Department of Medicine, Faculty of Medicine, University of Calgary, Foothills Medical Centre-North Tower, 9th Floor, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada.
BMC Health Serv Res. 2011 Nov 24;11:323. doi: 10.1186/1472-6963-11-323.
There is variation in cardiac catheterization utilization across jurisdictions. Previous work from Alberta, Canada, showed no evidence of a plateau in the yield of high-risk disease at cardiac catheterization rates as high as 600 per 100,000 population suggesting that the optimal rate is higher. This work aims 1) To determine if a previously demonstrated linear relationship between the yield of high-risk coronary disease and cardiac catheterization rates persists with contemporary data and 2) to explore whether the linear relationship exists in other jurisdictions.
Detailed clinical information on all patients undergoing cardiac catheterization in 3 Canadian provinces was available through the Alberta Provincial Project for Outcomes Assessment in Coronary Heart (APPROACH) disease and partner initiatives in British Columbia and Nova Scotia. Population rates of catheterization and high-risk coronary disease detection for each health region in these three provinces, and age-adjusted rates produced using direct standardization. A mixed effects regression analysis was performed to assess the relationship between catheterization rate and high-risk coronary disease detection.
In the contemporary Alberta data, we found a linear relationship between the population catheterization rate and the high-risk yield. Although the yield was slightly less in time period 2 (2002-2006) than in time period 1(1995-2001), there was no statistical evidence of a plateau. The linear relationship between catheterization rate and high-risk yield was similarly demonstrated in British Columbia and Nova Scotia and appears to extend, without a plateau in yield, to rates over 800 procedures per 100,000 population.
Our study demonstrates a consistent finding, over time and across jurisdictions, of linearly increasing detection of high-risk CAD as population rates of cardiac catheterization increase. This internationally-relevant finding can inform country-level planning of invasive cardiac care services.
心脏导管检查的利用率在司法管辖区之间存在差异。加拿大艾伯塔省的先前研究表明，在心脏导管检查率高达 600/10 万的情况下，高危疾病的检出率并没有达到平台期，这表明最佳检查率更高。本研究旨在：1）确定在使用当代数据时，高危冠状动脉疾病的检出率与心脏导管检查率之间是否存在先前证明的线性关系；2）探讨这种线性关系是否存在于其他司法管辖区。
通过艾伯塔省冠状动脉心脏病评估项目（APPROACH）疾病和不列颠哥伦比亚省及新斯科舍省的合作计划，获得了加拿大 3 个省所有接受心脏导管检查的患者的详细临床信息。这些省份中每个卫生区域的心脏导管检查和高危冠状动脉疾病检出率以及使用直接标准化方法产生的年龄调整率。采用混合效应回归分析评估导管检查率与高危冠状动脉疾病检出率之间的关系。
在当代艾伯塔省数据中，我们发现人群导管检查率与高危检出率之间存在线性关系。尽管在时间段 2（2002-2006 年）的检出率略低于时间段 1（1995-2001 年），但没有统计学证据表明存在平台期。不列颠哥伦比亚省和新斯科舍省也显示出类似的导管检查率与高危检出率之间的线性关系，并且这种关系似乎在检出率没有达到平台期的情况下，延伸到了每 10 万人口 800 次以上的检查率。
我们的研究表明，随着时间的推移和司法管辖区的不同，人群心脏导管检查率的增加与高危 CAD 检出率的线性增加之间存在一致的发现。这一具有国际相关性的发现可以为国家层面的介入性心脏护理服务规划提供信息。
