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Access to cardiac rehabilitation among South-Asian patients by referral method: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature143716
Source
Rehabil Nurs. 2010 May-Jun;35(3):106-12
Publication Type
Article
Author
Keerat Grewal
Yvonne W Leung
Parissa Safai
Donna E Stewart
Sonia Anand
Milan Gupta
Cynthia Parsons
Sherry L Grace
Author Affiliation
University of Toronto, ON. keerat.grewal@utoronto.ca
Source
Rehabil Nurs. 2010 May-Jun;35(3):106-12
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - ethnology - rehabilitation
Asia, Western - ethnology
Asian Continental Ancestry Group
Automation
Continuity of Patient Care
Emigrants and Immigrants
Female
Health Knowledge, Attitudes, Practice
Health Services Accessibility
Humans
India - ethnology
Male
Middle Aged
Ontario
Referral and Consultation
Abstract
People of South-Asian origin have an increased prevalence of coronary artery disease. Although cardiac rehabilitation (CR) is effective, South Asians are among the least likely people to participate in these programs. Automatic referral increases CR use and may reduce access inequalities. This study qualitatively explored whether CR referral knowledge and access varied among South-Asian patients. Participants were South-Asian cardiac patients receiving treatment at hospitals in Ontario, Canada. Each hospital refers to CR via one offour methods: automatically through paper or electronically, through discussion with allied health professionals (liaison referral), or through referral at the physician's discretion. Data were collected via interviews and analyzed using interpretive-descriptive analysis. Four themes emerged: the importance of predischarge CR discussions with healthcare providers, limited knowledge of CR, ease of the referral process for facilitators of CR attendance, and participants'needs for personal autonomy regarding their decision to attend CR. Liaison referral was perceived to be the most suitable referral method for participants. It facilitated communication between patients and providers, ensuring improved understanding of CR. Automatic referral may not be as well suited to this population because of reduced patient-provider communication.
PubMed ID
20450019 View in PubMed
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Cardiometabolic risk in Canada: a detailed analysis and position paper by the cardiometabolic risk working group.

https://arctichealth.org/en/permalink/ahliterature135666
Source
Can J Cardiol. 2011 Mar-Apr;27(2):e1-e33
Publication Type
Article
Author
Lawrence A Leiter
David H Fitchett
Richard E Gilbert
Milan Gupta
G B John Mancini
Philip A McFarlane
Robert Ross
Hwee Teoh
Subodh Verma
Sonia Anand
Kathryn Camelon
Chi-Ming Chow
Jafna L Cox
Jean-Pierre Després
Jacques Genest
Stewart B Harris
David C W Lau
Richard Lewanczuk
Peter P Liu
Eva M Lonn
Ruth McPherson
Paul Poirier
Shafiq Qaadri
Rémi Rabasa-Lhoret
Simon W Rabkin
Arya M Sharma
Andrew W Steele
James A Stone
Jean-Claude Tardif
Sheldon Tobe
Ehud Ur
Author Affiliation
Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
Source
Can J Cardiol. 2011 Mar-Apr;27(2):e1-e33
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cardiovascular Diseases - epidemiology - etiology - therapy
Diabetes Mellitus, Type 2 - epidemiology - etiology - prevention & control
Humans
Metabolic Syndrome X - complications - epidemiology - therapy
Practice Guidelines as Topic
Risk factors
Abstract
The concepts of "cardiometabolic risk," "metabolic syndrome," and "risk stratification" overlap and relate to the atherogenic process and development of type 2 diabetes. There is confusion about what these terms mean and how they can best be used to improve our understanding of cardiovascular disease treatment and prevention. With the objectives of clarifying these concepts and presenting practical strategies to identify and reduce cardiovascular risk in multiethnic patient populations, the Cardiometabolic Working Group reviewed the evidence related to emerging cardiovascular risk factors and Canadian guideline recommendations in order to present a detailed analysis and consolidated approach to the identification and management of cardiometabolic risk. The concepts related to cardiometabolic risk, pathophysiology, and strategies for identification and management (including health behaviours, pharmacotherapy, and surgery) in the multiethnic Canadian population are presented. "Global cardiometabolic risk" is proposed as an umbrella term for a comprehensive list of existing and emerging factors that predict cardiovascular disease and/or type 2 diabetes. Health behaviour interventions (weight loss, physical activity, diet, smoking cessation) in people identified at high cardiometabolic risk are of critical importance given the emerging crisis of obesity and the consequent epidemic of type 2 diabetes. Vascular protective measures (health behaviours for all patients and pharmacotherapy in appropriate patients) are essential to reduce cardiometabolic risk, and there is growing consensus that a multidisciplinary approach is needed to adequately address cardiometabolic risk factors. Health care professionals must also consider risk factors related to ethnicity in order to appropriately evaluate everyone in their diverse patient populations.
PubMed ID
21459257 View in PubMed
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A comparison of physical activity environments between South Asians and white Caucasians with coronary heart disease.

