Cardiac Care Services · 2020-02-07 · Cardiac Care Services in Waterloo Regional Municipality and Wellington and Dufferin Counties (WRWD) 2003 Update 1.0 Background In coronary

Waterloo Region Wellington Dufferin~ ~DISTRICT HEALTH COUNCIL

Cardiac Care Services in

Waterloo Regional Municipality and

Wellington and Dufferin Counties

November 2003 -- Update

Cardiac Care Services in Waterloo Regional Municipality and Wellington and Dufferin Counties (WRWD)

2003 Update 1.0 Background

In coronary artery disease (CAD), blockages in the blood vessels that supply the heart (coronary arteries) lead to angina (chest pain) or heart attacks (death of heart muscle). Heart disease is the leading cause of death and hospitalization in Waterloo Regional Municipality and Wellington-Dufferin Counties.

• In 1999 there were 253 deaths from heart attack (Myocardial Infarction) in the Region of Waterloo, 122 in Wellington County and 39 in Dufferin County.

• In 2001, 941 residents of Waterloo RM, 376 of Wellington County, and 98 of Dufferin County were admitted to hospital as a result of a heart attack.

Primary prevention through healthy lifestyles (smoking cessation, physical activity, heart healthy eating, maintaining healthy weight) remains the most important strategy for reducing the burden of cardiovascular disease1,2. In the 2001 Canadian Community Health Survey, a high proportion of WRWD residents aged 20 – 64 years reported the following heart disease risk factors3:

• 55% were physically inactive; • 26% were current smokers; • 38% were overweight (body mass index > 27); • 57% consumed fewer than 5 fruits or vegetables per day.

Based on the high percentage of WRWD residents with at least one of the above risk factors, heart disease will continue to place significant demands on the health care system in the district. This report examines the use of hospital-based cardiac services by residents of WRWD and in particular how this use has changed with the start up of the cardiac catheterization unit at St. Mary’s General Hospital in Kitchener. The specific services under study are described below. 1.1 Cardiac Catheterizations (CCath) Heart specialists use this hospital-based procedure to look for blockages in the individual arteries that carry blood to the heart muscle. This test combines injecting quantities of dye through a narrow tube inside the heart with taking x-ray pictures from outside. The combination provides the doctor with a clear picture of where arteries are clogged. Knowing the location of blockages in the arteries helps the physician advise the patient about the best treatment: medicines, surgery, or percutaneous coronary interventions (PCI).

• St. Mary’s General Hospital (SMGH), Kitchener began performing CCaths in February 2001.

• CCaths can be done either as a day patient or in-patient procedure. 1.2 Percutaneous Coronary Intervention (PCI) PCIs are procedures that use small inflatable balloons and other devices to open blocked blood vessels. Doctors insert these through the skin in the groin area and thread them up through blood vessels into the coronary arteries. They then use these devices to open the blockages.

1 Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, Ellis ST, Lincoff AM, Topol EJ. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA, 2003 290:898-904. 2 Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, Wilson PW. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA, 2003 20;290(7):891-7. 3 2001 Canadian Community Health Survey, Ontario electronic share file, weighted data. Ontario Ministry of Health and Long Term Care, 2002.

WRWDDHC 2003 Cardiac Care Brief Report, November 2003 Pg. 1 of 1

PCIs are easier on patients than heart surgery and less expensive to carry out. They are effective for many, but not all patients. Physicians may decide to proceed directly to a PCI in the same session as the cardiac catheterization – these are called ‘ad hoc PCIs’. In Ontario, there has been a large increase in PCIs over the past decade and in 2002/2003, 40% of all PCIs were ad hoc procedures4.

• St. Mary’s GH began performing PCIs in July 2003; until then residents from WRWD underwent PCIs, including ad hoc PCIs at other cardiac centers.

• The data for this report only includes procedures completed to the end of the 2002 fiscal year (March 31, 2003) and therefore does not include any PCIs performed at St. Mary’s.

1.3 Coronary Artery Bypass Graft (CABG) Coronary artery bypass graft or CABG (pronounced 'cabbage') is a type of heart surgery in which a blood vessel from another part of the body is grafted between the aorta (the main artery leading from the heart) and one or more coronary arteries to bypass blockages and restore blood flow to the heart. A bypass can be done on each of the four coronary arteries and is called single, double, triple or quadruple CABG depending on how many arteries are bypassed.

• St. Mary’s GH began performing CABGs in July 2003; until then residents from WRWD underwent CABGs at other cardiac centers.

