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The 2004 ACC/AHA Guidelines: a perspective and adaptation for Canada by the Canadian Cardiovascular Society Working Group.

https://arctichealth.org/en/permalink/ahliterature178142
Source
Can J Cardiol. 2004 Sep;20(11):1075-9
Publication Type
Article
Date
Sep-2004
Author
Paul W Armstrong
Peter Bogaty
Christopher E Buller
Paul Dorian
Blair J O'Neill
Author Affiliation
VIGOUR Centre, University of Alberta, Edmonton. paul.armstrong@ualberta.ca
Source
Can J Cardiol. 2004 Sep;20(11):1075-9
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
Canada
Defibrillators, Implantable - standards
Electrocardiography
Emergency Medical Services - standards
Emergency Service, Hospital - standards
Female
Guideline Adherence
Humans
Male
Myocardial Infarction - diagnosis - therapy
Myocardial Reperfusion - standards
Severity of Illness Index
Survival Analysis
Treatment Outcome
Abstract
Major changes in acute ST elevation myocardial infarction (STEMI) management prompted a comprehensive rewriting of the American College of Cardiology/American Heart Association Guidelines. The Canadian Cardiovascular Society (CCS) participated in both the writing process and the external review. Subsequently, a Canadian Working Group (CWG), formed under the auspices of the CCS, developed a perspective and adaptation for Canada. Herein, accounting for specific realities of the Canadian cardiovascular health system, is a discussion of the implications for prehospital care and transport, optimal reperfusion therapy and an approach to decision making regarding reperfusion options and invasive therapy following fibrinolytic therapy. Major recent developments regarding indications for implantable cardioverter defibrillator(s) (ICDs) also prompted a review of indications for ICDs and the optimal timing of implantation given the potential for recovery of left ventricular function. At least a 40-day, preferably a 12-week, waiting period was judged to be optimal to evaluate left ventricular function post-STEMI. A recommended algorithm for the insertion of an ICD is provided. Implementation of the new STEMI guidelines has substantial implications for resources, organization and priorities of the Canadian health care system. While on the one hand, the necessary incremental funding to provide tertiary and quaternary care and to support revascularization and device implantation capability is desirable, it is equally or more important to develop enhanced prehospital care, including the capacity for early recognition, risk assessment, fibrinolytic therapy and/or triage to a tertiary care centre as part of an enlightened approach to improving cardiac care.
PubMed ID
15457302 View in PubMed
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Applying the new STEMI guidelines: 1. Reperfusion in acute ST-segment elevation myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature177743
Source
CMAJ. 2004 Oct 26;171(9):1039-41
Publication Type
Article
Date
Oct-26-2004
Author
Peter Bogaty
Christopher E Buller
Paul Dorian
Blair J O'Neill
Paul W Armstrong
Author Affiliation
Quebec Heart Institute, Laval Hospital, Sainte-Foy.
Source
CMAJ. 2004 Oct 26;171(9):1039-41
Date
Oct-26-2004
Language
English
Publication Type
Article
Keywords
Anistreplase - administration & dosage
Canada
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Electrocardiography
Female
Guideline Adherence
Humans
Infusions, Intravenous
Middle Aged
Myocardial Infarction - diagnosis - drug therapy
Myocardial Reperfusion - standards
Risk assessment
Severity of Illness Index
Streptokinase - therapeutic use
Thrombolytic Therapy - adverse effects - standards
Treatment Outcome
Notes
Cites: Lancet. 1996 Sep 21;348(9030):771-58813982
Cites: Circulation. 2004 Aug 3;110(5):588-63615289388
Cites: Lancet. 1988 Aug 13;2(8607):349-602899772
Cites: Can J Cardiol. 2004 Sep;20(11):1075-915457302
Comment In: CMAJ. 2005 May 24;172(11):1425-6; author reply 142615911844
Comment In: CMAJ. 2005 May 24;172(11):1425; author reply 142615911845
Erratum In: CMAJ. 2004 Nov 23;171(11):1327
PubMed ID
15505262 View in PubMed
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A novel approach to cardiovascular health by optimizing risk management (ANCHOR): a primary prevention initiative examining the impact of health risk factor assessment and management on cardiac wellness.

https://arctichealth.org/en/permalink/ahliterature131036
Source
Can J Cardiol. 2011 Nov-Dec;27(6):809-17
Publication Type
Article
Author
Jafna L Cox
Brendan Carr
T Michael Vallis
Claudine Szpilfogel
Blair J O'Neill
Author Affiliation
Dalhousie University, Halifax, Nova Scotia, Canada.
Source
Can J Cardiol. 2011 Nov-Dec;27(6):809-17
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cardiovascular Diseases - epidemiology - prevention & control
Counseling - methods
Disease Management
Humans
Life Style
Morbidity - trends
Primary Health Care - methods
Primary prevention - methods
Risk Assessment - methods
Risk factors
Abstract
Cardiovascular disease (CVD) represents an increasing burden to health care systems. Modifiable risk factors figure prominently in the population-attributable risk for premature coronary artery disease. Primary care is well placed to facilitate CVD risk improvement. We plan to evaluate the ability of a novel primary care intervention providing systematic risk factor screening, risk-weighted behavioural counselling and pharmacological intervention to achieve 2 objectives: (1) optimized management of global CVD risk of patients and (2) increased patient adherence to lifestyle and pharmaceutical interventions aimed at decreasing global CVD risk. A pre-post longitudinal prospective design with a nonrandomized comparison group is being undertaken in 2 geographically diverse primary care practices in Nova Scotia with differing reimbursement models. Participants will complete a readiness to change and pre-post health risk assessment (HRA), that will trigger a 1-year intervention individualized around risk and readiness. The primary outcome will be the proportion of participants with Framingham moderate and high-risk strata that reduce their absolute risk by 10% and 25%, respectively. The secondary outcome will be the proportion of moderate and high-risk participants who reduce their risk category. The impact of the intervention on clinical and behavioural variables will also be examined. Low risk participants will be separately analyzed. Data from participants unable to change from the high risk category because of diabetes mellitus or established atherosclerotic disease will also be analyzed separately, with changes in clinical measures from baseline being assessed. A health economic analysis is planned.
PubMed ID
21944276 View in PubMed
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A novel approach to cardiovascular health by optimizing risk management (ANCHOR): behavioural modification in primary care effectively reduces global risk.