https://arctichealth.org/en/permalink/ahliterature137210
Source
Ethn Dis. 2010;20(4):390-5
Publication Type
Article
Date
2010
Author
Shazareen N Khan
Sherry L Grace
Paul Oh
Sonia Anand
Donna E Stewart
Gilbert Wu
Milan Gupta
Author Affiliation
University of Toronto, Ontario, Canada.
Source
Ethn Dis. 2010;20(4):390-5
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
Asia, Southeastern - ethnology
Coronary disease - ethnology
Female
Humans
Male
Middle Aged
Motor Activity
Multivariate Analysis
Ontario - epidemiology
Abstract
South Asians (SA) are predisposed to developing premature coronary heart disease (CHD), partly due to the early onset of classic risk factors, including physical inactivity. The nature of physical activity (PA) environments in South Asians in Canada remains unknown. Our objective was to examine differences in PA environments for South Asian vs White Caucasian (WC) CHD patients. In a cross-sectional study, 2657 hospitalized CHD patients in Ontario completed The Perceived Environments Related to Physical Activity Questionnaire to assess their home and neighborhood environment, perceived neighborhood safety and availability of recreational facilities. Patients self-reporting their ethnocultural background as WC (N = 1301, 48.6%) or SA (N = 171, 6.4%) were included in this study. South Asians were significantly younger, had lower body mass index, higher levels of education, lower income, were less likely to smoke and reside rurally, and were more likely to be married, have diabetes mellitus and have experienced prior myocardial infarction (MI) than WC patients. South Asians also had lower availability of home exercise equipment and perceived convenience of local PA facilities, but better and safer neighborhood environments than WC patients. Multivariate analyses revealed that SA ethnocultural background remained significantly related to reduced availability of home exercise equipment and fewer convenient local PA facilities. Since physical inactivity is an important CHD risk factor, and SA ethnocultural background is associated with high CHD risk, this may represent a novel target for risk reduction. Thus, further research is required to optimize SA awareness of the need for PA, and access to equipment and facilities.
Notes
SummaryForPatientsIn: Ethn Dis. 2010 Autumn;20(4):48821305843
PubMed ID
21305827 View in PubMed
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Effectiveness of inpatient and outpatient strategies in increasing referral and utilization of cardiac rehabilitation: a prospective, multi-site study.

https://arctichealth.org/en/permalink/ahliterature118174
Source
Implement Sci. 2012;7:120
Publication Type
Article
Date
2012
Author
Sherry L Grace
Kelly L Angevaare
Robert D Reid
Paul Oh
Sonia Anand
Milan Gupta
Stephanie Brister
Donna E Stewart
Author Affiliation
School of Kinesiology and Health Science, York University, 4700 Keele St, Toronto, Canada. sgrace@yorku.ca
Source
Implement Sci. 2012;7:120
Date
2012
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Appointments and Schedules
Coronary Artery Bypass - rehabilitation
Humans
Inpatients
Middle Aged
Ontario
Outpatients
Patient Care Management - organization & administration
Patient Education as Topic - organization & administration
Percutaneous Coronary Intervention - rehabilitation
Prospective Studies
Referral and Consultation - organization & administration
Sex Factors
Socioeconomic Factors
Abstract
Despite the evidence of benefit, cardiac rehabilitation (CR) remains highly underutilized. The present study examined the effect of two inpatient and one outpatient strategy on CR utilization: allied healthcare provider completion of referral (a policy that had been endorsed and approved by the cardiac program leadership in advance; PRE-APPROVED); CR intake appointment booked before hospital discharge (PRE-BOOKED); and early outpatient education provided at the CR program shortly after inpatient discharge (EARLY ED).In this prospective observational study, 2,635 stable cardiac inpatients from 11 Ontario hospitals completed a sociodemographic survey, and clinical data were extracted from charts. One year later, participants were a mailed survey that assessed CR use. Participating inpatient units and CR programs to which patients were referred were coded to reflect whether each of the strategies was used (yes/no). The effect of each strategy on participants' CR referral and enrollment was examined using generalized estimating equations.
A total of 1,809 participants completed the post-test survey. Adjusted analyses revealed that the implementation of one of the inpatient strategies was significantly related to greater referral and enrollment (PRE-APPROVED: OR = 1.96, 95%CI = 1.26 to 3.05, and OR = 2.91, 95%CI = 2.20 to 3.85, respectively). EARLY ED also resulted in significantly greater enrollment (OR = 4.85, 95%CI = 2.96 to 7.95).
These readily-implementable strategies could significantly increase access to and enrollment in CR for the cardiac population. The impact of these strategies on wait times warrants exploration.
Notes
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PubMed ID
23234558 View in PubMed
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Effect of cardiac rehabilitation referral strategies on utilization rates: a prospective, controlled study.

