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Achieving quality indicator benchmarks and potential impact on coronary heart disease mortality.

https://arctichealth.org/en/permalink/ahliterature131252
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Publication Type
Article
Author
Harindra C Wijeysundera
Nicholas Mitsakakis
William Witteman
Mike Paulden
Gabrielle van der Velde
Jack V Tu
Douglas S Lee
Shaun G Goodman
Robert Petrella
Martin O'Flaherty
Simon Capewell
Murray Krahn
Author Affiliation
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. wijeysundera@gmail.com
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Benchmarking - methods
Coronary Disease - mortality - therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization - methods - standards
Ontario - epidemiology
Prognosis
Quality Indicators, Health Care - utilization
Retrospective Studies
Risk Assessment - methods
Risk factors
Abstract
Quality indicators in coronary heart disease (CHD) measure the practice gap between optimal care and current clinical practice. However, the potential impact of achieving quality indicator benchmarks remains unknown.
Using a validated, epidemiologic model of CHD in Ontario, Canada, we estimated the potential impact on mortality of improved utilization on CHD quality indicators from 2005 levels to recommend benchmark utilization of 90%. Eight CHD disease subgroups were evaluated, including inpatients with acute myocardial infarction (AMI), acute coronary syndromes, and heart failure, in addition to ambulatory patients who were post-acute myocardial infarction survivors, or had heart failure, chronic stable angina, hypertension, or hyperlipidemia. The primary outcome was the predicted mortality reduction associated with meeting quality indicator targets for each CHD subgroup-treatment combination.
In 2005, there were 10,060 CHD deaths in Ontario, representing an age-adjusted CHD mortality of 191 per 100,000 people. By meeting quality indicator utilization benchmarks, mortality could be potentially reduced by approximately 20% (95% confidence interval 17.8-21.1), representing approximately 1960 avoidable deaths. The bulk of this potential benefit was in ambulatory patients with chronic stable angina (36% of reduction) and heart failure (31% of reduction). The biggest drivers were optimizing angiotensin-converting enzyme inhibitor use in chronic stable angina patients (approximately 440 avoidable deaths) and ß-blocker use in heart failure (approximately 400 avoidable deaths).
These findings reinforce the importance of quality indicators and could aid policy makers in prioritizing strategies to meet the goals outlined in the Canadian Heart Health Strategy and Action Plan for reducing cardiovascular mortality.
PubMed ID
21920697 View in PubMed
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Acute treatment of myocardial infarction in Canada 1999-2002.

https://arctichealth.org/en/permalink/ahliterature176049
Source
Can J Cardiol. 2005 Feb;21(2):145-52
Publication Type
Article
Date
Feb-2005
Author
Cynthia A Jackevicius
David Alter
Jafna Cox
Paul Daly
Shaun Goodman
Woganee Filate
Alice Newman
Jack V Tu
Author Affiliation
Pharmacy Department, University Health Network-Toronto General Hospital, Toronto, Ontario M5G 2C4. Cynthia.Jackevicius@uhn.on.ca
Source
Can J Cardiol. 2005 Feb;21(2):145-52
Date
Feb-2005
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Adult
Age Distribution
Aged
Angioplasty, Balloon
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Drug Utilization - statistics & numerical data
Emergency Service, Hospital
Female
Fibrinolytic Agents - contraindications - therapeutic use
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Myocardial Infarction - epidemiology - therapy
Myocardial Reperfusion - utilization
Patient Discharge
Physician's Practice Patterns - statistics & numerical data
Registries
Sex Distribution
Time Factors
Abstract
Therapy for management of acute myocardial infarction (AMI) varies according to patient, prescriber and geographical characteristics.
To describe the in-hospital use of reperfusion therapy for ST elevation MI (STEMI) and discharge use of acetylsalicylic acid, beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs) and statins in patients presenting with either STEMI or non-STEMI in Canada from 1999 to 2002.
Four Canadian registries (FASTRAK II, Canadian Acute Coronary Syndromes, Enhanced Feedback for Effective Cardiac Treatment and Improving Cardiovascular Outcomes in Nova Scotia) were used to identify patients with AMI in Canada and to measure in-hospital reperfusion and medication use. Use rates were compared by age, sex, time period and geographical area, according to available data.
Use rates for reperfusion in STEMI patients ranged from 60% to 70%, primarily representing fibrinolytic therapy. A delay in presentation to hospital after symptom onset represented an impediment to timely therapy, which was particularly pronounced for women and elderly patients. Overall, less than 50% of patients met the door-to-needle target of less than 30 min. Medication use rates at discharge increased from 1999/2000 to 2000/2001 across the different data sources: acetylsalicylic acid, 83% to 88%; beta-blockers, 74% to 89%; ACEIs, 54% to 67%; statins, 41% to 53%; and calcium antagonists, 21% to 32%.
Canadian and provincial rates of use of evidence-based medications for the treatment of AMI have increased over time, although there remains room for improvement. A single, comprehensive data source would supply better insights into the management of AMI in Canada.
PubMed ID
15729413 View in PubMed
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Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial.

