People with cystic fibrosis (CF) who live in Canada survive longer with the condition than their counterparts in the United States, a study Rick and I discuss on PodMed this week and published in Annals of Internal Medicine finds. 10 years longer! That's a significant amount of time in anyone's estimation, and the reasons behind it are sobering, though Rick and I agree that they also provide an opportunity to improve.
Researchers crunched data from two registrations: the Canadian Cystic Fibrosis Registry (CCFR) and U.S. Cystic Fibrosis Foundation Patient Registry (CFFPR). The Canadian registry represents 42 CF clinics while the US registry represents 110 clinics. Almost 6000 Canadian patients were included in this study along with over 45,000 US patients with the disease, with results indicating that north of the border, people with CF live on average 51 years, while domestically age expectancy is 40.6 years.
Lung transplantation is more common for CF patients in Canada than in the US: 10.3% were transplanted and transplanted earlier than CF patients in the US, where only 6.5% received new lungs. I query in the podcast whether there is a difference in availability of lungs for transplant between the two countries but no data is reported on that in this study. Perhaps more sobering is the fact that when types of insurance patients in the US had were used to stratify CF patients, those without insurance or who had Medicaid were the ones who died earlier, while CF patients with good insurance lived as long as their Canadian counterparts. Therein lies at least one opportunity to even things up, as care continues to improve for this condition.
Other topics this week include Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee ArthroplastyThe HIHO Randomized Clinical Trial and Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation in JAMA, and in NEJM, Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism. Until next week, y'all live well.