https://arctichealth.org/en/permalink/ahliterature136984
Source
Arch Intern Med. 2011 Feb 14;171(3):235-41
Publication Type
Article
Date
Feb-14-2011
Author
Sherry L Grace
Kelly L Russell
Robert D Reid
Paul Oh
Sonia Anand
James Rush
Karen Williamson
Milan Gupta
David A Alter
Donna E Stewart
Author Affiliation
School of Kinesiology and Health Sciences, Faculty of Health, York University, 368 Bethune, 4700 Keele St, Toronto, ON M3J 1P3, Canada. sgrace@yorku.ca
Source
Arch Intern Med. 2011 Feb 14;171(3):235-41
Date
Feb-14-2011
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - rehabilitation
Aged
Angioplasty, Balloon, Coronary - rehabilitation
Cooperative Behavior
Female
Health Services Accessibility - statistics & numerical data
Humans
Interdisciplinary Communication
Male
Medical Records Systems, Computerized - statistics & numerical data
Middle Aged
Odds Ratio
Ontario
Patient Acceptance of Health Care - statistics & numerical data
Patient care team
Patient Discharge - statistics & numerical data
Pilot Projects
Prospective Studies
Referral and Consultation - utilization
Rehabilitation Centers - utilization
Telephone
Utilization Review - statistics & numerical data
Abstract
Although cardiac rehabilitation (CR) has been shown to reduce mortality and is a recommended component in clinical practice guidelines, CR referral and utilization rates remain low. Referral strategies have been implemented to increase CR use but have yet to be compared concurrently. To determine the optimal strategy to maximize CR referral, enrollment, and participation, we evaluated 3 referral strategies compared with usual care: "automatic" only via discharge order or electronic record, health care provider liaison only, or a combined approach.
In this prospective controlled study, 2635 inpatients with coronary artery disease from 11 Ontario, Canada, hospitals using 1 of the 4 referral strategies completed a sociodemographic survey, and clinical data were extracted from medical charts. One year later, 1809 participants completed a mailed survey that assessed CR utilization. Referral strategies were compared using generalized estimating equations to control for effect of hospital.
Adjusted analyses revealed referral strategy was significantly related to CR referral and enrollment (P
PubMed ID
21325114 View in PubMed
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Ethnicity and sex affect diabetes incidence and outcomes.

https://arctichealth.org/en/permalink/ahliterature139796
Source
Diabetes Care. 2011 Jan;34(1):96-101
Publication Type
Article
Date
Jan-2011
Author
Nadia A Khan
Hong Wang
Sonia Anand
Yan Jin
Norman R C Campbell
Louise Pilote
Hude Quan
Author Affiliation
Division of General Internal Medicine, University of British Columbia, British Columbia, Canada. nakhan@shaw.ca
Source
Diabetes Care. 2011 Jan;34(1):96-101
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Canada
Diabetes Mellitus - epidemiology - ethnology - mortality
Female
Humans
Incidence
Male
Middle Aged
Sex Factors
Abstract
Diabetes guidelines recommend aggressive screening for type 2 diabetes in Asian patients because they are considered to have a higher risk of developing diabetes and potentially worse prognosis. We determined incidence of diabetes and risk of death or macrovascular complications by sex among major Asian subgroups, South Asian and Chinese, and white patients with newly diagnosed diabetes.
Using population-based administrative data from British Columbia and Alberta, Canada (1997-1998 to 2006-2007), we identified patients with newly diagnosed diabetes aged =35 years and followed them for up to 10 years for death, acute myocardial infarction, stroke, or hospitalization for heart failure. Ethnicity was determined using validated surname algorithms.
There were 15,066 South Asian, 17,754 Chinese, and 244,017 white patients with newly diagnosed diabetes. Chinese women and men had the lowest incidence of diabetes relative to that of white or South Asian patients, who had the highest incidence. Mortality in those with newly diagnosed diabetes was lower in South Asian (hazard ratio 0.69 [95% CI 0.62-0.76], P
Notes
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PubMed ID
20978094 View in PubMed
Less detail

