Changes in referral patterns for coronary revascularization: the impact on coronary artery bypass grafting surgery

• Main Author: Pittman, Natalia
• Format: Thesis
• Language: English
• Published: Memorial University of Newfoundland 2011
• Subjects: Canada; Newfoundland
• Online Access: https://research.library.mun.ca/11262/; https://research.library.mun.ca/11262/1/Pittman_Natalia.pdf

Background: -- Across Canada, waiting times for cardiac procedures, such as coronary artery bypass grafting (CABO), are higher than the ideal waiting time. From 1994 to 2002, there was a rapid increase in the number of patients receiving cardiac catheterizations and CABOs across Canada. The rates in Newfoundland and Labrador (NL) were higher than the Canadian average. This resulted in an extremely long waitlist with patients waiting longer than the acceptable benchmark time to have their surgery. In 2004, the number of people in Canada on cardiac surgery waitlists decreased significantly more than would be expected from simple waitlist management. The main reason is that the number of referral rates for CABO dropped dramatically. One major reason for this drop in referral rates may have been due to the introduction of drug-eluting stents in Canada in 2003. -- Objectives: -- The objective of this study is to identify changes in referral patterns for coronary revascularization and assess the impact on CABO waiting times in NL. This retrospective study will identify the changes that occurred during this time period and determine the reason(s) for these changes. -- Method: -- All 1341 patients who underwent a diagnostic cardiac catheterization in NL from ApriI 1, 2005 to September 30, 2005 were included in this study. Records from the Cardiac Program of Eastern Health were reviewed to determine referral rates, utilization rates, and wait times for percutaneous coronary intervention (PCI) and CABO procedures from 1998/1999 to 2007. The data obtained was compared to data from 1998/1999. -- Results: -- From 1998/1999 to 2005/2006 the number of coronary catheterizations increased by 21.6%. This was attributable to increased numbers of patients with stable angina, myocardial infarction or chest pain of uncertain etiology, treated not by revascularization procedures but by medical management. The proportion of patients diagnosed with critical coronary artery disease (CAD) decreased by 5%. Patients with critical CAD were ...