The Cardiovascular Health in Ambulatory Care Research Team (CANHEART)

Tu, Jack V.; Chu, Anna; Donovan, Linda R.; Ko, Dennis T.; Booth, Gillian L.; Tu, Karen; Maclagan, Laura C.; Guo, Helen; Austin, Peter C.; Hogg, William; Kapral, Moira K.; Wijeysundera, Harindra C.; Atzema, Clare L.; Gershon, Andrea S.; Alter, David A.; Lee, Douglas S.; Jackevicius, Cynthia A.; Bhatia, R. Sacha; Udell, Jacob A.; Rezai, Mohammad R.; Stukel, Thérèse A.

doi:10.1161/circoutcomes.114.001416

Cited by 146 publications

(70 citation statements)

References 22 publications

(22 reference statements)

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“…We used a look‐back window of 20 years (back to January 1, 1992) to exclude patients with prior cardiovascular disease. Previous cardiovascular disease was defined by prior hospitalization for acute myocardial infarction, stroke, congestive heart failure, percutaneous coronary intervention, and coronary artery bypass grafting, using previously validated algorithms 13, 14, 15, 16, 17, 18, 19. We also used a 1‐year washout period such that patients who had 1 of the 4 noninvasive diagnostic tests during the 2011 calendar year were excluded.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

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BackgroundThe optimal initial noninvasive diagnostic testing strategy for stable coronary artery disease (CAD) is unknown. Although American guidelines recommend an exercise stress test as the first‐line test, European guidelines suggest that stress imaging (myocardial perfusion imaging or stress echocardiography) or coronary computed tomography angiography may be preferable. Understanding the relationship between the initial strategy and downstream yield of obstructive CAD and major adverse cardiac events may provide insight as to the optimal strategy.Methods and ResultsWe conducted a population‐based retrospective cohort study of adults in Ontario, Canada, using health administrative and clinical data. The relationship between the initial testing strategy and obstructive CAD on invasive angiography was examined. Patients were then followed from their angiogram onward to determine whether they developed a composite end point of major adverse cardiac events. After adjusting for covariates, patients with initial myocardial perfusion imaging (odds ratio: 0.92; 95% confidence interval, 0.85, 1.00), coronary computed tomography angiography (odds ratio: 1.51; 95% confidence interval, 0.91, 2.49), or stress echo (odds ratio: 0.95; 95% confidence interval, 0.84, 1.08) did not a have significantly different yield of obstructive CAD compared with those with an initial exercise stress test. Furthermore, there was no significant difference in downstream major adverse cardiac events after invasive angiography among the 4 initial testing strategies after adjusting for clinically relevant covariates.ConclusionsOur study found no evidence to suggest significant differences in either yield of obstructive CAD or downstream major adverse cardiac events in patients undergoing an initial noninvasive testing strategy with stress or anatomical imaging compared with those undergoing an initial exercise stress test.

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Section: Methodsmentioning

confidence: 99%

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

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“…[7][8][9][10] The Cardiovascular Health in Ambulatory Care Research Team (CANHEART) "big data" initiative was established to measure and improve the cardiovascular health and quality of ambulatory cardiovascular care provided in Ontario, Canada. 11 It aims to contribute to a learning health care system by linking routinely collected information from multiple population-based data sources to form a single, comprehensive database that can RESEARCH Regional variations in ambulatory care and incidence of cardiovascular events be used to study the delivery and outcomes of clinical CVD care in the entire population over time. 11,12 In this CANHEART Regional Variations cohort study, we sought to identify patient and health system factors associated with regional variations in the incidence of major cardiovascular events.…”

mentioning

confidence: 99%

“…11 It aims to contribute to a learning health care system by linking routinely collected information from multiple population-based data sources to form a single, comprehensive database that can RESEARCH Regional variations in ambulatory care and incidence of cardiovascular events be used to study the delivery and outcomes of clinical CVD care in the entire population over time. 11,12 In this CANHEART Regional Variations cohort study, we sought to identify patient and health system factors associated with regional variations in the incidence of major cardiovascular events. In particular, we studied the delivery of preventive health care services provided by family physicians.…”

