Rising Rates of Cardiac Procedures in the United States and Canada

Abstract

Publicly funded Medicare programs in the United States and Canada face daunting fiscal challenges in the decades ahead. Since 1965, the US Medicare program has provided access to physicians and hospitals for elderly Americans, and the Canadian Medicare program has provided similar coverage for Canadians of all ages since 1967. Paying for growing numbers of enrollees in these Medicare programs to receive effective but expensive tests and treatments has begun to strain government budgets and the tax systems that support them. Article pp 374 and 380 The stakes are particularly high for patients with coronary heart disease (CHD). As a leading cause of mortality and morbidity in both countries, CHD remains a fertile field of innovation to improve health outcomes. If new tests and treatments are used indiscriminately, however, their impact may be minimal for many patients, deleterious for some patients, and costly for society. Two studies in this issue of Circulation document the dramatic rise in cardiac procedures since 1992 in the United States and Canada, respectively.1,2 Each of these studies used claims data from its Medicare program to assess rates of acute myocardial infarction (AMI) and cardiac procedures through 2001 and to estimate the diagnostic “yield” of stress tests and cardiac catheterizations that led to subsequent procedures. The US study included all elderly adults receiving fee-for-service care in the US Medicare program,1 and the Canadian study included adults of all ages residing in Ontario.2 In both countries, increases in procedure rates over time were most pronounced for stress imaging studies, cardiac catheterizations, and coronary angioplasty, whereas rates of AMI as a marker of CHD prevalence were relatively constant. By 2001, cardiac procedure rates for elderly patients in Ontario approached but did not yet exceed the corresponding rates for elderly patients in the United States during …