Central LHIN Health Service Needs Assessment and Gap Analysis:

Transcription

1 Central LHIN Health Service Needs Assessment and Gap Analysis: Appendix I: Cardiology & Cardiovascular Analysis November 2008 Final Interim Report 1

2 Cardiology & Cardiovascular: Summary of Gaps Although wait times for cardiac surgery in the LHIN are well below provincial targets, there appear to be shortages in the number of cardiologists, internists and cardiac surgeons within the LHIN. In order to bring the number of physicians up to the Ontario average would require an additional 2.6 cardiologists, 95 Internists and 1.6 cardiac surgeons. Growth rates in Hypertension and Heart Disease are projected to grow rapidly over the next ten years. Prevention, screening and programs to targets high-risk individuals should be funded. Rates are not uniform across the LHIN and will require different approaches: The variation across planning areas in the LHIN suggests that there are social determinants and ethnicity associations which will require targeted interventions for health promotion. Final Interim Report 2

3 Cardiology & Cardiovascular: Summary Currently, the Central LHIN has a lower prevalence rate than Ontario for hypertension, heart disease and ischemic heart disease. However, the prevalence rate is expected to increase in the next ten years, coinciding with the anticipated growth rate Overall, the Central LHIN has a much lower relative risk of heart disease and rate per 1,000 residents than the Province However, the prevalence rate is not uniform across the LHIN. Many studies have found that cardiovascular disease is strongly linked to poverty and ethnicity, which may account for the variation in the Central LHIN Southlake Regional Health Centre has close to 40% of all the cardiac inpatient cases in the Central LHIN. North York General has 20% and York Central has 15%. 63% of Central LHIN residents that required inpatient cardiac care, received that care from a Central LHIN hospital and 30% received care from a Toronto Central LHIN hospital The current service level for the Central LHIN remains stable, however, planning to meet future demand is required. There is an opportunity to reduce future incidence through improved primary care and health promotion. The variation across planning areas in the LHIN suggests that there are social determinants and ethnicity associations which will require targeted interventions for health promotion. Final Interim Report 3

4 Cardiology & Cardiovascular: Summary The Central LHIN currently has a lower prevalence rate than Ontario for hypertension, Heart Disease and Ischemic Heart Disease. This is expected to change over the next ten years due to the population growth that is anticipated. In ten years, the Central LHIN will have a higher prevalence rate than Ontario. The current and project prevalence rates vary by Central LHIN planning area. Some planning areas are much lower than provincial averages, while others are significantly higher. The South Simcoe and Northern York region has the highest prevalence of hypertension and heart disease while South East York has the lowest. The North York West and North York Central regions have the highest prevalence of ischemic heart disease while South East York has the lowest. Many Canadian and other studies find cardiovascular disease to have the greatest association with the experience of poverty. The one-year survival rates for heart attack admissions are higher in wealthier neigbourhoods as compared to those in the poorer neighbourhoods. Patients in higher income neighbourhoods had greater rates of coronary angiography and shorter waiting times for catheterization. These findings were not a function of severity of illness, specialty of attending physician or the characteristics of the hospital but rather the income level of the patient (Raphael, Dennis. Poverty and Policy in Canada: Implications for Health and Quality of Life. 2007). Final Interim Report 4

5 Cardiology & Cardiovascular: Summary The highest prevalence for most cardiac conditions is in the South West York region, followed by North York West. The anticipated growth rate of most cardiac conditions in the next ten years in South West York is also higher than the other planning areas, which may have a significant impact on current resources, especially given that there are no hospitals in this planning area. Final Interim Report 5

6 Physician Ratios for Cardiology, Internal Medicine and Cardiac Surgery in the Central LHIN (OHIP Active Physicians 2008) The table below contains the physician ratios in the LHIN, showing gaps as compared to the Ontario average for Cardiologists, Internists and Cardiac Surgeons. To bring levels up to the Ontario average would require an additional 2.6 cardiologists, 95 Internists and 1.6 cardiac surgeons. Active Physicians per 100,000 Residents Planning Area Cardiology Internal Medicine Cardiac Surgery North York West North York East North York Central South West York South Simcoe and Northern York Region Central York South East York Central LHIN Ontario Source: Scott s Medical Directory Ontario 2008 Final Interim Report 6