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confidence: 99%

Regional variations in ambulatory care and incidence of cardiovascular events

Chu

Maclagan

et al. 2017

CMAJ

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BACKGROUND: Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates. METHODS:We conducted a cohort study involving 5.5 million patients aged 40 to 79 years in Ontario, Canada, with no hospital stays for cardiovascular disease as of January 2008, through linkage of multiple population-based health databases. The primary outcome was the occurrence of a major cardiovascular event (myocardial infarction, stroke or cardiovascularrelated death) over the following 5 years. We compared patient demographics, cardiac risk factors and ambulatory health care services across the province's 14 health service regions, known as Local Health Integration Networks (LHINs), and evaluated the contribution of these variables to regional variations in cardiovascular event rates.RESULTS: Cardiovascular event rates across LHINs varied from 3.2 to 5.7 events per 1000 person-years. Compared with residents of high-rate LHINs, those of lowrate health regions received physician services more often (e.g., 4.2 v. 3.5 mean annual family physician visits, p value for LHIN-level trend = 0.01) and were screened for risk factors more often. Lowrate LHINs were also more likely to achieve treatment targets for hypercholesterolemia (51.8% v. 49.6% of patients, p = 0.03) and controlled hypertension (67.4% v. 53.3%, p = 0.04). Differences in patient and health system factors accounted for 74.5% of the variation in events between LHINs, of which 15.5% was attributable to health system factors alone. INTERPRETATION:Preventive ambulatory health care services were provided more frequently in health regions with lower cardiovascular event rates. Health system interventions to improve equitable access to preventive care might improve cardiovascular outcomes.

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“…The study population was derived from the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort (http://www.canheart.ca), which comprised the linkage of multiple individual‐level databases using encoded personal identifiers 11. Databases that were linked include the Canadian Institute for Health Information (CIHI) Discharge Abstract Database and the Ontario Diabetes Database, to identify hospitalizations for ACS and comorbidities; Same Day Surgery, and National Ambulatory Care Reporting System to identify same day surgical and emergency room visits respectively; Registered Persons Database for death information; the Ontario Drug Benefit prescription database, which was used to determine outpatient prescription drug use for patients aged ≥65 years; the Gamma‐Dynacare Medical Laboratory database, which captures 25% to 30% of all outpatient laboratory testing in Ontario was used to determine cholesterol levels; and the Registrar General of Ontario Vital Statistics Database, which was used to determine cause of death of all Ontarians.…”

Section: Methodsmentioning

confidence: 99%

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Alter

Koh

et al. 2018

JAHA

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BackgroundThe extent to which outcome benefits may be achieved through the implementation of aggressive low‐density lipoprotein (LDL) cholesterol targets in real world settings remains unknown, especially among elderly statin users following acute coronary syndromes.Methods and ResultsA population‐based cohort study consisting of 19 544 post‐acute coronary syndrome statin‐users aged ≥66 years between January 1, 2017 and March 31, 2014 was used to project the number of adverse outcome events (acute myocardial infarction or death from any cause) that could be prevented if all post‐acute coronary syndrome elderly statin users were treated to 1 of 2 LDL cholesterol target levels (≤50 and ≤70 mg/dL). The number of preventable adverse outcomes was estimated by using model‐based expected event probabilities as derived from Cox Proportional hazards models. In total, 61.6% and 25.5% of the elderly patients met LDL cholesterol targets of ≤70 and ≤50 mg/dL, respectively, based on current management. No more than 2.3 adverse events per 1000 elderly statin users (95% confidence interval: −0.7 to 5.4, P=0.62) could be prevented over 8.1 years if all patients were to be treated from current LDL cholesterol levels to either of the 2 LDL cholesterol targets of 70 or 50 mg/dL.ConclusionsThe number of acute myocardial infarctions or death that could be prevented through the implementation of LDL cholesterol targets with statins is negligible among an elderly post‐acute coronary syndrome population. Such findings may have implications for the applicability of newer agents, such as proprotein convertase subtilisin/kexin type‐9‐ inhibitors.

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The Cardiovascular Health in Ambulatory Care Research Team (CANHEART)

Cited by 146 publications

References 22 publications

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Regional variations in ambulatory care and incidence of cardiovascular events

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

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