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CANADA HEART CARE SEEN TRAILING U.S.

Americans live better than Canadians after suffering a heart attack because they are treated with clot-busting drugs and more invasive treatments more quickly, according to a study by the Ontario Heart and Stroke Foundation.

The study found that while fewer Canadians are suffering heart attacks and more are surviving them, the quality of life for heart attack patients is significantly better in the United States.

The survey said 54 percent of Canadians found that their chest pain had lessened after surgery or drug treatment, compared with 69 percent of U.S. patients.

Twelve months after a heart attack, 31 percent of Canadians rated their health as better than a month before their heart attack, while 44 percent of Americans noted their health had improved.

The reason, according to foundation spokesman Dr. Andy Wielgosz, is that U.S. doctors are "more likely to go with invasive procedures such as angioplasty or bypass surgery" because of the greater availability of these treatments and the general mind-set favoring radical intervention.

"It doesn't make a difference in survivorship, but Americans do have fewer problems with angina (heart pain) and ischemia (reduced blood flow to the heart) after they are discharged from (the) hospital," he said.

As a result, a "year down the road" after their heart attacks, "American patients are feeling better than Canadian patients," he said.

The foundation study, its seventh on heart and stroke issues, found that in the past 13 years, the number of Canadians suffering fatal heart attacks has dropped by 24 percent, largely due to the early use of clot-busting drugs while heart attack patients are in the hospital.

Among Canadians ages 25 to 74, the number of deadly heart attacks fell from 54,600 in 1984 to 41,400 in 1997, the study found.

Another foundation spokesman, cardiologist Dr. Anthony Graham, said a significant proportion of heart attack survivors continue to face life-threatening problems, including recurring heart attacks and heart failure.

"To reduce the toll of heart disease, we need to do a better job of secondary prevention -- preventing the second, third or even fourth heart attack," he said. "This requires slowing down the progression of coronary artery disease, with much greater focus on controlling all modifiable risk factors."

Another problem facing Canadians' quality of life after a heart attack is that only one-third of the survivors participate in rehabilitation programs, despite the evidence that they improve functional ability and may help to reduce the risk of another heart attack.

The study blamed this on limited rehabilitation facilities and the difference between men and women who suffer heart attacks.

Though about 50 percent of men who suffer heart attacks participate in a rehabilitation program, only about one-third of female survivors enroll in cardiac programs, Wielgosz said.

"One reason is that women are less likely to be referred (to a program), and they don't get the same support at home," he said. "Sometimes this is because they are usually older, and there is no pressure on them to re-enter the work force."

Another problem facing Canadian heart patients is the waiting lists for nonemergency heart surgery, which can be up to 14 months.

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