7 Heart Disease & hypertension (CCHS 2005): Risk Factors The main risk factors for Heart Disease and hypertension are identified in the table: Age: > 55 Employment: unemployed/social assistance Household income: < $50,000 Personal income: < $30,000 Education: < secondary school Immigrant Former smoker Household size: < 3 Country of Origin: outside Canada Language: neither English nor French Weight: BMI > 18 Source: CCHS 2005, Infonaut Note Statistics Canada Immigrant Definition includes: Foreign-born population (also known as the immigrant population) and Recent Immigrant Foreign born populations are defined in the 2006 Census as persons who are, or who have been, landed immigrants in Canada. In this analysis, the foreign-born population does not include non-permanent residents, who are persons in Canada on employment or student authorizations, or are refugee claimants. The foreign-born population also excludes persons born outside Canada who are Canadian citizens by birth. The latter are considered part of the Canadian-born or non-immigrant population. Recent immigrants refer to landed immigrants who came to Canada up to five years prior to a given census year. For the 2006 Census, recent immigrants are landed immigrants who arrived in Canada between January 1, 2001 and Census Day, May 16, Similarly, recent immigrants in the 2001 Census were newcomers at the time of the 2001 Census, i.e., they came to Canada between January 1, 1996 and Census Day, May 15, Final Interim Report 7

8 Hypertension (High Blood Pressure) The following three slides show the current and projected prevalence rates for hypertension in the Central LHIN and the province of Ontario Overall, the Central LHIN has a slightly lower Relative Risk (RR) of hypertension than Ontario However, four areas show a higher prevalence for hypertension than the Provincial average Within the Central LHIN, the South Simcoe & North York Region area has the highest Relative Risk Factor. Further, this is an area with few primary care services (e.g. physicians, walk-in clinics) for regular monitoring Other areas with high Relative Risk numbers are North York West and Central York. South West York is only slightly above Ontario. North York West is an area with a population that has a number of risk factors identified for hypertension (e.g. low levels of education, low income levels, significant immigrant population). Central York has a significant immigrant population South West York will experience highest growth in population with hypertension over next ten years. Although South East York has a significantly lower Relative Risk, close to 1/4 of Central LHIN s population with hypertension live in this area. This area will experience the second highest growth in population with hypertension over the next ten years. North York Central and North York West are expected to experience growth in hypertension risk rates that are similar or less than Ontario in the next ten years. Final Interim Report 8

9 Hypertension (CCHS 2005): Prevalence South Simcoe & N York Region Central York Region S E York Region S W York Region N York West N York Central N York East Central LHIN % Hypertension # Hypertension Relative Risk 17.75% 15, % 26, % 46, % 26, % 32, % 33, % 12, % 193, Ontario 15.29% 1,611, Source: CCHS 2005, Infonaut Final Interim Report 9

10 Hypertension (CCHS): Projected Growth ( ) South Simcoe and Northern York Region Central York Region South East York Region South West York Region North York West North York Central North York East Central LHIN Ontario % growth Year Source: CCHS 2005, Environics Analytics Population Projections 2008 to 2018, Infonaut Final Interim Report 10

11 Heart Disease (CCHS 2005): Prevalence South Simcoe & N York Region Central York Region S E York Region S W York Region N York West N York Central N York East Central LHIN % Heart Disease # Heart Disease RR 5.22% 4, % 6, % 10, % 5, % 9, % 10, % 4, % 51, Ontario 4.80% 506, Source: CCHS 2005 Questions related to Heart Disease that is asked by the Canadian Community Health Survey Do you have Heart Disease? (Y/N) Do you choose certain foods or avoid others because you are concerned about heart disease? In the past 12 months, did you require a visit to a medical specialist for a diagnosis or a consultation for a new illness or condition? (Y/N) If so, was that for a Heart Condition or Stroke? Final Interim Report 11

12 Heart Disease Overall, the Central LHIN has a much lower Relative Risk of Heart Disease than Ontario Two areas within Central LHIN are greater than Ontario: South Simcoe & North York Region and North York West South West York and South East York are significantly lower than other areas of the Central LHIN and Ontario Although RR for South East York is lower, approximately 20% of the Central LHIN s population with Heart Disease live in this area North York Central and North York West each have approximately 20% of the population with Heart Disease living in these areas Heart Disease rates in North York West, North York East and North York Central are expected to grow less than or equal to the Ontario growth rate over the next 10 years. Heart Disease rates in South West York and South East York will experience significant growth over in a similar time frame. Final Interim Report 12

13 Heart Disease (CCHS): Projected Growth ( ) South Simcoe and Northern York Region Central York Region South East York Region South West York Region North York West North York Central North York East Central LHIN Ontario % growth Year Source: CCHS 2005, Environics Analytics Population Projections 2008 to 2018, Infonaut Final Interim Report 13

14 Ischemic Heart Disease (ICES 2006/07): Prevalence Ischemic heart disease (IHD) (or myocardial ischaemia)- a term applied specifically to a disease characterized by reduced blood supply to the heart muscle, usually due to coronary artery disease. This is due to a symptomatic narrowing of the coronary arteries by atherosclerotic changes. A decreased blood supply to the heart causes anginal pain. Its risk increases with age, smoking, hypercholesterolaemia (high cholesterol levels), diabetes, hypertension (high blood pressure) and is more common in men and those who have close relatives with ischaemic heart disease. Symptoms of stable ischaemic heart disease include angina (characteristic chest pain on exertion) and decreased exercise tolerance. Unstable IHD presents itself as chest pain or other symptoms at rest, or rapidly worsening angina. Diagnosis of IHD is with an electrocardiogram, blood tests (cardiac markers), cardiac stress testing or a coronary angiogram. Depending on the symptoms and risk, treatment may be with medication, percutaneous coronary intervention (angioplasty) or coronary artery bypass surgery (CABG). It is the most common cause of death in most Western countries, and a major cause of hospital admissions. There is limited evidence for population screening, but prevention (with a healthy diet and sometimes medication for diabetes, cholesterol and high blood pressure) is used both to prevent IHD and to decrease the risk of complications. Source: Various including ICES and Wikipedia (Reference traced back to Loria V, Dato I, Graziani F, Biasucci LM (2008). "Myeloperoxidase: a new biomarker of inflammation in ischemic heart disease and acute coronary syndromes". Mediators Inflamm. 2008) Final Interim Report 14

15 Ischemic Heart Disease (ICES 2006/07): Prevalence Overall, the Central LHIN has a lower rate of Ischemic Heart Disease than the province of Ontario North York West and North York Central are the only two areas higher than Ontario, but only slightly. South East York has a significantly lower relative risk rate. Slightly more than 60% of the Central LHIN s population with Ischemic Heart Disease live in South East York, North York Central and North York West. South Simcoe & N York Region Central York Region % IHD # IHD RR 5.9% 4, % 7, S E York Region 4.7% 16, S W York Region 5.9% 8, N York West 6.9% 12, N York Central 6.9% 15, N York East 5.8% 5, Central LHIN 5.9% 70, Ontario 6.2% 613, Source: ICES InTool 2006/07 Final Interim Report 15

16 ICES Reports Prevalence of Ischemic Heart Disease by Planning Area for the Central LHIN This graph compares prevalence rate of ischemic heart disease by planning area for the LHIN. South West York Region and North York West rank higher than the Provincial rate. Overall, the Central LHIN has a lower rate of Ischemic Heart Disease than the province of Ontario North York West and South West York are the only two areas higher than Ontario. Slightly more than 60% of the Central LHIN s population with Ischemic Heart Disease live in South East York, North York Central and North York West. Source: ICES intool 2007 Final Interim Report 16

17 ICES Reports Prevalence of Acute Myocardial Infarction in the Central LHIN 2006/07 This graph compares the prevalence rate of hospitalized acute myocardial infarction for the Central LHIN versus the Province. The Central LHIN consistently ranks lower for men and women compared to the Province for all age groups. Source: ICES InTool 2007 Final Interim Report 17

18 ICES Reports Survival Rates for Acute Myocardial Infarction in the Central LHIN 2006/07 This graph compares post-acute myocardial infarction survival rate per 100 patients age 20+ for each of the LHINs from 2004 to The Central LHIN ranks below the Ontario average in each of the years examined. Most LHINs experience results very close to the Ontario average with the Central LHIN having a slightly better experience than their immediate neighbouring LHINs Source: ICES InTool 2007 Final Interim Report 18

19 ICES Reports Arrhythmia in the Central LHIN by Planning Area Age & Sex 2006/07 This graph compares the prevalence rate of arrhythmia by planning area in the Central LHIN. With the exception of North York East, all of the planning areas rank higher than the Provincial rate. South West York Region has the highest prevalence rate for arrhythmia in the LHIN. Source: ICES InTool 2007 Final Interim Report 19

20 ICES Reports Coronary Heart Failure and Angiotensin-Converting Enzyme Inhibitor Usage This graph compares the usage of ACE inhibitors or ARBs within 30 days of hospital discharge for coronary heart failure for the Province by LHIN. The Central LHIN ranks higher than the provincial average for 2004/05 and 2005/06. Source: ICES InTool 2007 Final Interim Report 20

21 ICES Reports Newly Diagnosed Coronary Heart Failure Patients Who Received an ECHO or ACE Inhibitor Prescription Within One Year of Diagnosis This graph compares the ECHO and ACE inhibitor prescription rate for newly diagnosed CHF patients within one year of diagnosis for the LHINs. The Central LHIN ranks slightly higher in patients who received ECHOs and ACE inhibitor prescriptions compared to the Province. Source: ICES InTool 2007 Final Interim Report 21

22 ICES Reports Newly Hospitalized Coronary Heart Failure Patients This graph compares the number and percentage of newly hospitalized CHF patients for each of the LHINs. The Central LHIN ranks slightly higher than the other LHINs. Source: ICES InTool 2007 Final Interim Report 22

23 ICES Reports Distribution of Physician Type Most Responsible for Newly Hospitalized Coronary Heart Failure Patients This graph compares the distribution of physician type most responsible for newly diagnosed CHF patients in the Province. In the Central LHIN, the GP/FP plays a small role in care, whereas the distribution for cardiologist, internist and other specialist is relatively equal. The low usage of GP/FP in the Central LHIN is a significant contrast compared to the other LHINs in CHF management for newly diagnosed patients. Source: ICES InTool 2007 Final Interim Report 23

24 ICES Reports Distribution of GP Physician Type Most Responsible For Newly Hospitalized Coronary Heart Failure Patients This graph compares the percentage of newly hospitalized CHF patients with a GP/FP as the most responsible physician who received a specialist consultation. Although the Central LHIN ranks the lowest, only 7% of patients with CHF in the LHIN were primarily cared for by a GP/FP. Source: ICES InTool 2007 Final Interim Report 24

25 ICES Reports Distribution of GP Physician Type Most Responsible For Newly Hospitalized Coronary Heart Failure Patients This graph compares prevalence rate of ischemic heart disease by planning area and sex for the LHIN. Consistent with the province, men have a higher rate of ischemic heart disease than women. South West York Region men have a significantly higher rate of ischemic heart disease than the Ontario men rate. Source: ICES InTool 2007 Final Interim Report 25

26 Inpatient Cardiac Cases As noted on the previous ten slides Central LHIN is performing on par or slightly better than the province for many common cardiac diseases and the associated treatment. The population of the Central LHIN is currently younger and healthier, however this may change over time as the population ages. The next five slides provide an overview of the distribution rates for inpatient cardiac cases within the LHIN and throughout the Province Central LHIN has a much lower percentage of inpatient cardiac cases when compared to the overall proportion of the population Central LHIN has a significantly lower rate per 1,000 citizens than Ontario Close to 63% of Central LHIN patients requiring inpatient cardiac care received care from a Central LHIN hospital. Approximately 30% received care from a Toronto Central LHIN hospital. Approximately 60% of Central LHIN residents requiring inpatient cardiac care are male. Close to 42% are males between the ages of 55 and 75. Slightly more than 30% are females over the age of 65. South East York and North York Central account for close to 40% of the inpatient cardiac cases. Southlake Regional Health Centre has close to 40% of all the cardiac inpatient cases in the Central LHIN. North York General has 20% and York Central has 15%. Final Interim Report 26

27 Distribution of Inpatient Cardiac Cases by Patient LHIN for the Province of Ontario DAD, FY 2006/07 LHIN Name Inpatient Cases % Inpatient Cases Population 20+ years Rate per 1000 Erie St. Clair 7, , South West 9, , Waterloo Wellington 5, , Hamilton Niagara Haldimand Brant 16, ,035, Central West 6, , Mississauga Halton 9, , Toronto Central 9, , Central 13, ,212, Central East 14, ,123, South East 6, , Champlain 11, , North Simcoe Muskoka 5, , North East 11, , North West 4, , Total Province 134, ,603, Final Interim Report 27

28 Outflow - Distribution of Inpatient Cardiac Cases for Central LHIN Residents by Hospital LHIN Attended - FY 2006/07 LHIN Name Inpatient Cases % Inpatient Cases Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central 3, Central 8, Central East South East Champlain North Simcoe Muskoka North East North West Total Province 134, Final Interim Report 28

