Seidel JE, Ghali WA, Faris PD, Bow CJD, Waters NM, Graham MM, Galbraith PD, Mitchell LB, Knudtson ML for the APPROACH Investigators. Geographical location of residence and access to cardiac revascularization services. Can J Cardiol 2004 Apr 5; 20(5) :517-523.

Background: The centralization of health care services has numerous potential benefits but may compromise access for individuals living in remote areas.

Objectives: To examine the association between a patient’s place of residence and the likelihood of undergoing a coronary revascularization procedure within one year after cardiac catheterization.

Methods: All Alberta residents undergoing cardiac catheterization between 1995 and 1998 were examined. Geographical distance from patient place of residence to a centralized catheterization facility was calculated. The adjusted odds of undergoing cardiac revascularization within one year of catheterization was determined as a function of distance, controlling for differences in patient age, clinical factors and economic status.

Results: Of 21,816 residents who underwent cardiac catheterization in the province, 10,997 had a revascularization procedure. Graphical examination of distance revealed a change in revascularization rates in patients living more than 450 km from revascularization centres. Further analysis was conducted using this cutpoint. Patients living in these remote areas were more likely to undergo a coronary revascularization procedure within the next year (adjusted odd ratio1.65, 95%CI 1.05 to 2.59). However, these same residents were also less likely to undergo catheterization in the first place when compared with other Albertans (270 versus 398 procedures per 100,000 population).

Conclusion: Only a small proportion of the population living in Alberta’s most remote areas were more likely to undergo a revascularization procedure, indicating a remarkable uniformity of access to revascularization after coronary cardiac catheterization has occurred. This study examines the use of an existing database to gain further insights into the relationship between geography and access to cardiac care, and the distance-access relationship for coronary revascularization in Alberta.

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