Wait time strategies
Provinces given “F” for cardio
OTTAWA – While the Canadian
Cardiovascular Society (CCS) gives provincial governments an “A” for
meeting or exceeding the benchmark for access to cardiac bypass surgery
(CABG), it thinks that an “F” is a fair grade for governments’ failure
to look at the “big picture” of cardiac care that is provided to
Dr. Blair O’Neill, Chair of the CCS Access to Care Working Group, said
“Adopting a benchmark for CABG is a good start. But the First Ministers
originally promised to address cardiac care, so the CCS developed
patient-centred benchmarks for cardiac care – which encompass a broad
range of services and procedures.
“This included benchmarks for referral to a specialist upon a patient’s
first symptoms, right through to completion of rehabilitation and return
to a healthy and productive life.
“Yet, by choosing a surgical procedure such as CABG, which is performed
on only a limited population and is no longer as common as procedures
such as angioplasty, governments are not making a meaningful and
positive impact on wait times for Canadians – one in three of whom will
die from heart disease. CABG is important but only one narrow aspect of
“Also,” added Dr. Chris Simpson, Co-Chair of the Working Group, “access
to CABG was already an “A” before the First Ministers adopted the
benchmark, so the bar was set pretty low to begin with. What we’d like
to see is the full spectrum of cardiac-care benchmarks adopted by all
provinces, and as part of the pan-Canadian Heart Health Strategy that is
currently under development.”
The CCS looks forward to contributing to further dialogue on wait time
strategies for the cardiovascular healthcare of all Canadians. Please go
to www.ccs.ca for a copy of the CCS’s
benchmarks and a commentary on wait times.
The CCS is the national voice for approximately 1600 cardiovascular
physicians and scientists. The CCS mission is to promote cardiovascular
health and care through knowledge translation (including dissemination
of research and encouragement of best practices); professional
development; and leadership in health policy.
The Canadian Cardiovascular Society (CCS) is a member of the Wait Time
Alliance (WTA). The Canadian Medical Association formed the WTA in 2005,
in response to the First Ministers’ commitment to develop benchmarks for
medically accepted wait times in five priority areas, including cardiac
care. Please see: www.cma.ca for more
details about the WTA.
CCS Benchmarks for Access to Cardiovascular Care
The CCS has developed a comprehensive range of patient-centred and
evidence-based benchmarks. These benchmarks are published in the CCS
report, Universal Access, but When? Treating the Right Patient at the
Right Time, (see www.ccs.ca). They were
also published in the WTA’s August 2005 report, It’s About Time!
The “Patient’s Journey”
The CCS’s benchmarks for access to care reflect the many steps that
patients take to receive cardiovascular healthcare services and
procedures. The patient’s journey is about many steps – not just one,
(such as access to cardiac bypass surgery). The patient journey begins
with the first visit to a primary healthcare provider, then to a
specialist, then through many additional steps including testing,
procedures and surgery, and finally to completion of rehabilitation and
return to a healthy and productive life.
Unless all steps in a patient’s care are addressed, optimal care cannot
be provided. For this reason, the CCS stresses that all of its
benchmarks must be adopted to truly have a meaningful impact on
patients’ access to cardiovascular care. This is the “big picture” of
cardiac care for patients. The CCS believes that wait times for most, if
not all other areas of care, are also about the patient’s journey, (and
not just one procedure or service).
Cardiac bypass surgery (CABG), while potentially life-saving and very
important for some patients, is a procedure that is necessary for only a
small proportion of patients accessing cardiac care in Canada. Most
patients require other services.
Angioplasty, for example, a procedure involving the opening of an artery
with a balloon via a catheter, is twice as common as CABG, and is not
addressed at all in the WTA report card. Addressing only the wait for
CABG (as governments have done) will not address the wait time to see a
cardiologist, or to have other required tests (such as a stress test, an
echocardiogram, a cardiac catheterization), or a therapeutic procedure
for other cardiac conditions.
The CCS is a partner in the development of the Canadian Heart Health
Strategy to fight cardiovascular disease in Canada. See: