D'Arcy Little, MD, CCFP
Director of Medical Education,
York Community Services, Toronto, ON
Background
Coronary artery bypass grafting (CABG) is an accepted therapeutic intervention for the treatment of coronary artery disease (CAD). Depending on the clinical situation, CABG can improve the symptoms of angina, patient survival (triple vessel or left main disease), and quality of life. Over the last two decades, there has been a substantial growth in the use of CABG in Canada and it is now one of the most common surgical procedures performed in North America. Most of the overall increase in the frequency with which this procedure is performed has been seen in the elderly population.1,2 However, this increase has not taken place without controversy. While some health critics have argued that the procedure is overused, patients often express concern about waiting lists.3 This article will discuss the costs of CABG in the elderly and potential avenues to reduce these costs and improve patient outcomes.
In Ontario, the overall rate of CABG grew 31% during the years 1981 to 1989, and in 1989-90 this surgery was performed at a rate of 66 procedures per 100,000 members of the population. Notably, during this period, the highest annual increase was in those patients aged 65 to 74 years. Thirty-seven percent of cases were performed in patients over 65 years of age.