• The data for this report only includes surgeries completed to the end of the 2002 fiscal year (March 31, 2003) and therefore does not include any CABGs performed at St. Mary’s.

1.4 Ontario Cardiac Care Centres Table 1 lists the 17 cardiac care centres in Ontario and the procedures that they provided in 2002/2003. These centres report directly to the Ontario Cardiac Care Network. In addition, as part of hospital reporting procedures, data from these centers are also submitted to the Canadian Institute for Health Information. Both sets of data are used in this report. Table 1. Ontario Cardiac Care Centres and Services Provided in 2002/2003

Cardiac Care Centre Procedures Provided in 2002/2003

Thunder Bay Regional Hospital Peterborough Regional Health Centre Hotel Dieu Grace Hospital (Windsor) Southlake Regional Health Centre (Newmarket) *St. Mary’s General Hospital, Kitchener

CCath only

Rouge Valley Health System (Scarborough) CCath + PCI University of Ottawa Heart Institute Sault Area Hospitals Kingston General Hospital Sudbury Regional Hospital St. Michael’s Hospital (Toronto) London Health Sciences Centre Sunnybrook & Women’s College Health Sciences Toronto East General Hospital Trillium Health Centre (Mississauga) University Health Network (Toronto) Hamilton Health Sciences

CCath, PCI, CABG

* PCI + CABG were added to services at St. Mary’s in July 2003.

4 2002/2003 Annual Statistical Report, Cardiac Care Network of Ontario, Toronto, July 2003.


This report provides a summary of the data on cardiac services for WRWD residents. A description of the methodology for the analysis and expanded data tables and are provided in Appendices A and B respectively. 2.0 Cardiac Service Patterns for WRWD Residents 2.1 Cardiac Catheterization Services Figure 1 provides a map of the WRWD district and the location of the closest cardiac care centers. Figures 2 to 4 illustrate that the pattern of CCath service use is influenced by the proximity of WRWD residents to these cardiac centers; patients prefer to use services ‘close to home’. For example, after the opening of the cardiac catheterization unit at St. Mary’s General hospital, the proportion of Waterloo residents having CCaths in London dropped from 54% in 2000 to 9% in 2001 and in Hamilton from 26% to 10%. However the opening of the CCath unit at St. Mary’s had little impact on residents of Dufferin County - fewer than 5 Dufferin County residents had CCaths performed there in 2001 or 2002. But the opening of the much closer CCath unit at Southlake HC in Newmarket resulted in Dufferin residents using this center for 32% of their CCaths in 2002. (Note: the most recent data available for this report are up to March 31 2003 and therefore do not include cardiac service use since the initiation of PCI services at St. Mary’s GH (July, 2003)) Figure 1. Map of Waterloo RM, Wellington and Dufferin Counties and the closest cardiac care centers.

Newmarket

Mississauga

Toronto

Hamilton

Cambridge

WaterlooGuelph

London

Kitchener

Orangeville


Cardiac Care

Waterloo RM

Wellington County

Dufferin County

2.2 Cardiac Catheterizations – Waterloo Regional Municipality Residents As expected, the opening of the cardiac catheterization (CCath) unit at St. Mary’s General Hospital in Kitchener had the greatest impact on residents of Waterloo Regional Municipality. Figure 2 below provides a breakdown of the cardiac center location for all CCaths performed on residents of the region from 1996 to 2002. By 2002 fiscal year, 82% of all CCaths for Waterloo RM residents were performed at St. Mary’s and the number of CCaths performed had increased to 1226 (1241 in 2001) from a low of 959 in 1998. It is expected that the opening of the PCI unit at St. Mary’s (July 2003) has further increased this proportion since this unit allows patients to undergo catheterizations and proceed to PCI in the same session (ad hoc PCIs). Ad hoc PCIs have increased in Ontario over the past few years as mentioned previously.

Figure 2. Cardiac Catheterizations for Waterloo RM Residents, by Cardiac Care Centre Performing the Procedure, 1996-2002

990 1000

0

200

400

600

800

1000

1200

1400

1996 1997 1998 1999 2000 2001-CCN

2002-CCN

#CC

ath

St. Mary's London Trillium Other Ont.

Hamilton Toronto

Source: 1996-2000 - CIHI Moribidity database, Provincial Health Planning Database, MOHLTC, April 2003. 2001-2002 - 2001/2002 and 2002/2003 Annual Statistical Reports, Cardiac Care Network of Ontario, Toronto, 2003. Note: 2002 (fiscal year) CCaths totals may have been affected by the SARS outbreak in Toronto which resulted in reductions in most health care services in southern Ontario during March, 2003.

• Volume of CCaths increased from 1,074 in 1996 to a high of 1,241 in 2001/02; • Number of CCaths in 2002/03 (1,226) was likely lower than in 2001/02 because of

reductions in service resulting from the SARS outbreak in Ontario; • CCath rates increased from 351/100000 adult population in 1996/97 to 374 in 2001/02; • CCath rate for Waterloo RM is still 21% below the 2003/04 target of 474/100000 adult

population; • Large numbers of Waterloo RM residents continued to go to other cardiac care centers

for CCaths in 2002/03 including Hamilton (167, 8% of CCaths), London (97, 5%), and Toronto hospitals (180, 9%);

• Median wait times for outpatient CCaths at the most frequently used hospitals were: St. Mary’s GH, 13 days; Hamilton Health Sciences, 54 days; London Health Sciences, 29 days; University Health Network (Toronto), 26 days; Trillium Health Centre, 28 days;

• Median wait times for inpatient CCaths were: St. Mary’s GH, 2 days; Hamilton, 3 days; London, 2 days; University Health Network, 1 day; Trillium HC, 4 days.


2.3 Cardiac Catheterizations – Wellington County Residents The opening of the cardiac catheterization (CCath) unit at St. Mary’s General Hospital in Kitchener had an impact on residents of Wellington County, particularly in 2002/03, the second full year of operation. Figure 3 below provides a breakdown of the cardiac center location for all CCaths performed on residents of Wellington C from 1996 to 2002 fiscal years. By 2002 fiscal year, 68% (419) of Wellington residents CCaths were performed at St. Mary’s, up from 49% (254) in 2001.

Figure 3. Cardiac Catheterizations for Wellington County Residents, by Cardiac Care Centre Performing the Procedure,

1996-2002

419254

0

100

200

300

400

500

600

700

1996 1997 1998 1999 2000 2001-CCN

2002-CCN

#CC

ath

St. Mary's London Trillium Other Ont.

Hamilton Toronto


• Volume of CCaths increased from 350 in 1996 to a high of 615 in 2002/03; • Number of CCaths in 2002/03 would likely have been even higher if not for the

reductions in service resulting from the SARS outbreak in Ontario; • CCath rates increased from 276/100000 adult population in 1996/97 to 425 in 2002/03; • CCath rate for Wellington County is still 10% below the 2003/04 target of 474/100000

adult population; • Large numbers of Wellington residents continued to receive CCaths at other cardiac

care centers in 2002/03 including London (53, 4% of CCaths), Hamilton (52, 4%), and Toronto hospitals (51, 4%).

• Median wait times for outpatient CCaths at the hospitals most frequently used were: St. Mary’s, 13 days; London Health Sciences, 29 days; Hamilton Health Sciences, 54 days; Sunnybrook (Toronto), 18 days; Trillium HC, 54 days.

• Median wait times for inpatient CCaths were: St. Mary’s, 2 days; London, 2 days; Hamilton, 3 days; Sunnybrook, 1 day, Trillium, 4 days.


2.4 Cardiac Catheterizations – Dufferin County Residents As expected, the opening of the cardiac catheterization unit at St. Mary’s had no impact on the residents of Dufferin County. The volume of CCaths has remained fairly constant for Dufferin County residents between 1996 and 2002. However, there has been a change in the pattern of cardiac center use for Dufferin residents with increased use of the new CCath units in Mississauga (Trillium HC) and Newmarket (Southlake HC), both of which are more accessible to parts of Dufferin County than are services in Toronto. In 2002/03 Toronto hospitals continued to perform more than half (90, 55%) of all CCaths on Dufferin residents.


• Volume of CCaths was virtually unchanged between 1996 and 2002 fiscal years; • Number of CCaths in 2002/03 would likely have been even higher if not for the

reductions in service resulting from the SARS outbreak in Ontario; • CCath rate in 2002/03 was 446/100000 adult population, 19% below the 2003/04 target

for Dufferin (550/100000 adult population); • CCath target rate for Dufferin (550/100000 adults) is higher than for Waterloo RM (474)

and Wellington (also 474) because of a higher incidence of heart attack and an older population;

• Cardiac centers performing the highest volumes of CCaths for Dufferin residents in 2002/03 were: Toronto hospitals (90, 55% of CCaths), Newmarket (64 (39%) and Mississauga (11, 7%).

• Median wait times for CCath outpatients at the hospitals most frequently used by Dufferin residents were: University Health Network (Toronto), 26 days; Southlake Regional Health Centre (Newmarket), 7 days; St. Michael’s (Toronto), 28 days.

