Determinants of physical activity after hospitalization for coronary artery disease: the Tracking Exercise After Cardiac Hospitalization (TEACH) Study.

BACKGROUND: Little is known about physical activity levels in patients with coronary artery disease (CAD) who are not engaged in cardiac rehabilitation. We explored the trajectory of physical activity after hospitalization for CAD, and examined the effects of demographic, medical, and activity-related factors on the trajectory. DESIGN: A prospective cohort study. METHODS: A total of 782 patients were recruited during CAD-related hospitalization. Leisure-time activity energy expenditure (AEE) was measured 2, 6 and 12 months later. Sex, age, education, reason for hospitalization, congestive heart failure (CHF), diabetes, and physical activity before hospitalization were assessed at recruitment. Participation in cardiac rehabilitation was measured at follow-up. RESULTS: AEE was 1948+/-1450, 1676+/-1290, and 1637+/-1486 kcal/week at 2, 6 and 12 months, respectively. There was a negative effect of time from 2 months post-hospitalization on physical activity (P<0.001). Interactions were found between age and time (P=0.012) and education and time (P=0.001). Main effects were noted for sex (men more active than women; P<0.001), CHF (those without CHF more active; P<0.01), diabetes (those without diabetes more active; P<0.05), and previous level of physical activity (those active before hospitalization more active after; P<0.001). Coronary artery bypass graft patients were more active than percutaneous coronary intervention (PCI) patients (P=0.033). CONCLUSIONS: Physical activity levels declined from 2 months after hospitalization. Specific subgroups (e.g. less educated, younger) were at greater risk of decline and other subgroups (e.g. women, and PCI, CHF, and diabetic patients) demonstrated lower physical activity. These groups need tailored interventions.

Incidence, comorbidity, case fatality and readmission of hospitalized stroke patients in Canada.

BACKGROUND: Stroke is a leading cause of death and disability, and poses a significant burden of care for those who survive. OBJECTIVES: To estimate the incidence of hospitalization for stroke and describe the impact of age, sex and comorbidity on in-hospital mortality, length of stay and readmission rates. METHODS: Health insurance numbers were used to link acute care hospitalizations across Canada in 1999/2000 for stroke patients with no discharges for a stroke within the preceding five years. Patients were followed up for one year from the date of their initial admission. RESULTS: The numbers of men (15,367) and women (16,740) in the study were similar. The incidence of all types of stroke (International Classification of Diseases, ninth revision, codes 430, 431 and 434/436) for hospitalized men and women was 14.4 per 10,000, with a 15-fold rise from 8.7 for the age group of 45 to 64 years to 131.9 per 10,000 for the age group 80 years and older. For the index episode, stroke patients spent an average of 21.0 days in the hospital, and 18.2% died in the hospital within 28 days. Of those who survived the first episode, 10.3% were readmitted to the hospital within one year with a recurrent stroke, and overall 37.1% were readmitted for any cause (including stroke). Among these stroke patients, hypertension was codiagnosed in 35%; diabetes in 17%; arrhythmia in 15%; ischemic heart disease in 13.6%; and congestive heart failure in 5%. CONCLUSIONS: Hospital records linked by patient identification can produce more accurate national estimates of patients hospitalized with stroke than any current countrywide surveillance system.

Incident cerebrovascular disease in rural and urban Alberta.

STUDY OBJECTIVE: This study examines the pattern of incidence and health service utilisation of cerebrovascular disease cases in urban and rural areas within a publicly funded health care system. DESIGN: A population-based study covering a large geographic region, using population-wide administrative health data. Age- and sex-standardised incidence and mortality rates were calculated for rural and urban areas. Final status (discharge or death), place of service and place of residence were reported for all cases across several different subsets of cerebrovascular disease. SETTING: The province of Alberta, located in western Canada. PARTICIPANTS: Incident cases of cerebrovascular disease (stroke and transient ischaemic attack) and 4 different definitions of incident stroke were identified from data on emergency department admissions in the 1999/2000 fiscal year. MAIN RESULTS: The rate of cerebrovascular disease per 10,000 was similar between urban (13.24) and rural (13.82) areas. Rural residents frequently reported their incident episode to urban emergency departments. Although the mortality is similar between urban and rural residents, rural dwellers die more frequently in the emergency department setting than urban dwellers, who die more often as in-patients. CONCLUSIONS: Overall mortality is similar between urban and rural residents. A large proportion of rural residents receive diagnoses and treatment for cerebrovascular disease in urban areas. Location of service and location of death differs between rural and urban cases of cerebrovascular disease.

Regional comparisons of inpatient and outpatient patterns of cerebrovascular disease diagnosis in the province of Alberta.

The diagnosis of cerebrovascular disease (CBVD) from administrative data has been critically examined by epidemiologists in recent years. Much of the existing literature suggests that hospital discharge diagnoses based on ICD-9-CM codes are an unreliable source of information for determining a diagnosis of stroke, particularly when four- and five-digit codes are used. We examined how diagnoses for CBVD in hospital inpatient and outpatient facilities vary between rural and urban areas and among the 16 administrative health regions. Our analysis revealed differences in diagnostic patterns between the two sources of data, differences between rural and urban areas, and variation across most of the regions. Geographic variation in health service utilization, diagnostic practices, specialty of the physician making the diagnosis, and disease burden may explain our findings. Our results suggest that the diagnosis of patients attending rural facilities are either coded differently (and less precisely) than those of urban residents or are coded more precisely only after the patients attend urban facilities. Regional differences in coding practices show that any CBVD surveillance system based on administrative data requires a large-scale (in this case, province-wide) and person-oriented approach.