Heart attacks are down sharply in Canada and more people who have them are
leaving hospital alive.
The stroke story isn't so simple.
While stroke rates have fallen over the last five years, overall there has been
no improvement in a person's risk of dying within 30 days of being admitted for
a "brain attack," according to a new national report.
And despite growing calls on doctors to curb the use of cesarean sections to
deliver babies, the nation's C-section rate now stands at an all-time high,
according to Canadian Institute of Health Information data. C-sections now
account for nearly 28 per cent of deliveries in Canada.
The Canadian C-section rate increased 23 per cent over seven years — from 22.5
per cent in 2001-02 to 27.7 per cent in 2007-08.
In B.C. and PEI, more than 30 per cent of babies are now born via cesarean.
Overall, more than 78,000 C-sections were performed in Canada in 2007-2008,
making it the single most frequently performed surgical intervention on Canadian
women, according to CIHI.
Highlights of this year's annual "health indicators" report include:
Heart attacks: The rate of Canadians being admitted to hospital with a heart
attack is falling. Between 2003-04 and 2007-08, there was a 13-per-cent drop.
(The rates don't include Quebec because of differences in data collection.) Over
the same time, the 30-day, in-hospital death rate from heart attack fell 11 per
cent, and unplanned re-admissions to hospital after a heart attack decreased by
Overall, 49,220 Canadians were hospitalized for heart attacks in 2007-08. The
rates were highest in Newfoundland and Labrador, and lowest in B.C.
Men had four times as many heart attacks as women between the ages of 20 and 44,
but the gender gap shrinks with age: By age 65, men have only one and a half
times more myocardial infarctions than women.
People in the poorest neighbourhoods were 66 per cent more likely to
hospitalized with a heart attack than those in the richest neighbourhoods.
The report also reflects a dramatic shift in how doctors are restoring blood to
dying heart muscle. Heart attacks result when blood vessels supplying blood to
the heart are suddenly blocked. Angioplasty, a procedure that uses a balloon to
open a clogged artery, and stents — tiny, cage-like tubes that keep arteries
propped open — have become the favoured treatment for heart attacks over bypass
surgery, where the chest is opened and blood vessels taken from other parts of
the body are used to reroute blood around the blocked artery.
Over the past decade, the number of angioplasties performed in Canada has more
than doubled, while cardiac bypass dropped 18 per cent. In 2007-2008, there were
more than 36,000 discharges for angioplasty. Men were more likely than women to
undergo angioplasty or bypass for heart attacks.
Stroke: Hospitalization rates fell 14 per cent between 2003-04 and 2007-08,
according to the CIHI data. The in-hospital death rate for stroke improved only
for patients aged 20 to 44, a 28-per-cent drop.
"But there are so few strokes in that age group that it doesn't make a
difference in the overall number," says Helen Angus, vice-president of research
at CIHI. The rate didn't change for other ages and held steady at 18 per cent,
or just about double the risk of dying in hospital from a heart attack.
"The important thing is that we are preventing people from having a stroke in
the first place," through lifestyle interventions such as quitting smoking and
lowering blood pressure, says Dr. Frank Silver, a spokesman for the Canadian
Stroke Network and professor of neurology at the University of Toronto.
"We are getting better at treating a stroke in progress and we're especially
better in reducing the severity of the stroke, the burden from the stroke in
terms of the neurological deficit."
And while the overall mortality rate hasn't changed, "there is a lot of
variation between hospitals" and designated regional stroke centres, Silver
says. Stroke patients who are treated by a neurologist or neurosurgeon are 40
per cent less likely to die. But only a quarter of stroke patients in Canada
were treated by a specialist last year.
"There's a big push across the country to organize stroke care across the
country," Silver said.
He said it's unfair to compare stroke with heart attacks. "They're very
different diseases. Stroke is clearly more devastating."
Doctors are using potent clot-busting agents that run the risk of actually
"What we're showing is that we're maintaining the same mortality, but improving
the outcomes of those patients who survive," Silver says. "There's nothing worse
than living with a stroke but being disabled and bed-ridden for the rest of your
C-sections: In the 1960s, about five per cent of Canadian women delivered via
C-section. Today, C-sections account for more than one-quarter of deliveries in
Canada. Women who are older, obese, having their first child or expecting a
multiple birth are more likely to have a cesarean section.
In Canada, the number of deliveries for older mothers is increasing. So, too,
are multiple births, mainly because of increased use of fertility treatments.
But other factors are driving the rates.
"There is an attitudinal difference between some care-providers. Some try as
much as they can to assist women to have a natural, normal birth and there are
some who don't feel it's as important," says Dr. Jan Christilaw, president of
B.C. Women's Hospital and Health Centre.
That holds true for all of Canada, she says, and not just B.C., where the
C-section rate was 31.3 per cent in 2007-08. The rate was 37.5 per cent in the
greater Victoria area.
While life-threatening risks are rare, lethal complications such as blood clots
are more common in women who have cesarean sections. The surgery also increases
the risk of wound and bladder infections.
"Most C-sections that are done are done because they really are the best thing
for mom and baby. I'm not trying to say that it's always a negative thing,"
"But if you can manage to have a normal delivery, and do it safely, you will
have better outcomes and better complications than if you have to resort to
Hip fractures: About 10 to 20 per cent of people who break a hip die within six
months, 50 per cent are unable to walk without assistance and 25 per cent
require long-term home care. Elderly women suffer 80 per cent of broken hips.
The hip-fracture rate dropped 21 per cent over the 10-year period ending
2007-08. But waits for hip-repair surgery have increased, with fewer patients
getting surgery on the day of admission to hospital, or the next day.
Knee replacement rates increased by 83 per cent over the same period, with the
fastest growth (128 per cent) in 45- to 54-year-olds. That group also saw the
highest increase (66 per cent) in hip replacements.
One of the biggest declines was in preventable hospitalizations, "things like
diabetes or hypertension complications that actually could, and probably should
be managed in the community," Angus says. The rate dropped by 29 per cent from
2001-02 to 2007-08.
Source : Canwest News Service