• Median wait times of CCath inpatients were: University Health Network, 1 day; Southlake, 1 day; St. Michael’s (Toronto), 3 days.

Figure 4. Cardiac Catheterizations for Dufferin County Residents, by Cardiac Centre Performing the Procedure, 1996-2002

90101

6432

020406080

100120140160180200

1996 1997 1998 1999 2000 2001-CCN 2002-CCN

#CC

ath

St. Mary's London Trillium NewmarketHamilton Toronto


2.5 Cardiac Catheterizations – St. Mary’s General Hospital The place of residence of CCath patients at St. Mary’s GH is presented in Figure 5 below. As with the cardiac service use data provided for residents of WRWD, the patient population is

of unty. In the

second year of operation the number of Waterloo RM residents increased but the proportion of patients that this represented dropped to 49%. In 2002 there was a large increase in patients from the neighbouring counties of Brant, Grey, Bruce, Huron, and Wellington using the service. Figure 5. Place of Residence of Cardiac Catheterization Patients at St. Mary’s GH

Source: 2001/2002 and 2002/2003 Annual Statistical Reports, Cardiac Care Network of Ontario, Toronto, June and October 2003.

CCaths at St. Mary’s General Hospital:

• 1593 CCaths performed in 2001 fiscal year, first full year of unit operation; • 28% increase in 2002 (2044 completed CCaths); • Waterloo residents accounted for 62% of CCaths in 2001 (990) and 49% in 2002 (1000); • Wellington residents having CCaths increased by 65% from 2001 (254) to 2002 (419); • Use by residents of Grey, Bruce, Huron, Oxford, Brant, and Haldimand-Norfolk Counties

more than doubled from 2001 to 2002; • Few Dufferin County residents had CCaths at St. Mary’s; • The start up of PCI services at St. Mary’s (July 2003) is expected to further increase

CCath unit use since it provides the opportunity for ad hoc PCIs; • The number of CCaths completed at St. Mary’s was 14% below the MOHLTC approved

volume in 2001 and 11% above in 2002. • Median wait times for CCath at St. Mary’s in 2001 was 2 days for in-patients and 13

days for outpatients.

largely influenced by proximity to Kitchener. In the year that it opened (2001 fiscal year), 62% CCath patients were from the Waterloo region, while 16% were from Wellington Co

diac Catheterizations Performed at St. Mary's GH, by

11

419

83 53 41 78 50 61 87 3623

158

46233918922

254

136

0

200

400

Well

ington

Wate

rloo

Brant

Haldim

and-N

orfolk

Bruce

GreyHuro

n

Oxford

Perth

Unkn R

es

All Othe

r

CarPatient Place of Residence, 2001- 2002 Fiscal Years

9901000

1000

1200

2001/02 2002/03

600

800

#CC

aths


2.5 Revascularization Services for WRWD Residents, 1996-2002

te

d

Table 2. Revascularization Procedures (Coronary Artery Bypass Grafts - CABG,

Procedure 1996 1997 1998 1999 2000 2001 2002

Once the source of the coronary artery blockage has been identified, patients undergo either a coronary artery bypass graft (CABG) or a percutaneous coronary intervention (PCI) to alleviathe blockage. Together, these two procedures are known as revascularization services. Table 2 below summarizes the data on revascularization for residents of WRWD from 1996 to 2002 fiscal years. Following the pattern of CCath procedure changes, the number of revascularizationprocedures more than doubled for residents of Waterloo and of Wellington C between 1996 an2002, while there was a less dramatic increase for residents of Dufferin C.

Percutaneous Coronary Interventions - PCI) for Residents of WRWD, 1996-2002. 2002/03

Rate Target Rate

Residents of Waterloo RM CABG* 207 215 215 230 220 326 371* 92 104PCI 96 133 134 164 212 302 358 107 133Total 303 348 349 394 432 628 729 199 237

Residents of Wellington County CABG* 92 87 108 114 123 12 * 9 166 90 104PCI 54 49 66 76 95 142 164 113 133Total 146 136 174 190 218 271 330 203 237

Residents of Dufferin County CABG* 28 38 39 37 32 35 30* 65 121PCI 18 25 27 39 46 46 45 122 154Total 46 63 66 76 78 81 75 187 275

Source: 1996-2000, CIHI patient abstract database, PHPDB, 2003; 2001-2002, Annual Statistical Reports, Cardiac Care Network of Ontario, 2003.

*2002 data are for all completed surgical cases, not just CABG procedures. Note: In 2002 fiscal year, the number of cardiac procedures performed may have been affected by the reductions in health care services in March 2003 that resulted from the SARS outbreak in Toronto.

