Waiting for coronary revascularization: A comparison between New York State, the Netherlands and Sweden

Abstract

Objecti6e: To compare waiting times for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery in New York State, the Netherlands and Sweden and to determine whether queuing adversely affects patients' health. Methods: We reviewed the medical records of 4487 chronic stable angina patients who underwent PTCA or CABG in one of 15 New York State hospitals (n = 1021) or were referred for PTCA or CABG to one of ten hospitals in the Netherlands (n = 1980) or to one of seven hospitals in Sweden (n=1486). We measured the median waiting time between coronary angiography and PTCA or CABG. New York was 13 days compared with 35 and 42 days, respectively, in the Netherlands and Sweden (P B0.001). For CABG, New York patients waited 17 days, while Dutch and Swedish patients waited 72 and 59 days, respectively (PB 0.001). The Swedish and Dutch waiting list mortality rate was 0.8% for CABG candidates and 0.15% for PTCA candidates. Conclusions: There were large variations in waiting time for coronary revascularization among these three sites. Patients waiting for CABG were at greatest risk of experiencing an adverse event. In both the Netherlands and Sweden, the capacity to perform coronary revascularization has been expanded since this study began. Further international cooperation may identify other areas where quality of care can be improved. © 1997 Elsevier Science Ireland Ltd.

Gender, socioeconomic position, revascularization procedures and mortality in patients presenting with STEMI and NSTEMI in the era of primary PCI. Differences or inequities?

“…In the great majority of cases, differences in access have been interpreted as discrimination towards women and socially disadvantaged groups. Since delaying access to revascularization procedures increases the risk of mortality [31,32], one would expect that longer term outcomes would also follow the same socioeconomic and gender gradient; instead, the results from Piedmont do not point to such a trend. There are several possible explanations for the apparent contradiction of clear differences in access to a life-saving technology and the absence of differences in hard outcomes that deserve to be discussed.…”

Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease

“…There are reports that delays caused by waiting lists for cardiac surgery may pose risks. [26][27][28] The trial was initiated in April 1997, and one-year follow-up data were available in August 1999. Since practice evolves continuously, it is relevant to consider the differences between the techniques used in this study and newly developed techniques for coronary revascularization that may affect future practice, such as surgery without cardiopulmonary bypass and new, minimally invasive approaches.…”

Methods for studying adverse events on surgical wait lists

“…An intention-to-treat analysis of these trials, however, might have underestimated the survival benefit of surgical revascularization as a significant proportion of patients initially randomized to medical treatment crossed over to surgery. Population-based studies show that from 0.4 to 1.3% of patients scheduled for CABG die preoperatively (Bernstein et al 1997;Morgan et al 1998;Rexius et al 2004). Again, these proportions are affected by the incidence of both surgery and death.…”