Grant: Operating Grant

Although great advances have been made in the treatment of heart disease, it continues to be the leading cause of mortality and morbidity in Canada. Fueled by technological advances and evidence demonstrating their benefits, treatment of patients with heart disease has increasingly relied upon the use of cardiac procedures to improve blood flow to the heart. These procedures include angioplasty and bypass surgery procedures. In Canada, there has been an extraordinary growth of these cardiac procedures. Our group has previously shown that there was a 3-fold increased use of angioplasty and a 1.6-fold increased use in bypass surgery in the past decade. It is further projected that volume of angioplasty will continue to increase at a rapid pace. However, recent studies have questioned the appropriateness of this growth. For example, a study showed that many angioplasty and bypass surgery procedures were performed inappropriately on heart disease patients without symptoms. Inappropriate -- because the majority of these patients would not be expected to benefit even if the procedures were successful. Accordingly, our grant will examine the appropriateness of angioplasty and bypass surgery procedures. We will first determine the proportion of appropriate and inappropriate procedures in Ontario, then evaluate factors associated with appropriateness, and finally assess whether performing more appropriate procedures is associated with better outcomes. This project is very timely, unique and innovative, and it is one of the first efforts in Canada to objectively examine the clinical need for cardiac procedures. Our research has many potential implications. First, it may help to ensure all patients are getting necessary heart procedures. Second, eliminating unnecessary procedures will reduce the associated costs and waiting lists. Finally, we expect that findings from our project will have a substantial impact on the clinical use of heart procedures across Canada.