Identification and management of cardiometabolic risk in Canada: a position paper by the cardiometabolic risk working group (executive summary).

https://arctichealth.org/en/permalink/ahliterature135665
Source
Can J Cardiol. 2011 Mar-Apr;27(2):124-31
Publication Type
Article
Author
Lawrence A Leiter
David H Fitchett
Richard E Gilbert
Milan Gupta
G B John Mancini
Philip A McFarlane
Robert Ross
Hwee Teoh
Subodh Verma
Sonia Anand
Kathryn Camelon
Chi-Ming Chow
Jafna L Cox
Jean-Pierre Després
Jacques Genest
Stewart B Harris
David C W Lau
Richard Lewanczuk
Peter P Liu
Eva M Lonn
Ruth McPherson
Paul Poirier
Shafiq Qaadri
Rémi Rabasa-Lhoret
Simon W Rabkin
Arya M Sharma
Andrew W Steele
James A Stone
Jean-Claude Tardif
Sheldon Tobe
Ehud Ur
Author Affiliation
St. Michael's Hospital, Toronto, Ontario, Canada. LeiterL@smh.ca
Source
Can J Cardiol. 2011 Mar-Apr;27(2):124-31
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Cardiovascular Diseases - epidemiology - etiology - prevention & control
Diabetes Mellitus, Type 2 - complications - epidemiology - therapy
Humans
Incidence
Metabolic Syndrome X - complications - epidemiology - therapy
Obesity - complications - epidemiology - therapy
Practice Guidelines as Topic
Risk Assessment - methods
Risk factors
Abstract
With the objectives of clarifying the concepts related to "cardiometabolic risk," "metabolic syndrome" and "risk stratification" and presenting practical strategies to identify and reduce cardiovascular risk in multiethnic patient populations, the Cardiometabolic Working Group presents an executive summary of a detailed analysis and position paper that offers a comprehensive and consolidated approach to the identification and management of cardiometabolic risk. The above concepts overlap and relate to the atherogenic process and development of type 2 diabetes. However, there is confusion about what these terms mean and how they can best be used to improve our understanding of cardiovascular disease treatment and prevention. The concepts related to cardiometabolic risk, pathophysiology, and strategies for identification and management (including health behaviours, pharmacotherapy, and surgery) in the multiethnic Canadian population are presented. "Global cardiometabolic risk" is proposed as an umbrella term for a comprehensive list of existing and emerging factors that predict cardiovascular disease and/or type 2 diabetes. Health behaviour interventions (weight loss, physical activity, diet, smoking cessation) in people identified at high cardiometabolic risk are of critical importance given the emerging crisis of obesity and the consequent epidemic of type 2 diabetes. Vascular protective measures (health behaviours for all patients and pharmacotherapy in appropriate patients) are essential to reduce cardiometabolic risk, and there is growing consensus that a multidisciplinary approach is needed to adequately address cardiometabolic risk factors. Health care professionals must also consider ethnicity-related risk factors in order to appropriately evaluate all individuals in their diverse patient populations.
PubMed ID
21459258 View in PubMed
Less detail

Prevalence and predictors of subclinical atherosclerosis among asymptomatic "low risk" individuals in a multiethnic population.