https://arctichealth.org/en/permalink/ahliterature173735
Source
JAMA. 2005 Jul 20;294(3):309-17
Publication Type
Article
Date
Jul-20-2005
Author
Christine A Beck
Hugues Richard
Jack V Tu
Louise Pilote
Author Affiliation
Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
Source
JAMA. 2005 Jul 20;294(3):309-17
Date
Jul-20-2005
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Benchmarking
Cluster analysis
Hospitals - standards
Humans
Medical Record Linkage
Myocardial Infarction - mortality - therapy
Outcome and Process Assessment (Health Care)
Quality Indicators, Health Care
Quebec
Abstract
Hospital report cards are increasingly being implemented for quality improvement despite lack of strong evidence to support their use.
To determine whether hospital report cards constructed using linked hospital and prescription administrative databases are effective for improving quality of care for acute myocardial infarction (AMI).
The Administrative Data Feedback for Effective Cardiac Treatment (AFFECT) study, a cluster randomized trial.
Patients with AMI who were admitted to 76 acute care hospitals in Quebec that treated at least 30 AMI patients per year between April 1, 1999, and March 31, 2003.
Hospitals were randomly assigned to receive rapid (immediate; n = 38 hospitals and 2533 patients) or delayed (14 months; n = 38 hospitals and 3142 patients) confidential feedback on quality indicators constructed using administrative data.
Quality indicators pertaining to processes of care and outcomes of patients admitted between 4 and 10 months after randomization. The primary indicator was the proportion of elderly survivors of AMI at each study hospital who filled a prescription for a beta-blocker within 30 days after discharge.
At follow-up, adjusted prescription rates within 30 days after discharge were similar in the early vs late groups (for beta-blockers, odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82-1.37; for angiotensin-converting enzyme inhibitors, OR, 1.17; 95% CI, 0.90-1.52; for lipid-lowering drugs, OR, 1.14; 95% CI, 0.86-1.50; and for aspirin, OR, 1.05; 95% CI, 0.84-1.33). In addition, adjusted mortality was similar in both groups, as were length of in-hospital stay, physician visits after discharge, waiting times for invasive cardiac procedures, and readmissions for cardiac complications.
Feedback based on one-time, confidential report cards constructed using administrative data is not an effective strategy for quality improvement regarding care of patients with AMI. A need exists for further studies to rigorously evaluate the effectiveness of more intensive report card interventions.
Notes
Comment In: ACP J Club. 2005 Nov-Dec;143(3):7916262236
Comment In: JAMA. 2005 Jul 20;294(3):369-7116030283
PubMed ID
16030275 View in PubMed
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Administrative hospitalization database validation of cardiac procedure codes.

