1488668  PMID: 1544075

Abstract

We reviewed recent reports from administrative databases and clinical registries addressing the utilization of coronary artery bypass grafting (CABG) in Canada. The Canadian CABG rate per 100,000 people increased from 31.1 to 43.2 between 1981-82 and 1986-87. Between 1981 and 1986 the rate in the United States increased from 69.9 to 95.3 per 100,000, consistently about two times the Canadian rate. Provincial data have shown particular growth in utilization among elderly people. However, in the United States the 1985 CABG rate was twice as high as the aggregated age-specific rates for Ontario and Manitoba among people 65 to 74 years of age and four times higher among those 75 years or more. Limited registry data suggest that the Canadian CABG case mix is similar to the case mix in major US centres and that, utilization growth notwithstanding, the procedure is largely applied to patients who should, in theory, benefit (i.e., those with severe angina, impaired left ventricular function and left main-stem or triple-vessel disease). However, chart audits and registry evaluations using explicit criteria are needed to compare the use of CABG in Canada and the United States. In addition, Canadian data show moderate regional and municipal variations, the 1986-87 rates per 100,000 population in major census metropolitan areas varying from 19.5 to 46.9. Areas with consistently low rates raise particular concerns about impaired access to CABG. Reasons for variations should therefore be a research priority.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson G. M., Lomas J. Monitoring the diffusion of a technology: coronary artery bypass surgery in Ontario. Am J Public Health. 1988 Mar;78(3):251–254. doi: 10.2105/ajph.78.3.251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Anderson G. M., Lomas J. Regionalization of coronary artery bypass surgery. Effects on access. Med Care. 1989 Mar;27(3):288–296. doi: 10.1097/00005650-198903000-00007. [DOI] [PubMed] [Google Scholar]
  3. Anderson G. M., Newhouse J. P., Roos L. L. Hospital care for elderly patients with diseases of the circulatory system. A comparison of hospital use in the United States and Canada. N Engl J Med. 1989 Nov 23;321(21):1443–1448. doi: 10.1056/NEJM198911233212105. [DOI] [PubMed] [Google Scholar]
  4. Brook R. H., Chassin M. R., Fink A., Solomon D. H., Kosecoff J., Park R. E. A method for the detailed assessment of the appropriateness of medical technologies. Int J Technol Assess Health Care. 1986;2(1):53–63. doi: 10.1017/s0266462300002774. [DOI] [PubMed] [Google Scholar]
  5. Brook R. H., Kosecoff J. B., Park R. E., Chassin M. R., Winslow C. M., Hampton J. R. Diagnosis and treatment of coronary disease: comparison of doctors' attitudes in the USA and the UK. Lancet. 1988 Apr 2;1(8588):750–753. doi: 10.1016/s0140-6736(88)91550-4. [DOI] [PubMed] [Google Scholar]
  6. Campeau L. Letter: Grading of angina pectoris. Circulation. 1976 Sep;54(3):522–523. [PubMed] [Google Scholar]
  7. Chassin M. R., Kosecoff J., Park R. E., Winslow C. M., Kahn K. L., Merrick N. J., Keesey J., Fink A., Solomon D. H., Brook R. H. Does inappropriate use explain geographic variations in the use of health care services? A study of three procedures. JAMA. 1987 Nov 13;258(18):2533–2537. [PubMed] [Google Scholar]
  8. Davis P. K., Parascandola S. A., Miller C. A., Campbell D. B., Myers J. L., Pae W. E., Pierce W. S., Wisman C. B., Waldhausen J. A. Mortality of coronary artery bypass grafting before and after the advent of angioplasty. Ann Thorac Surg. 1989 Apr;47(4):493–498. doi: 10.1016/0003-4975(89)90422-0. [DOI] [PubMed] [Google Scholar]
  9. Folland S., Stano M. Small area variations: a critical review of propositions, methods, and evidence. Med Care Rev. 1990 Winter;47(4):419–465. doi: 10.1177/107755879004700403. [DOI] [PubMed] [Google Scholar]
  10. Gray D., Hampton J. R., Bernstein S. J., Kosecoff J., Brook R. H. Audit of coronary angiography and bypass surgery. Lancet. 1990 Jun 2;335(8701):1317–1320. doi: 10.1016/0140-6736(90)91196-h. [DOI] [PubMed] [Google Scholar]
