Death rates from coronary heart disease in New Zealand are among the highest in the world although they have steadily fallen since a peak in 1968. The health care system is largely publicly funded with most cardiologi...
详细信息
Death rates from coronary heart disease in New Zealand are among the highest in the world although they have steadily fallen since a peak in 1968. The health care system is largely publicly funded with most cardiologists being salaried, although there has been a growth in fee-far-service private practice. Waiting times in public hospitals for bypass surgery can be years for chronic stable angina. The publicly funded health care system is being reformed. In 1993 there were in New Zealand, for a population of just less than 3.5 million: 6,227 coronary angiograms;1,365 percutaneous interventions;and 1,513 coronary artery bypass only operations. The percutaneous intervention rate was 391 per million. There has been an increase in new device use so that in Auckland 11% of percutaneous interventions involved new devices.
Background Implementation of the complex treatment strategies that have been shown to improve survival of patients with congestive heart failure (CHF) may require certain expertise. We wanted to examine the associatio...
详细信息
Background Implementation of the complex treatment strategies that have been shown to improve survival of patients with congestive heart failure (CHF) may require certain expertise. We wanted to examine the association between pattern of outpatient care and survival of patients with CHF. Methods In a retrospective cohort study conducted with national Veterans Health Administration (VHA) databases, we examined the association between the pattern of outpatient care and survival in 11,661 patients discharged from VA hospitals between October 1, 1991, and September 30, 1992, with the primary diagnosis of CHF (cohort 1). Patients were divided into 4 groups, on the basis of their pattern of outpatient care over a 12-month period after discharge: 1) general medicine clinic visits only (GM-only);2) cardiology clinic visits only (CARD-only);3) general medicine and cardiology (MIXED) clinic visits;and 4) neither general medicine nor cardiology clinic visits (no-GM/CARD). We used the Cox proportional hazards model to evaluate 1-year survival, controlling for clinical and demographic factors. Consistency of our results was examined by performing identical analysis on a cohort of patients discharged from VHA hospitals between October 1, 1994, and September 30, 1995 (cohort 2, n 10, 141). Results The overall 1-year mortality rate was 23% in the primary cohort. The unadjusted mortality rate was highest for patients in the no-GM/CARD follow up (29%) and lowest for patients in the MIXED group (19%). By use of the MIXED group as reference and adjusting for important clinical and demographic factors, the risk of death (risk ratio [95% CI]) was 1.12 (0.94-1.34) in the CARD-only group, 1.26 (1.15-1.38) in the GM-only group, and 1.48 (1.28-172) in the no-GM/CARD group. Cohort-2 results were consistent with cohort 1 for most covariates, and significant survival differences were again found between GM-only and the MIXED group (1.25 [1.14-1.37]). Conclusions We found an improved survival as
暂无评论