DIFFERENCES IN FIVE YEAR OUTCOMES AND FOLLOW-UP CARE POST INDEX CORONARY ANGIOGRAPHY AMONG FIRST NATION PEOPLE AND ALL OTHER MANITOBANS

Abstract

Ischemic Heart Disease (IHD) mortality rates are decreasing among the general population, but among First Nation (FN) people a different story has unfolded. FN people are disproportionately affected by IHD as evidenced by higher rates of acute myocardial infarction (AMI), IHD hospitalizations, and mortality. While explanations for health disparities among FN populations generally focus on individual lifestyle and behavior choices, there is emerging agreement that historical and persistent colonial practices influence health status and access to healthcare. Index coronary angiography (ICA) represents entry into the cardiac care system for many patients with IHD, and it is not known whether cardiovascular disparities persist among those patients. To compare health and treatment outcomes between FN and non-FN ICA recipients; controlling for recipient characteristic differences. This retrospective cohort study analyzed administrative health data for all Manitoba adult ICA recipients between 2000/01-2008/09. Angiograms were considered index if the recipient had not received an invasive cardiac procedure (angiography, percutaneous coronary intervention [PCI], or coronary-artery bypass graft [CABG]) in the preceding 365 days. Recipients were stratified into AMI and non-AMI groups based on whether the angiogram was performed within seven days of an AMI. Adjusted Cox proportional hazards models were used to estimate associations between ethnicity and five-year all-cause mortality, cardiovascular mortality, cardiovascular-related hospitalizations, PCI, and CABG procedures. The likelihood of visiting a family physician, internist, or cardiovascular specialist at three-months and one-year was also analyzed. A total of 25,816 ICAs were identified; 6,497 AMI-related group and 19,319 non-AMI group. In both groups, FN recipients had increased all-cause and cardiovascular mortality, and subsequent hospitalizations for AMI, congestive heart failure, IHD, and all-causes within five-years. FN recipients were less likely to visit a family physician, internist, or cardiovascular specialist within three-months, or within one-year. PCI and CABG rates were not different in the AMI group, while FN recipients were more likely to undergo CABG and less likely to receive PCI in the non-AMI group. FN ICA recipients experience worse long-term health outcomes even after controlling for characteristic variables, regardless of clinical presentation. Furthermore, FN patients seem to face disparity in access to follow-up care with both family physicians and specialists. Primary and cardiac healthcare practice strategies to circumvent access disparities with cardiac follow-up services are imperative.