• Revascularization rates remain significantly below the targets for residents of WRWD: Waterloo

RM ( ), Wellington C ( ), and Dufferin C ( ).•

of PCIs on Dufferin C residents were performed in Toronto hospitals.

rmed in London, over ¼ in Toronto hospitals, and about re in Toronto

ndon, 31%; Trillium, 26%.

16% below 14% below 32% below In 2002, about 1/3 of PCIs were performed in Mississauga and another 1/3 in London for residents of Waterloo RM and Wellington C; 84%

• In 2002, about ½ of CABGs were perfo1/5 in Hamilton for residents of Waterloo RM and Wellington C; 93% of CABGs wehospitals for Dufferin C residents.

• Median wait times for PCI’s at the most frequently used hospitals were: University Health Network (Toronto), not available; Sunnybrook (Toronto), 5 days; St. Michael’s (Toronto), 6 days; Hamilton

Health Sciences, 12 days; London Health Sciences, 9 days; Trillium Health Centre, 6 days; • Percentage of PCIs completed as ad hoc PCIs: University Health Network, 22%; Sunnybrook,

30%; St. Michael’s, 14%; Hamilton, 50%; Lo• Median wait times for urgent CABGs at the most frequently used hospitals were: University

Health Network, 2 days; Sunnybrook, 4 days; St. Michael’s, 7 days; Hamilton, days; London, 5days; Trillium, 4 days.

• Percentage of urgent CABGs completed within recommended wait times: University Health Network, 88%; Sunnybrook, 72%; St. Michael’s, 59%; Hamilton, 69%; London, 68%; Trillium, 66%.


Appendix A - Methodology

The

1. Cardiac catheterizations are typically performed as day procedures, but may also be performed a in al fter ion with acute myocardial infarction, or angina). If th for a tien rocedure is reported in both the hospital and the

day procedure CIHI records. T for such an occurrence, the in-patient ths had t subt d fro day

in-patient also ansf to an hos for th ath xampl a

resident who is a patient in d to St. Mary’s for the CCath. In case, the th wo be re ed on ran er ho l re since s ormed on rand R r pat howev e pa reco uld dicat t th

ry’s); this CCath would also be recorded on day proce reco for S ry’s. T ata p m w ddr by ex ing

the hospital records for the c Despite these challenges, it was important to use the HI da ince it vide on C s f1996 to 2001 (fiscal years), thus providing the oppor ity to e ine tr s in hs for Dresidents before and after the St. Mary’s start-up. The the CIHI database, and the Cardiac Care Network (CCN) annual statistical report. Some of this discrepancy is acc I onc d hav unlikely to

ccount for the magnitude of the discrepancy in the data: a higher grand total for CCaths for Waterloo resi n and Tor 1). The higher grand tota r he CCN report cday procedure, since the CCN data for Percutaneous Coronary Intervention and for Coronary Artery Byp s . Since thstandar for the 2001 and 2002 fiscal years. Procedu

Pro

Cardiac catheterizations (CCath) on residents of Wellington and Dufferin County and Waterloo Regional Municipality residents are reported by hospitals to the Canadian Institute for Health Information (CIHI). These data are subsequently provided to the MOHLTC’s Provincial Health Planning Database (PHPDB). The Cardiac Care Network of Ontario (CCN) also maintains a n ‘on-time’ database of all cardiac procedures in Ontario. Cardiac procedures are reported directly to the CCN by the various cardiac centres including St. Mary’s. In 2003 the CCN produced statistical reports for the 2001/2002 and 2002/2003 fiscal years (April 1 – March 31) with the data provided both by county/regional municipality of the patient and by cardiac care centre performing the procedure.

re were challenges in using the CCath procedure data from CIHI:

while a pthe CCa

tient is is per

hospitmed on

(e.g., an in-pa

admisst, the p

hus to avoid double counting CCa o be racte m the procedure totals for that hospital.

2. An may be tr erred other pital e CC , for e e a W terlooGrand River GH might be transferre

this perf

CCa uld cordie

the Ge

d Rivtie

spita cords,in

it waa G ive nt, r th nt rd wo also e tha e

procedure was performed at another hospital (St. Mathe dure rds t. Ma his d roble as a essing amin only

ardiac care centres.