  11. Iezzoni L. I., Burnside S., Sickles L., Moskowitz M. A., Sawitz E., Levine P. A. Coding of acute myocardial infarction. Clinical and policy implications. Ann Intern Med. 1988 Nov 1;109(9):745–751. doi: 10.7326/0003-4819-109-9-745. [DOI] [PubMed] [Google Scholar]
  12. Leape L. L., Park R. E., Solomon D. H., Chassin M. R., Kosecoff J., Brook R. H. Does inappropriate use explain small-area variations in the use of health care services? JAMA. 1990 Feb 2;263(5):669–672. [PubMed] [Google Scholar]
  13. Martin C. A., Hobbs M. S., Armstrong B. K., de Klerk N. H. Trends in the incidence of myocardial infarction in Western Australia between 1971 and 1982. Am J Epidemiol. 1989 Apr;129(4):655–668. doi: 10.1093/oxfordjournals.aje.a115182. [DOI] [PubMed] [Google Scholar]
  14. Morgan P. P., Cohen L. The Ottawa Heart Institute: it's good, but can we afford it? CMAJ. 1990 Mar 15;142(6):616–620. [PMC free article] [PubMed] [Google Scholar]
  15. Morin J. E., Symes J. F., Guerraty A. J., Poirier N. L., Sampalis J. Coronary artery bypass profile in Canada and the United States. Can J Cardiol. 1990 Oct;6(8):319–322. [PubMed] [Google Scholar]
  16. Naunheim K. S., Fiore A. C., Wadley J. J., McBride L. R., Kanter K. R., Pennington D. G., Barner H. B., Kaiser G. C., Willman V. L. The changing profile of the patient undergoing coronary artery bypass surgery. J Am Coll Cardiol. 1988 Mar;11(3):494–498. doi: 10.1016/0735-1097(88)91522-7. [DOI] [PubMed] [Google Scholar]
  17. Naylor C. D. A different view of queues in Ontario. Health Aff (Millwood) 1991 Fall;10(3):110–128. doi: 10.1377/hlthaff.10.3.110. [DOI] [PubMed] [Google Scholar]
  18. Naylor C. D. Coronary artery bypass surgery rates in Ottawa. CMAJ. 1990 Dec 15;143(12):1287–1287. [PMC free article] [PubMed] [Google Scholar]
  19. Naylor C. D., Jaglal S. B. Impact of intravenous thrombolysis on short-term coronary revascularization rates. A meta-analysis. JAMA. 1990 Aug 8;264(6):697–702. [PubMed] [Google Scholar]
  20. Park R. E., Fink A., Brook R. H., Chassin M. R., Kahn K. L., Merrick N. J., Kosecoff J., Solomon D. H. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Public Health. 1986 Jul;76(7):766–772. doi: 10.2105/ajph.76.7.766. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Peters S., Chagani K., Paddon P., Nair C. Coronary artery bypass surgery in Canada. Health Rep. 1990;2(1):9–26. [PubMed] [Google Scholar]
  22. Rahimtoola S. H. A perspective on the three large multicenter randomized clinical trials of coronary bypass surgery for chronic stable angina. Circulation. 1985 Dec;72(6 Pt 2):V123–V135. [PubMed] [Google Scholar]
  23. Roos L. L., Sharp S. M. Innovation, centralization, and growth. Coronary artery bypass graft surgery in Manitoba. Med Care. 1989 May;27(5):441–452. [PubMed] [Google Scholar]
  24. Roos L. L., Sharp S. M., Wajda A. Assessing data quality: a computerized approach. Soc Sci Med. 1989;28(2):175–182. doi: 10.1016/0277-9536(89)90145-7. [DOI] [PubMed] [Google Scholar]
  25. Roos N. P., Roos L. L., Jr, Henteleff P. D. Elective surgical rates--do high rates mean lower standards? Tonsillectomy and adenoidectomy in Manitoba. N Engl J Med. 1977 Aug 18;297(7):360–365. doi: 10.1056/NEJM197708182970705. [DOI] [PubMed] [Google Scholar]
  26. Wennberg J. Which rate is right? N Engl J Med. 1986 Jan 30;314(5):310–311. doi: 10.1056/NEJM198601303140509. [DOI] [PubMed] [Google Scholar]
  27. Winslow C. M., Kosecoff J. B., Chassin M., Kanouse D. E., Brook R. H. The appropriateness of performing coronary artery bypass surgery. JAMA. 1988 Jul 22;260(4):505–509. [PubMed] [Google Scholar]
  28. van Walraven C., Wang B., Ugnat A. M., Naylor C. D. False-positive coding for acute myocardial infarction on hospital discharge records: chart audit results from a tertiary centre. Can J Cardiol. 1990 Nov;6(9):383–386. [PubMed] [Google Scholar]

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