Researchers at Yale School of Medicine and Ontario's Institute for Clinical Evaluative Sciences comparing notes of heart failure survival have found that short-term survival of the elderly patients are better in US than in Canada. However this proverbial advantage is said to be lost over time.
Appearing in the current Archives of Internal Medicine the study attempts to comparatively plot patterns of hospital care and its outcomes for 28,521 US Medicare patients and 8,180 Canadian patients as seen from their medical records.
Their study significantly found that within 30 days of hospitalization for heart failure compared to the Canadian sample, the US sample had a 20 percent lower risk of death and hence an advantage for survival. But a year later the differences were virtually zero. Principal investigator and professor of medicine at Yale, Dr. Harlan M. Krumholz said, "Despite being based on the same medical literature, the health care systems in the United States and Canada have very different results with respect to patients with heart failure".
He suggested that the findings raised critical questions of whether the American system proved better in providing acute care, while the Canadian system stronger in providing chronic care.
Lead author Dennis Ko from University of Toronto, suggested several potential reasons for the results. He observed that the differential results were possibly owed to "the Canadian system's emphasis on primary care” besides the fact that “all patients have health insurance, including a drug benefit”.
He said these factors possibly lead to better patient monitoring and reduced financial barriers to long-term care. The study also found that that the probability of exposure to tests and procedures were higher among US hospitalized patients, but as far as receiving medications they were equally placed with the Canadian patients.
There being hardly any biological reason for the different results, Krumholz observed, "Both systems can improve, but the American system may want to focus on outpatient care whereas the Canadian system (on) their inpatient care". He noted that the only differences if any lay in the fact that the patients “receive care in systems that are organized differently".
He said that this study therefore served to help identify “how best to configure an optimal health care delivery system” with the intention of providing patients with the best chances of survival in the short as well as long run.
The close to 2 percent difference in short term survival rates showed that patients in Canadian maybe at a disadvantage as far as survival in the in the short term pointing to a need to improve such care. At the same time the researchers also noted some differences in the prescription practices at the time of discharge.
But given the limited insights provided by medical records, a further study has been suggested to explore the differences in greater detail. With heart failure, being the most common reason for hospitalization of people aged 65 and above in both countries, the study results clearly provides pointers for improvements in geriatric care.