CI ta s pro s data Cath rom tun xam end CCat WRW

re are discrepancies between the 2001 fiscal year totals for cardiac catheterizations (CCath) from

ounted for by the different reporting timeframes for the two databases, i.e., hospitals report to CIHe the patient is discharged, but a CCath is reported to CCN on the date it is performed. This woule the greatest impact in the first year of start up of a new hospital unit. However, this is

ade ts as well as higher totals for St. Mary’s, and corresponding lower numbers for Hamilton, London,

onto hospitals in the annual statistical report compared with CIHI (See Table l fo Waterloo residents corresponds with lower totals for Wellington and Dufferin residents in t

ompared with CIHI. It appears that the discrepancy may be in the reporting relating to CCath as a

as Grafts closely matches the CIHI data and neither of these procedures occurs as a day proceduree CCN is the provincial reporting organization for cardiac procedures, and is therefore the ‘gold d’, their data are used in this report

re codes used in querying the CIHI data were: cedure CIHI Procedure Code (CCP)

CCath Cardiac Catheterization 4995, 4996, 4997, 4892-4897

PCI Percutaneous Coronary Intervention 4797, 4802, 4803

BG Coronary Artery Bypass Graft 4811-4815, 4819 CA


Table 1. 2001 (Fiscal) Cardiac Catheterization Procedures: Data from Canadian Institute for Health Information1 (CIHI) vs. Data from Cardiac Care Network2 (CCN)

2001 - CIHI 2001-CCNPlace of Residence of Patient

Hospital Performing Procedure

Day Procedures In-Patient Total Total

St. Mary's GH* 655 0 655 990Hamilton 48 59 107 85London 111 70 181 95Trillium 19Waterloo RM 76 95 24Toronto Hosp 31 56 87 38Other Ont Hosp 9 1 10 0Waterloo Total 873 262 1135 1232St. Mary's GH 1 0 1 0Hamilton 4 2 6 0London 0 0 0Trillium 24 0 24 14Toronto Hosp 122 0 122 133Other Ont Hosp 86 0 86 0

Dufferin C

Dufferin Total 237 0 237 147St. Mary's GH 118 102 220 254Hamilton 109 0 109 99London 117 0 117 72Trillium 45 0 45 25Toronto Hosp

Wellington C 64 0 64 72

Other Ont Hosp 15 54 69 0Wellington Total 468 156 624 522

*Includes 364 Ccaths on patients transferred from Grand River GH & Cambridge MH 1 CIHI Patient Abstract Database, Provincial Health Planning Database, MoHLTC, Queried July 2003. 2 2001/2002 Annual Statistical Report, Cardiac Care Network of Ontario, Toronto, July 2003.


WRWDDHC

Table 1. Cardiac Catheterizations (CCaProcedure

Cardiac Care Centre

2003 Cardiac Care Brief Report, November 2003 Pg. 11 of 11

Appendix B – Data Tables ths) Completed on WRWD Residents, 1996-20021,2, by Hospital Performing

Number of CCaths Percent of Total CCaths 1996 1997 1998 1999 2000 2001 2002 1996 1997 1998 1999 2000 2001 2002#CC #CC %CC %CC C %CC %CC CC #CC #CC #CC #CC #CC %CC %C %

Residents of Waterloo Region~Wellington~Dufferin DHC Area 42 12 4 0%

442 1 4 14% 290 1 7 58%9 3

24 2 42 8 89 1% 1% 2% 2% 2% 2% 4%

169 19 0 2006 100% 100% 100% 100% 100% 100% 100%ent f Waterloo RM

2 9 0 1000 --- --- 2% 80%25 5 115 3% 22% 23% 7%66 5 44 62% 60% 62% 8%

2 49 7

0 1%107 12 1

Residents of Wellington County - 2 4

19 9 % 22% % 823 2 53 59% 61% 61% 444 % 14% 9%3 56 6 - 6

53 5 2 6 0% %ts Du ferin County

- 0 % --- % -- 0% - 0 0 7% --- 12% --- --- 0% 0%3 4

11 1 12 %

16 1 1 100% 100% 1 % 100 % 0% 100%

St. Mary's GH 0 0 --- 16 4 1419 0% --- 1% 2% 65% 71%Hamilton 196 336 326 508 8 167 21% 22% 8% 26% 10% 8%London 790 852 832 969 8 6 97 54% 55% 54% 54% 9% 5%Trillium 0 7 --- 28 0 6 54 0% 0% --- 2% 5% 3% 3%Toronto Hosp 365 396 352 266 8 1 180 27% 25% 23% 15% 15% 11% 9%Other Ont Hosp 12 12 29 30 7 3WRWD Total 1354 1568 1516 1785 6 1

