Investigators at the School of Medicine and the Institute for Clinical Evaluative Sciences in Ontario, Canada, report that elderly heart-failure patients hospitalized in the United States have better short-term survival than those in Canada, but lose that advantage over time.
Published in the Nov. 28 issue of Archives of Internal Medicine, the study compared the patterns of care and outcomes of 28,521 Medicare patients with 8,180 similarly aged patients hospitalized in Canada. Compared to Canadian patients, those in the United States had almost a 20% lower risk of dying within 30 days of being hospitalized for heart failure, but by one year there was virtually no difference in the survival rates.
"Despite being based on the same medical literature, the health care systems in the United States and Canada have very different results with respect to patients with heart failure," says principal investigator Dr. Harlan M. Krumholz, the Harold H. Hines Professor of Internal Medicine and director of Yale-New Haven Hospital Center for Outcomes Research and Evaluation.
"The findings raise questions about whether the American system is poised to provide better acute care, whereas the Canadian system is better positioned to provide chronic care," he notes.
Dr. Dennis Ko, lead author of the article and assistant professor at the University of Toronto, says there are several potential explanations for the results. "The Canadian system has a greater emphasis on primary care, and all patients have health insurance, including a drug benefit. It is possible that our approach leads to better patient follow-up and fewer financial barriers to care," explains Ko.
The study also showed that patients hospitalized in the United States were more likely to undergo tests and procedures, but just as likely to receive medications.
"Both systems can likely improve, but the American system may want to focus attention on outpatient care whereas the Canadian system may want to examine their inpatient care more closely," says Krumholz. "There is no reason for the different outcomes among patients in the United States and Canada except that they receive care in systems that are organized differently. We can take advantage of this natural experiment to learn how best to configure an optimal health care delivery system that puts our patients in the best position to do well in the short and long run."
Other authors on the study included Dr. Jack V. Tu, Dr. Frederick A. Masoudi, Yongfei Wang, Dr. Edward P. Havraneck, Saif S. Rathore, Alice M. Newman, Linda R. Donovan, Dr. Douglas S. Lee and Dr. JoAnne M. Foody.
-- By Karen Peart
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