How safe is the wait?

Patients awaiting coronary artery bypass grafting (CABG) in Ontario are at much greater risk of death than the general population. However, the authors of a new study conclude patients awaiting CABG in Ontario are at similar or decreased vital risk when compared with thousands of other patients living with coronary artery disease. In an attempt to benchmark the burden of delayed care on patients David Naylor and colleagues determined the vital risk among people waiting for CABG in Ontario and compared it with the risk in the general population and among people living with coronary artery disease. The authors report that among 21 220 patients awaiting CABG, there were 82 preoperative deaths over a median followup of 18 days and the standard mortality rate was 2.92 (95% confidence limit 2.29-3.55). Among 21 220 matched 6-month survivors of an acute myocardial infarction, there were 663 deaths over a median follow up of 185 days and the standard mortality rate was 3.84 (95% confidence limit 3.54-4.14). In an accompanying editorial, David Hadorn discusses how mortality rate studies like this one can be meaningfully interpreted without patient-level adjustments. Benchmarking the vital risk of waiting for coronary artery bypass surgery — C.D. Naylor; J.P. Szalai; M. Katic What can mortality rates tell us about waiting lists? — D.C. Hadorn