29 INFLOW - Distribution of Inpatient Cardiac Cases for Central LHIN Hospitals by Patient Home LHIN - FY 2006/07 LHIN Name Cardiac Case Count Cardiac Case % Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central 8, Central East South East Champlain North Simcoe Muskoka 1, North East North West Total Province 11, Final Interim Report 29

30 Distribution of Central LHIN Cardiac Inpatients by Age and Gender (DAD, FY 2006/07) Age Group Female Male % of Females Only % of Males Only % Female of Total % Male of Total Total Final Interim Report 30

31 Sub-LHIN Distribution of Central LHIN Cardiology Inpatients by Age (DAD FY 2006/07) Cases Proportion Number of Inpatients Total South Simcoe and Northern York Region Central York Region South East York Region South West York Region North York West North York Central North York East Percent of Inpatients Total South Simcoe and Northern York Region Central York Region South East York Region South West York Region North York West North York Central North York East Final Interim Report 31

32 Central LHIN Hospital Inpatient Statistics for Cardiac PCCs (DAD FY 2006/07) Central LHIN Hospital PCC Total Cases Acute Days Total Days ALC Days Avg Acute LOS Avg Total LOS Avg ALC LOS North York General Hospital Cardiology North York General Hospital Cardio/Thoracic North York General Hospital Vascular Surgery Stevenson Memorial Hospital Cardiology Stevenson Memorial Hospital Cardio/Thoracic Stevenson Memorial Hospital Vascular Surgery Southlake RHC Cardiology Southlake RHC Cardio/Thoracic Southlake RHC Vascular Surgery York Central Hospital Cardiology York Central Hospital Cardio/Thoracic York Central Hospital Vascular Surgery Markham Stouffville Hospital Cardiology Markham Stouffville Hospital Cardio/Thoracic Markham Stouffville Hospital Vascular Surgery Humber River Regional Memorial Cardiology Humber River Regional Memorial Cardio/Thoracic Humber River Regional Memorial Vascular Surgery Total Final Interim Report 32

33 Emergency Department Cardiac Cases The following four slides represent the data on distribution of cardiac cases in FY 2006/ % of Central LHIN residents that required inpatient cardiac care, received that care from a Central LHIN hospital and 30% received care from a Toronto Central LHIN hospital. The rate per 1,000 for ED Cardiology cases for Central LHIN is 32.8 however this also varies by planning area: South East York and North York East and are significantly below this rate at 25.4 and 28.8 per 1,000 respectively. South West York and North York Central are slightly higher at 33.6 and 34.7 per 1,000 respectively. Central York s rate per 1,000 is the highest at 39.7, and is followed by South Simcoe and Northern York at 37.7 and North York West at Slightly more Central LHIN males (51.2%) than females (48.8%) receive Emergency Care for cardiology. 33

34 Distribution of ED (NACRS) Cardiac Cases by Patient LHIN for the Province of Ontario - FY 2006/07 LHIN Name Clinic Emerg EMS Medical Day/Night Surgical Day/Night Other Total Population 20+ years Rate per 1000 Erie St. Clair , South West , Waterloo Wellington , Hamilton Niagara Haldimand Brant ,035, Central West , Mississauga Halton , Toronto Central , Central ,212, Central East ,123, South East , Champlain , North Simcoe Muskoka , North East , North West , Total Province ,603, Final Interim Report Source: NACRS 2006/07 34

35 Distribution of ED (NACRS) Cardiac Cases for Central LHIN Residents by LHIN Hospital Attended - FY 2006/07 LHIN Name Clinic Emerg EMS Medical Day/Night Surgical Day/Night Other Total Erie St. Clair South West Waterloo Wellington Hamilton Niagara Haldimand Brant Central West Mississauga Halton Toronto Central Central Central East South East Champlain North Simcoe Muskoka North East North West 2 2 Total Province Final Interim Report Source: NACRS 2006/07 35

36 Distribution of Central LHIN Patients ED (NACRS) Cardiology by Case Type and SubLHIN - NACRS FY 2006/07 Medical Day/Night Surgical Day/Night Other Total Population 20+ years Rate per 1000 LHIN Planning Area Clinic Emerg EMS South Simcoe and Northern York Region , Central York Region , South East York Region , South West York Region , North York West , North York Central , North York East , Total ,212, Final Interim Report Source: NACRS 2006/07 36

37 Distribution of Central LHIN Cardiac ED (NACRS) Patients by Age and Gender (FY 2006/07) Age Group Female Male % of Females Only % of Males Only % Female of Total % Male of Total Total Final Interim Report Source: NACRS 2006/07 37