https://arctichealth.org/en/permalink/ahliterature162074
Source
Atherosclerosis. 2008 Mar;197(1):435-42
Publication Type
Article
Date
Mar-2008
Author
Jasmine Grewal
Sonia Anand
Shofiqul Islam
Eva Lonn
Author Affiliation
The Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
Source
Atherosclerosis. 2008 Mar;197(1):435-42
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Adult
Aged
Asian Continental Ancestry Group - statistics & numerical data
Canada - epidemiology
Carotid Artery Diseases - ethnology - ultrasonography
Coronary Artery Disease - ethnology
Cross-Sectional Studies
Ethnic Groups - statistics & numerical data
European Continental Ancestry Group - statistics & numerical data
Female
Humans
Indians, North American - statistics & numerical data
Male
Middle Aged
Predictive value of tests
Prevalence
Risk factors
Severity of Illness Index
Abstract
Current approaches to cardiovascular (CV) risk assessment have limitations. Subclinical atherosclerosis (SCA) as determined by carotid ultrasound is an independent predictor of myocardial infarction and stroke and can refine CV risk assessment.
We aimed to determine the prevalence and predictors of SCA in a multiethnic population classified as low risk for coronary heart disease (CHD) events by the Framingham Risk Assessment Model.
We conducted a cross-sectional population study in 1015 Canadian adults of Caucasian European, South Asian, Chinese and Aboriginal ancestry. CHD risk was calculated by the 10-year Framingham Risk Score (FRS). Novel and conventional CHD risk factors were measured and high-resolution carotid ultrasound was performed. SCA was defined as carotid intima media thickness (IMT) >or=75th percentile adjusted for age, sex and ethnicity.
Seven hundred and fifty two (74%) participants were classified as low risk by FRS. Of these, 175 (23%) had evidence of SCA. Independent predictors of SCA among low-risk subjects included female sex, systolic blood pressure, and apolipoprotein B.
Many individuals classified at low CHD risk by the FRS have SCA and are at increased long-term risk for vascular events. Carotid IMT can identify subjects with SCA, who may benefit from early intervention.
PubMed ID
17675040 View in PubMed
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Prevalence of mitral valve prolapse in ethnic groups.

https://arctichealth.org/en/permalink/ahliterature180466
Source
Can J Cardiol. 2004 Apr;20(5):511-5
Publication Type
Article
Date
Apr-2004
Author
Michael Theal
Khalid Sleik
Sonia Anand
Qilong Yi
Salim Yusuf
Eva Lonn
Author Affiliation
Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Canada.
Source
Can J Cardiol. 2004 Apr;20(5):511-5
Date
Apr-2004
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Cross-Sectional Studies
Echocardiography
Ethnic Groups - statistics & numerical data
Female
Humans
Male
Middle Aged
Mitral Valve Prolapse - epidemiology - ethnology - etiology - ultrasonography
Ontario - epidemiology
Prevalence
Sex Factors
Ventricular Function, Left
Abstract
Mitral valve prolapse (MVP) was reported to be a common disorder occurring in 5% to 15% of the general population and to be frequently associated with serious complications. The reported high prevalence and complication rates of MVP have been challenged recently by the findings of the Framingham Heart Study, which was conducted in a Caucasian population; the findings in other ethnic groups remain uncertain. The prevalence of MVP was studied in a true population sample comprising 972 Canadians of South Asian (n=336), European (n=322) and Chinese (n=314) descent. MVP was diagnosed by two-dimensional echocardiography. The prevalence of MVP for the entire study cohort was 2.7% and did not differ significantly between the three ethnic groups evaluated (2.7% in South Asian, 3.1% in European and 2.2% in Chinese [P=0.79]). Age, sex, history of cardiac risk factors, blood pressure, abnormalities on electrocardiography, left atrial size, left ventricular end-diastolic and end-systolic diameters and volumes, and left ventricular ejection fraction were similar in subjects with and without MVP. There was a trend toward lower body mass index in subjects with MVP compared to those without MVP (24.5+/-5.5 kg/m(2) versus 26.0+/-4.3 kg/m(2), respectively, P=0.10). The prevalence of cardiovascular diseases, including history of angina, previous myocardial infarction, previous cardiac surgery and previous stroke, was similar in subjects with MVP (7.7%) and in those without MVP (6.7%) (P=0.84). The authors concluded that MVP has a much lower prevalence than previously estimated and the prevalence of MVP is similar among different ethnic groups. From a population perspective, the prevalence of serious cardiovascular complications associated with MVP is low.
PubMed ID
15100753 View in PubMed
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9 records – page 1 of 1.