Resid s oSt. Mary's GH 0 --- --- 0 2 9 0% 0% 82%Hamilton 138 244 208 305 2 8 13% 2 27% 9%London 755 664 572 724 9 9 71% 64% 4%Trillium 0 --- --- 6 1 2 18 0% --- --- 1% 2% 2% 1%Toronto Hosp 169 170 150 94 5 4 39 16% 16% 16% 8% 9% 4% 3%Other Ont Hosp 8 --- --- 13 9 10 1% --- --- 1% 0% 1%Waterloo Total 1070 1071 959 1126 4 4 1226 100% 100% 100% 100% 100% 100% 100%

St. Mary's GH 0 0 0 0 -- 5 419 0% 0% 0% 0% --- 49% 68%Hamilton 68 84 114 199 0 9 52 19 28% 37% 35 19% %London 206 234 252 245 8 7 6%Trillium --- 0 0 17 7 2 25 0% --- 0% 3% 7% 5% 4%Toronto Hosp 72 73 74 69 3 6 51 21% 19% 18% 13% 12% 13% 8%Other Ont Hosp --- 5 15 14 -- 15 1% --- 4% 3% --- 1% 2%Wellington Total 350 384 414 535 6 2 15 100% 10 100% 100% 100 100% 100%

Residen of fSt. Mary's GH 0 --- 0 --- -- 0 0 0 --- - 0%London 12 --- 21 --- --Trillium 0 --- 0 --- 2 1 11 0% --- 0% --- 20% 10% 7%Toronto Hosp 144 153 128 103 0 0 90 89% 91% 75% 83% 69% 69% 55%Other Ont Hosp 5 11 8 13 0 32 64 4% 12% 9% 13% 15 22% 39%Dufferin Total 161 169 170 124 0 47 65 00 % 100 10 --- fewer than 5 cases in cell or would permit residual disclosure of fewer than 5 cases. 11996-2000 - CIHI Patient Abstract Database, queried from PHPDB, July 2003 (qualifying on cardiac care centres only). 22001-2002 - 2001/02 and 2002/03 Annual Statistical Reports, Cardiac Care Network of Ontario, Toronto, July & October, 2003.

Appendix B – Data Tables

Table 2. Percutaneous Coronary Interventions (PCI) Completed on WRWD Residents, 1996-20021,2, by Hospital Performing Procedure

Number of PCIs Percent of Total PCIs 1996 1997 1998 1999 2000 2001 2002 1996 1997 1998 1999 2000 2001 2002

Cardiac Care Centre #PCI #PCI #PCI #PCI #PCI #PCI #PCI %PCI %PCI %PCI %PCI %PCI %PCI %PCIResidents of Waterloo Region~Wellington~Dufferin DHC Area

Hamilton HS 35 53 45 102 115 109 110 21% 26% 20% 37% 33% 22% 19%London HS 93 101 135 115 148 134 167 55% 49% 59% 41% 42% 27% 29%Trillium HC (Peel) --- --- 141 170 0% 0% 0% --- --- 29% 30%Toronto CCCs* 39 53 46 56 82 110 110 23% 26% 20% 20% 23% 22% 19%Other Ont CCCs 1 --- --- 12 0% 0% 0% --- --- 0% 2%WRWD Total 168 207 227 279 353 494 569 100% 100% 100% 100% 100% 100% 100%

Residents of Waterloo RM Hamilton HS 22 44 30 70 71 70 83 23% 33% 22% 43% 33% 23% 23%London HS 61 73 88 84 115 94 120 64% 55% 66% 51% 54% 31% 34%Trillium HC (Peel) --- 96 114 0% 0% 0% 0% --- 32% 32%Toronto CCCs* 13 16 15 7 20 42 36 14% 12% 11% 4% 9% 14% 10%Other Ont CCCs 1 3 --- 5 0% 0% 1% 2% --- 0% 1%Waterloo Total 96 133 134 164 212 302 358 100% 100% 100% 100% 100% 100% 100%

Residents of Wellington County Hamilton HS 13 9 14 31 42 38 27 24% 18% 21% 41% 44% 26% 16%London HS 29 28 43 31 33 39 47 54% 57% 65% 41% 35% 27% 29%Trillium HC (Peel) --- 41 56 0% 0% 0% 0% --- 28% 34%Toronto CCCs* 11 12 9 12 --- 27 34 20% 24% 14% 16% --- 19% 21%Other Ont CCCs 2 --- 0% 0% 0% 3% --- 0% 0%Wellington Total 54 49 66 76 95 145 164 100% 100% 100% 100% 100% 100% 100%

Residents of Dufferin County Toronto CCCs* 15 25 22 37 43 41 38 83% 100% 81% 95% 93% 87% 84%Other Ont CCCs 3 5 2 3 6 7 17% 0% 19% 5% 7% 13% 16%Dufferin Total 18 25 27 39 46 47 45 100% 100% 100% 100% 100% 100% 100% --- fewer than 5 cases in cell or releasing number would result in residual disclosure of fewer than 5 cases. 11996-2000 - CIHI Patient Abstract Database, queried from PHPDB, July 2003 (qualifying on cardiac care centres only). 22001-2002 - 2001/02 and 2002/03 Annual Statistical Reports, Cardiac Care Network of Ontario, Toronto, July & October, 2003.


