Cardiac health of Albertans improving, shows study

A new analysis of cardiac procedures performed across the province from 2003 to 2010 shows the heart health of Albertans may be improving.

Although the raw number of cardiac procedures hasn’t changed significantly during that period, figures adjusted for population growth tell a different story.

For example, the number of coronary artery bypass surgeries in the province fell from 84 per 100,000 people in 2003, to 42 per 100,000 in 2010. The number of cardiac catheterizations, in which a catheter is inserted into an artery or chamber of the heart to assess damage, fell from 480 per 100,000 in 2003 to 430 per 100,000 in 2010.

“It’s difficult to draw definitive conclusions from the data but they suggest at least two possibilities,” says Dr. Sean McMurtry, lead author of the research study and a cardiologist at the Mazankowski Alberta Heart Institute.

“It may be that many Albertans have reduced their cardiovascular risk factors by quitting smoking, eating better and exercising more, thereby improving population health. However, medical practice has also changed, with angioplasty being used more frequently as a treatment option than cardiac bypass surgery,” says Dr. McMurtry, who is also an assistant professor in the University of Alberta’s Faculty of Medicine and Dentistry.

“Given the increased population in Alberta over the study period and the falling rates of acute coronary syndromes, or heart attacks, we’re treating, this is very suggestive of improving cardiac health.”

In angioplasty, a cardiologist attempts to remove obstructions in arteries by inserting a catheter with a special balloon on the end which, when inflated, opens up the fatty deposits clogging the vessel. A stent, or tube, is then usually inserted to help keep the artery open. In bypass surgery, a blood vessel from the patient is grafted onto a coronary

artery to bypass damage or narrowing caused by atherosclerosis, or hardening of the arteries.

The paper reports other interesting findings:
• Rates of cardiac catheterization for the Edmonton and Calgary zones declined more than did rates for other zones.
• Cases of acute coronary syndrome, the term used for symptoms caused by obstruction in the coronary arteries, fell from 435 per 100,000 in 2000 to 281 per 100,000 in 2010.
• The absolute number of bypass surgeries has declined from 2,013 in 2003 to 1,266 in 2009.

Dr. Merril Knudtson (photo by Paul Rotzinger courtesy of Alberta Health Services)

Alberta is unique in the country in maintaining a comprehensive database of information about cardiac procedures called the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease, or APPROACH.

Begun in 1995 by Dr. Merril Knudtson of the Libin Cardiovascular Institute of Alberta, an entity of both Alberta Health Services (AHS) and the University of Calgary, APPROACH currently tracks more than 200,000 patients with chronic heart disease in the province.

“Ultimately the information helps physicians, administrators and even patients make the most informed decisions they can when it comes to cardiovascular health care,” says Dr. Knudtson, who is also a co-author of the study. “At the same time, there is a dynamic and complex interplay of factors and the data doesn’t always lend itself to conclusive, black-and-white interpretation.”

For example, the research paper notes there are geographic differences in the use of cardiac procedures, with northern Alberta consistently having higher rates of use than the provincial average and southern Alberta consistently having lower rates than the provincial average.”

“We know that people in the non-urban regions of our province, especially the north, carry a greater burden of risk factors and prevalence of heart disease than the two largest cities,” says Dr. Blair O’Neill, Senior Medical Director of the Cardiovascular Health and Stroke Strategic Clinical Network for Alberta Health Services.

“One of our goals as one health system is to reduce geographic inequities to care. It is reassuring that people living in zones without advanced cardiac facilities appear to have equitable access to cardiac procedures,” Dr. O’Neill adds.

Although the news about apparent improvements in cardiovascular health is encouraging, people still need to pay attention to their own heart health.

“Cardiovascular disease kills thousands of Albertans every year,” Dr. McMurtry says. “It’s encouraging that we may be seeing improvements in the area, but everyone still needs to reduce their risk factors by quitting smoking, eating a healthy diet and getting enough exercise.”

“Recent Temporal Trends and Geographic Distribution of Cardiac Procedures in Alberta” is to be published in the Canadian Journal of Cardiology. It was published online earlier this year.

Related media coverage

“Albertans are taking better care of their heart health: analysis” Calgary Herald

“Albertans Getting the Heart Smart Message” Metro News

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