https://arctichealth.org/en/permalink/ahliterature112805
Source
Can J Cardiol. 2013 Nov;29(11):1400-7
Publication Type
Article
Date
Nov-2013
Author
Jafna L Cox
T Michael Vallis
Angela Pfammatter
Claudine Szpilfogel
Brendan Carr
Blair J O'Neill
Author Affiliation
Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: jafna.cox@dal.ca.
Source
Can J Cardiol. 2013 Nov;29(11):1400-7
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Canada
Cardiovascular Diseases - prevention & control
Counseling
Female
Health Behavior
Humans
Life Style
Male
Metabolic Syndrome X - epidemiology
Middle Aged
Motivational Interviewing
Primary Health Care
Primary prevention - methods
Prospective Studies
Risk assessment
Risk factors
Risk Management
Risk Reduction Behavior
Abstract
Primary care is well positioned to facilitate cardiovascular risk improvement and reduce future cardiovascular disease (CVD) burden.
The efficacy of risk factor screening, behavioural counselling, and pharmacological treatment to lower CVD risk was assessed via a prospective pre- and postintervention health risk assessment, individualized intervention with behaviour modification, risk factor treatment, and linkage to community programs, with 1-year follow-up and final health risk assessment. Primary outcome was the proportion of subjects with moderate and high baseline Framingham Risk Score (FRS) reducing their risk by 10% and 25%, respectively; the secondary end point was the proportion dropping = 1 risk category.
Patients were enrolled (N = 1509) from March 2006 through October 2008 and 72% completed the study. This analysis focuses on 563 subjects with moderate or high baseline FRS, and excluded 325 low-risk patients and 205 with established CVD or diabetes mellitus. Median age was 56 years, 57.7% were female. The primary outcome was achieved in 31.8% (N = 112; 95% confidence interval [CI], 26.9%-36.6%) of moderate risk FRS participants and 47.9% (N = 101; 95% CI, 41.2%-54.6%) of high-risk participants. The secondary outcome was achieved by 37.2% (N = 210; 95% CI, 33.2%-41.2%). Prevalence of metabolic syndrome fell from 79.2% (N = 446; 95% CI, 75.9%-82.6%) at entry to 52.8% (N = 303; 95% CI, 48.7%-56.9%) at study end. Significant improvements in all modifiable risk factors occurred through lifestyle modification.
Global cardiovascular risk can be effectively decreased via lifestyle changes informed by readiness to change assessment and individualized counselling targeting specific behaviours.
ClinicalTrials.gov number NCT01620996.
PubMed ID
23796526 View in PubMed
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Survey of diabetes care in patients presenting with acute coronary syndromes in Canada.

https://arctichealth.org/en/permalink/ahliterature114333
Source
Can J Cardiol. 2013 Sep;29(9):1134-7
Publication Type
Article
Date
Sep-2013
Author
Blair J O'Neill
Ursula M Mann
Milan Gupta
Subodh Verma
Lawrence A Leiter
Author Affiliation
University of Alberta, Edmonton, Alberta, Canada. Blair.oneill@albertahealthservices.ca
Source
Can J Cardiol. 2013 Sep;29(9):1134-7
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - complications - therapy
Canada
Cardiology - methods - standards
Diabetes Mellitus - diagnosis - etiology - therapy
Endocrinology - methods - standards
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Hyperglycemia - etiology - therapy
Hypoglycemic agents - therapeutic use
Physician's Practice Patterns
Questionnaires
Abstract
Diabetes (DM) adversely affects prognosis in acute coronary syndromes (ACS). Guidelines promote optimal glycemic management. Cardiac care often occurs in subspecialty units where DM care might not be a primary focus. A questionnaire was circulated to 1183 cardiologists (CARDs), endocrinologists (ENDOs), and internists between February and May 2012 to determine current practices of DM management in patients presenting with ACS. The response rate was 14%. ENDOs differed in perception of DM frequency compared with CARDs and the availability of ENDO consultation within 24 hours and on routinely-ordered tests. Disparity also existed in who was believed to be primarily responsible for in-hospital DM care in ACS: ENDOs perceived they managed glycemia more often than CARDs believed they did. CARDs indicated they most often managed DM after discharge and ENDOs said this occurred much less. However, CARDs reported ENDOs were the best health care professional to follow patients after discharge. ENDOs had higher comfort initiating and titrating oral hypoglycemic agents or various insulin regimens. There was also no difference in these specialists' perceptions that optimizing glucose levels during the acute phase and in the long-term improves cardiovascular outcomes. Significant differences exist in the perception of the magnitude of the problem, acute and longer-term process of care, and comfort initiating new therapies. Nevertheless, all practitioners agree that optimal DM care affects short- and long-term outcomes of patients. Better systems of care are required to optimally manage ACS patients with DM during admission and after discharge from cardiology services.
PubMed ID
23623476 View in PubMed
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