https://arctichealth.org/en/permalink/ahliterature130676
Source
Med Care. 2013 Apr;51(4):e22-6
Publication Type
Article
Date
Apr-2013
Author
Douglas S Lee
Audra Stitt
Xuesong Wang
Jeffery S Yu
Yana Gurevich
Kori J Kingsbury
Peter C Austin
Jack V Tu
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada M4N3M5. dlee@ices.on.ca
Source
Med Care. 2013 Apr;51(4):e22-6
Date
Apr-2013
Language
English
Publication Type
Article
Keywords
Cardiac Surgical Procedures - classification
Cardiovascular Diseases - epidemiology - surgery
Clinical Coding - standards - statistics & numerical data
Cohort Studies
Coronary Artery Bypass - classification
Coronary Care Units - organization & administration
Databases as Topic
Endovascular Procedures - classification
Forms and Records Control - standards
Hospitalization - statistics & numerical data
Humans
Medical Records Systems, Computerized - standards
Ontario - epidemiology
Registries
Reproducibility of Results
Abstract
Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries.
To examine accuracy of cardiac procedure coding in administrative databases versus a prospective clinical registry.
We examined a total of 182,018 common cardiac procedures including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, valve surgery, and cardiac catheterization procedures during fiscal years 2005 and 2006 across 18 cardiac centers in Ontario, Canada.
Accuracy of codes in the Canadian Institute for Health Information (CIHI) administrative databases were compared with the clinical registry of the Cardiac Care Network.
Comparing 17,511 CIHI and 17,404 registry procedures for CABG surgery, the positive predictive value (PPV) of CIHI-coded CABG surgery was 97%. In 6229 CIHI-coded and 5885 registry-coded valve surgery procedures, the PPV of the administrative data source was 96%. Comparing 38,527 PCI procedures in CIHI to 38,601 in the registry, the PPV of CIHI was 94%. Among 119,751 CIHI-coded and 111,725 registry-coded cardiac catheterization procedures, the PPV of administrative data was 94%. When the procedure date window was expanded from the same day to ±1 days, the PPV was 96% (PCI) and exceeded 98% (CABG surgery), 97% (valve surgery), and 95% (cardiac catheterization).
Using a clinical registry as the gold standard, the coding accuracy of common cardiac procedures in the CIHI administrative database was high.
PubMed ID
21979370 View in PubMed
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Age disparities in stroke quality of care and delivery of health services.

https://arctichealth.org/en/permalink/ahliterature149008
Source
Stroke. 2009 Oct;40(10):3328-35
Publication Type
Article
Date
Oct-2009
Author
Gustavo Saposnik
Sandra E Black
Antoine Hakim
Jiming Fang
Jack V Tu
Moira K Kapral
Author Affiliation
Stroke Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. saposnikg@smh.toronto.on.ca
Source
Stroke. 2009 Oct;40(10):3328-35
Date
Oct-2009
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Aging - physiology - psychology
Atrial Fibrillation - drug therapy - prevention & control
Cohort Studies
Cost of Illness
Deglutition Disorders - diagnosis - prevention & control - therapy
Emergency Medical Services - standards - statistics & numerical data - trends
Female
Health Policy
Health Services - economics
Hospital Units - standards - statistics & numerical data - trends
Hospitalization - economics
Humans
Longevity
Male
Middle Aged
Mortality - trends
Ontario
Outcome Assessment (Health Care) - economics
Patient Discharge - economics
Pneumonia - epidemiology
Prospective Studies
Quality of Health Care - statistics & numerical data - trends
Quality of Life
Severity of Illness Index
Stroke - complications - mortality - therapy
Thrombolytic Therapy - statistics & numerical data - trends
Warfarin - therapeutic use
Abstract
Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.
This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.
Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.
In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
PubMed ID
19696418 View in PubMed
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Amiodarone-induced thyroid dysfunction: brand-name versus generic formulations.

https://arctichealth.org/en/permalink/ahliterature133038
Source
CMAJ. 2011 Sep 6;183(12):E817-23
Publication Type
Article
Date
Sep-6-2011
Author
Meytal A Tsadok
Cynthia A Jackevicius
Elham Rahme
Vidal Essebag
Mark J Eisenberg
Karin H Humphries
Jack V Tu
Hassan Behlouli
Jennifer Joo
Louise Pilote
Author Affiliation
Division of Internal Medicine, McGill University Health Center, Montréal, Que.
Source
CMAJ. 2011 Sep 6;183(12):E817-23
Date
Sep-6-2011
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Amiodarone - adverse effects
Anti-Arrhythmia Agents - adverse effects
Atrial Fibrillation - drug therapy
Chi-Square Distribution
Drugs, Generic - adverse effects
Female
Humans
Incidence
Income
Length of Stay - statistics & numerical data
Male
Proportional Hazards Models
Quebec - epidemiology
Retrospective Studies
Risk factors
Thyroid Diseases - chemically induced - epidemiology
Abstract
Amiodarone is associated with dysfunction of the thyroid. Concerns have arisen regarding the potential for adverse effects with generic formulations of amiodarone. We evaluated and compared the risk of thyroid dysfunction between patients using brand-name versus generic formulations of amiodarone and identified risk factors for thyroid dysfunction.
We conducted a retrospective cohort study of patients with atrial fibrillation aged 66 years and older. We used administrative databases that linked information on demographics and clinical characteristics, claims for prescription drugs and discharges from hospital. We estimated thyroid dysfunction using person-year incidence.
Of the 60,220 patients in the cohort, 2804 (4.7%) used the brand-name formulation of amiodarone and 6278 (10.4%) used the generic formulation. Baseline characteristics between these two groups were comparable. The median maintenance dose of amiodarone was 200 mg/d for both groups. The total incidence rate for thyroid dysfunction was 14.1 per 100 person-years for both formulations. The mean time to clinical dysfunction of the thyroid was 4.32 years for the brand-name formulation and 4.09 years for the generic formulation. In a multivariate analysis, there was no significant difference in the incidence rates of thyroid dysfunction between the generic and brand formulations (hazard ratio 0.97, 95% confidence interval 0.87-1.08). Factors associated with an increased risk of thyroid dysfunction were being a woman, increasing age and having chronic obstructive pulmonary disease.
In this population-based study, we saw no difference between brand-name and generic formulations of amiodarone in terms of incidence of thyroid dysfunction.
Notes
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Comment In: CMAJ. 2011 Sep 6;183(12):1350-121746827
PubMed ID
21746822 View in PubMed
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Angiotensin II receptor blockers for the treatment of heart failure: a class effect?

