Annette Schultz1, Lindsey Dahl2, Elizabeth McGibbon3, Jarvis Brownlie4, Catherine Cook5, Basem Elbarouni6, Alan Katz7, Thang Nguyen6, Jo Ann Sawatzky2, Moneca Sinclaire2, Karen Throndson6, Randy Fransoo7. 1. College of Nursing Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: annette.schultz@umanitoba.ca. 2. College of Nursing Rady Faculty of Health Sciences (RFHS), University of Manitoba, Winnipeg, Manitoba, Canada. 3. Rankin School of Nursing Faculty of Health Sciences, St. Francis Xavier University, Antigonish, Nova Scotia, Canada. 4. Department of History, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada. 5. Indigenous Health, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada, First Nations, Métis and Inuit Health, Max Rady College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada. 6. St. Boniface General Hospital, Max Rady College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada. 7. Manitoba Centre for Health Policy, and College of Medicine, RFHS, University of Manitoba, Winnipeg, Manitoba, Canada.
Abstract
BACKGROUND: First Nations (FN) people experience high rates of ischemic heart disease (IHD) morbidity and mortality. Increasing access to angiography may lead to improved outcomes. We compared various outcomes and follow-up care post-index angiography between FN and non-FN patients. METHODS: All index angiography patients in Manitoba were identified between April 1, 2000 and March 31, 2009 and categorized into acute myocardial infarction (AMI) or non-AMI groups based on whether their angiogram occurred within 7 days of an AMI. Cox proportional hazard models estimated associations between FN status and outcomes related to mortality, subsequent hospitalizations, revascularizations, and physician visits. RESULTS: Cardiovascular mortality was higher among FN patients in the non-AMI group (hazard ratio [HR] = 1.50, 95% confidence interval [CI], 1.17-1.94) and in the AMI group (HR = 1.57, 95% CI, 1.05-2.35). FN patients were also more likely to have a subsequent hospitalization for AMI (HR = 2.26, 95% CI, 1.79-2.85) in the non-AMI group. FN patients in the non-AMI group were less likely to receive percutaneous coronary intervention (HR = 0.85, 95% CI, 0.73-0.99) and more likely to undergo coronary artery bypass graft (HR = 1.26, 95% CI, 1.10-1.45). FN patients in both groups were less likely to visit a cardiologist/cardiac surgeon, internal medicine specialist, or family physician within 3 months and 1 year of angiography. CONCLUSIONS: Cardiovascular health and follow-up care outcomes of FN and non-FN patients who undergo angiography are not the same. Addressing Indigenous determinants of health are necessary to improve cardiovascular outcomes.
BACKGROUND: First Nations (FN) people experience high rates of ischemic heart disease (IHD) morbidity and mortality. Increasing access to angiography may lead to improved outcomes. We compared various outcomes and follow-up care post-index angiography between FN and non-FN patients. METHODS: All index angiography patients in Manitoba were identified between April 1, 2000 and March 31, 2009 and categorized into acute myocardial infarction (AMI) or non-AMI groups based on whether their angiogram occurred within 7 days of an AMI. Cox proportional hazard models estimated associations between FN status and outcomes related to mortality, subsequent hospitalizations, revascularizations, and physician visits. RESULTS: Cardiovascular mortality was higher among FN patients in the non-AMI group (hazard ratio [HR] = 1.50, 95% confidence interval [CI], 1.17-1.94) and in the AMI group (HR = 1.57, 95% CI, 1.05-2.35). FN patients were also more likely to have a subsequent hospitalization for AMI (HR = 2.26, 95% CI, 1.79-2.85) in the non-AMI group. FN patients in the non-AMI group were less likely to receive percutaneous coronary intervention (HR = 0.85, 95% CI, 0.73-0.99) and more likely to undergo coronary artery bypass graft (HR = 1.26, 95% CI, 1.10-1.45). FN patients in both groups were less likely to visit a cardiologist/cardiac surgeon, internal medicine specialist, or family physician within 3 months and 1 year of angiography. CONCLUSIONS: Cardiovascular health and follow-up care outcomes of FN and non-FN patients who undergo angiography are not the same. Addressing Indigenous determinants of health are necessary to improve cardiovascular outcomes.
Authors: Dominique Vervoort; Donna May Kimmaliardjuk; Heather J Ross; Stephen E Fremes; Maral Ouzounian; Angela Mashford-Pringle Journal: CJC Open Date: 2022-06-04