Waiting for coronary revascularization: a comparison between New York State, The Netherlands and Sweden.
OBJECTIVE
To compare waiting times for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery in New York State, the Netherlands and Sweden and to determine whether queuing adversely affects patients' health.


METHODS
We reviewed the medical records of 4487 chronic stable angina patients who underwent PTCA or CABG in one of 15 New York State hospitals (n = 1021) or were referred for PTCA or CABG to one of ten hospitals in the Netherlands (n = 1980) or to one of seven hospitals in Sweden (n = 1486). We measured the median waiting time between coronary angiography and PTCA or CABG.


RESULTS
The median waiting time for PTCA in New York was 13 days compared with 35 and 42 days, respectively, in the Netherlands and Sweden (P < 0.001). For CABG, New York patients waited 17 days, while Dutch and Swedish patients waited 72 and 59 days, respectively (P < 0.001). The Swedish and Dutch waiting list mortality rate was 0.8% for CABG candidates and 0.15% for PTCA candidates.


CONCLUSIONS
There were large variations in waiting time for coronary revascularization among these three sites. Patients waiting for CABG were at greatest risk of experiencing an adverse event. In both the Netherlands and Sweden, the capacity to perform coronary revascularization has been expanded since this study began. Further international cooperation may identify other areas where quality of care can be improved.
Bernstein
S J
SJ
Departments of Medicine and Health Management and Policy, University of Michigan, Ann Arbor 48109-0376, USA.
Rigter
H
H
Brorsson
B
B
Hilborne
L H
LH
Leape
L L
LL
Meijler
A P
AP
Scholma
J K
JK
Nord
A S
AS
D000787:Angina Pectoris / Q000150:complications / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data*; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D009426:Netherlands / Q000453:epidemiology; D018579:Patient Selection; D013548:Sweden / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists