title: A multi-region assessment of population rates of cardiac catheterization and yield of high-risk coronary artery disease.
abstract: BACKGROUND
  There is variation in cardiac catheterization utilization across jurisdictions. Previous work from Alberta, Canada, showed no evidence of a plateau in the yield of high-risk disease at cardiac catheterization rates as high as 600 per 100,000 population suggesting that the optimal rate is higher. This work aims 1) To determine if a previously demonstrated linear relationship between the yield of high-risk coronary disease and cardiac catheterization rates persists with contemporary data and 2) to explore whether the linear relationship exists in other jurisdictions.
  
  
  METHODS
  Detailed clinical information on all patients undergoing cardiac catheterization in 3 Canadian provinces was available through the Alberta Provincial Project for Outcomes Assessment in Coronary Heart (APPROACH) disease and partner initiatives in British Columbia and Nova Scotia. Population rates of catheterization and high-risk coronary disease detection for each health region in these three provinces, and age-adjusted rates produced using direct standardization. A mixed effects regression analysis was performed to assess the relationship between catheterization rate and high-risk coronary disease detection.
  
  
  RESULTS
  In the contemporary Alberta data, we found a linear relationship between the population catheterization rate and the high-risk yield. Although the yield was slightly less in time period 2 (2002-2006) than in time period 1(1995-2001), there was no statistical evidence of a plateau. The linear relationship between catheterization rate and high-risk yield was similarly demonstrated in British Columbia and Nova Scotia and appears to extend, without a plateau in yield, to rates over 800 procedures per 100,000 population.
  
  
  CONCLUSIONS
  Our study demonstrates a consistent finding, over time and across jurisdictions, of linearly increasing detection of high-risk CAD as population rates of cardiac catheterization increase. This internationally-relevant finding can inform country-level planning of invasive cardiac care services.
authors: Department of Medicine, Faculty of Medicine, University of Calgary, Foothills Medical Centre-North Tower, 9th Floor, 1403 29th Street NW, Calgary, AB T2N 2T9, Canada.
authors: Fiona M
authors: FM
authors: Clement
authors: Braden J
authors: BJ
authors: Manns
authors: Brenda
authors: B
authors: Brownell
authors: Peter D
authors: PD
authors: Faris
authors: Michelle M
authors: MM
authors: Graham
authors: Karin
authors: K
authors: Humphries
authors: Michael
authors: M
authors: Love
authors: Merril L
authors: ML
authors: Knudtson
authors: William A
authors: WA
authors: Ghali
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000706:statistics & numerical data* / Q000639:trends; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011159:Population Surveillance; D019057:Quality-Adjusted Life Years; D012041:Regional Medical Programs / Q000592:standards*; D012307:Risk Factors; D017678:Sex Distribution; D013996:Time and Motion Studies; D014600:Utilization Review