Better survival for heart failure patients in U.S. in short-term only: study

Elderly patients with heart failure show better short-term survival rates in the U.S. compared to Canada, but the long-term survival rates are about equal between the two countries, a new study suggests.

In heart failure, the ventricles or lower chambers of the heart are unable to pump blood effectively. The condition is the most common cause of hospitalization for people aged 65 or over in both countries.

Dr. Dennis Ko of the University of Toronto and colleagues compared hospital care and 30-day and one-year mortality rates for 28,521 patients in the U.S. and 8,180 patients in Ontario. Patients in both groups had a mean age of 80 years.

The death rate at 30 days was 8.9 per cent for the U.S. and 10.7 per cent for Canadian patients, according to the team's analysis of anonymous medical records from 1998 to 2001.

At one year, the difference disappeared (32.2 versus 32.3 per cent). Factors such as age, blood pressure and other factors including hypertension and hospital size were taken into account for both groups.

"We could not assess the possible reasons for this finding, but differences in health care provision in the two countries may play an important role," the investigators wrote in the Nov. 28 issue of the Archives of Internal Medicine.

"It is plausible that better short-term outcomes in the United States may relate to the intensity of hospital care, and the similar long-term outcomes between the countries may reflect better access in Canada to outpatient follow-up and prescription drugs."

Budget constraints and resulting hospital bed shortages mean Canadian physicians are more likely to admit higher-risk patients with heart failure, while lower-risk patients would be hospitalized in the U.S., the study's authors noted.

Less than one-third of patients in both countries were discharged from hospital with a prescription for beta-blockers, which are commonly prescribed for heart patients.

Of patients in the U.S., 53.4 per cent were prescribed angiotensin-converting enzyme inhibitors, another class of heart medication, compared to 63.4 per cent in Canada.

Previous studies in Canada have recommended raising the number of patients who leave hospital with prescriptions for heart medications to optimal levels.