Appendix B – Data Tables

Hospital Performing Procedure Table 3. Coronary Artery Bypass Grafts (CABG) Completed on WRWD Residents, 1996-20021,2, by

Number of CABG Percent of Total CABG 1996 199 99 9 0 20 20 19 9 19 1 2 2001 20027 1 8 1 99 2 00 01 02 96 1 97 98 999 000

Cardiac Care C e B %CABG %CABG %CABG %CABG %CABGentr #CABG #CABG #CABG #CABG #CABG #CABG #CABG %CABG %CA GResidents of Waterloo Region~Wellington~Dufferi

7 4 2 %18 1 1 5

6 2 %

Other Ont CCCs 1 1 3 1 2 2 12 0% 0% 1% 0% 1% 0% 2%WRWD Total 7 40 6 8 3 5 49 0 0 00 00 0 00% 100%32 3 3 2 3 1 75 10 4 10 % 10 % 1 % 1 % 1 0% 1

Residents of Waterl oo RMHamilton HS 2 65 60 90 6 73 65 25% 0% 28% 39 29 22% 18%5 3 3 % %

12 1 1 6

2

Waterloo Total 7 15 15 30 220 329 371 0% 0% 00% 00% 00% 00% 100%20 2 2 2 10 10 1 1 1 1Re t W o nsiden s of ellingt n Cou ty

21 27 44 57 44London HS 1 51 56 43 37 51 72 55% 9% 52% 38 30 36% 43%5 5 % %

%1 1

9 1 1 10 10 1 1 % 1 1side s of ufferi Coun y

Toronto CCCs* 26 93% 100% 100% 82% 93%38 37 37 30 31 28 95% 94%2 2 7

2 10 10 1 1 1 1sul esi dis sure we an 5 ses.

1996-2000 - CIHI Patient Abstract Database, queried from PH/0

PDB, July 2003 (qualifying on cardiac care centres only). 22 /02 d 2 3 nua tatis al R rts rdia are work Ont , Tor o, J & Oc

n DHC Area Hamilton HS 6 86 88 13 120 120 105 23% 5% 24% 35 32% 24% 21%London HS 1 84 91 167 166 194 250 55% 4% 53% 44% 44% 38% 51%Trillium HC (Peel) 10 59 47 0% 0% 0% 0% 3% 12% 10%Toronto CCCs* 9 69 80 79 77 135 153 21% 0% 22% 21 21% 26% 31%

London HS 9 33 34 124 129 143 178 62% 2% 62% 54% 59% 43% 48%Trillium HC (Peel) --- 40 32 0% 0% 0% 0% --- 12% 9%Toronto CCCs* 5 16 20 16 24 72 92 12% 7% 9% 7% 11% 22% 25%Other Ont CCCs 1 1 1 --- 1 4 0% 0% 0% 0% --- 0% 1%

Hamilton HS 23 40 25% 24% 25% 39% 46% 31% 24%

Trillium HC (Peel) 5 15 15 0% 0% 0% 0 4% 10% 9%Toronto CCCs* 8 15 23 26 23 32 33 20% 7% 21% 23% 19% 22% 20%Other Ont CCCs 2 1 1 1 6 0% 0% 2% 1% 1% 1% 4%Wellington Total 2 87 08 14 123 143 166 0% 0% 00% 00 00% 00% 100%

Re nt D n t

Other Ont CCCs 2 2 7% 0% 5% 0% 6% 18% 7%Dufferin Total 8 38 39 37 32 38 30 0% 0% 00% 00% 00% 00% 100% --- fewer than 5 cases in cell or releasing number would re t in r dual clo of fe r th ca1

001-2002 - 2001 an 002 An l S tic epo , Ca c C Net of ario ont uly tober, 2003.


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Cardiac Care Services · 2020-02-07 · Cardiac Care Services in Waterloo Regional Municipality and Wellington and Dufferin Counties (WRWD) 2003 Update 1.0 Background In coronary