Canadian researchers call for more angiograms

07/05/05

More tests need to be prescribed to save and prolong the lives of Canadians living with coronary artery disease, says a study released today from the University of Alberta.

The research shows that the more Alberta physicians prescribe cardiac catheterizations--also know as angiograms--to detect people with coronary artery disease, the more people they are finding who have high-risk blockages and who would benefit from therapeutic treatment, such as bypass surgery and angioplasty. "We're not doing enough to test people in Alberta, and, as Alberta is among the leading provinces in Canada in performing angiograms per capita, we can safely say that we need to be doing a lot more of these procedures across the country," said Dr. Michelle Graham, a cardiologist at the U of A and lead author of the study, which appears today in the Canadian Medical Association Journal.

According to Statistics Canada, cardiovascular diseases cause more deaths in Canada than any other disease, and 54 per cent of all cardiovascular deaths are due to coronary artery disease. In 2002 (the latest year for which Statistics Canada has data), cardiovascular diseases caused 74,626 Canadian deaths.

According to Graham's study, an average of 525 men and 240 women per 100,000 in Alberta received angiograms each year between 1995 and 2002.

"We would like to see much higher rates of testing in both men and women," said Graham. "We haven't yet reached the optimal rate, but we will know when we do because the rate of testing and the rate of high-risk disease detections will level off--we haven't seen that yet."

Graham's research also showed that of the people who received angiograms and fell into the "high-risk" category, about 75 per cent were eligible to receive potentially life-saving bypass surgery or angioplasty.

However, Graham noted, it is important to ensure that every patient who receives an angiogram truly needs one. The procedure, which involves injecting a patient's coronary arteries with a special dye that doctors can track, can be risky. Potential complications include heart attack, stroke, and even death.

The procedure is also expensive. Due to the related costs of angiograms, including the need for special equipment and trained personnel, the procedure is currently conducted in Alberta in just two cities: Edmonton (at the University of Alberta and Royal Alexandra Hospitals) and Calgary (at the Foothills Hospital).

"It's a challenge, because the risks and costs associated with angiograms are such that you don't want to test everyone--you only want to test patients who have the appropriate indications for the procedure. But, even still, our research shows that we need to be performing more of them to detect and save those people who are at risk," said Graham.

Graham added that Canada is about the middle of the pack among developed nations in terms of angiograms prescribed per capita (with the U.S. prescribing by far the most), so there are many other places around the world where increased use of angiograms would result in more high-risk people being detected and subsequently treated.

Graham and her colleagues in the study were able to compile their results through access to a comprehensive database managed by the Alberta Provincial Project for Outcomes Assessment in Coronary Heart disease (APPROACH) project, and a team of researchers at the U of A and the University of Calgary.

"We are uniquely positioned to do this research in Alberta thanks to the APPROACH database," said Graham. "And now we are seeing the other provinces, and even countries, follow suit and create similar databases of their own."

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