https://arctichealth.org/en/permalink/ahliterature164481
Source
Pharmacotherapy. 2007 Apr;27(4):526-34
Publication Type
Article
Date
Apr-2007
Author
Marie Hudson
Karin Humphries
Jack V Tu
Hassan Behlouli
Richard Sheppard
Louise Pilote
Author Affiliation
Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec. marie.hudson@mcgill.ca
Source
Pharmacotherapy. 2007 Apr;27(4):526-34
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Angiotensin II Type 1 Receptor Blockers - therapeutic use
Antihypertensive Agents - therapeutic use
Benzimidazoles - therapeutic use
Benzoates - therapeutic use
Biphenyl Compounds - therapeutic use
British Columbia
Drug Prescriptions - statistics & numerical data
Female
Heart Failure - drug therapy - mortality
Hospital Information Systems - statistics & numerical data
Humans
Losartan - therapeutic use
Male
Ontario
Proportional Hazards Models
Quebec
Retrospective Studies
Survival Analysis
Survival Rate
Tetrazoles - therapeutic use
Treatment Outcome
Valine - analogs & derivatives - therapeutic use
Abstract
To examine the class effect of angiotensin II receptor blockers (ARBs) on mortality in patients with heart failure who were aged 65 years or older.
Retrospective population-based study.
Administrative database that stores information on hospital discharge summaries for the Canadian provinces of Quebec, Ontario, and British Columbia.
A total of 6876 patients aged 65 years or older who were discharged with a primary diagnosis of heart failure between January 1, 1998, and March 31, 2003, and who filled at least one prescription for an ARB within 90 days of discharge.
Times to all-cause death in patients receiving individual ARBs were compared. Models were adjusted for demographic, clinical, physician, and hospital characteristics; models were also adjusted for dosage categories, which were represented by time-dependent variables. The cohort of 6876 patients had a mean +/- SD age of 78 +/- 7 years, and most (62%) were women. Losartan was the most frequently prescribed ARB (61%), followed by irbesartan (14%), valsartan (13%), candesartan (10%), and telmisartan (2%). Irbesartan, valsartan, and candesartan were associated with better survival rates than losartan (adjusted hazard ratios [HRs] and 95% confidence intervals [CIs] 0.65 [0.53-0.79], 0.63 [0.51-0.79], and 0.71 [0.57-0.90], respectively). No difference was noted in mortality in patients prescribed telmisartan compared with those receiving losartan (HR 0.92 [95% CI 0.55-1.54]).
Elderly patients with heart failure who were prescribed losartan had worse survival rates compared with those prescribed other commonly used ARBs. The absence of a class effect for ARBs is consistent with data showing pharmacologic differences among the drugs.
PubMed ID
17381379 View in PubMed
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An overview of the methods and data used in the CCORT Canadian Cardiovascular Atlas project.

https://arctichealth.org/en/permalink/ahliterature185190
Source
Can J Cardiol. 2003 May;19(6):655-63
Publication Type
Article
Date
May-2003
Author
Courtney C Kennedy
Susan E Brien
Jack V Tu
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Canada.
Source
Can J Cardiol. 2003 May;19(6):655-63
Date
May-2003
Language
English
Publication Type
Article
Keywords
Canada
Cardiovascular Diseases - mortality - therapy
Drug Utilization Review
Hospital records
Hospitalization - statistics & numerical data
Humans
Outcome Assessment (Health Care)
Patient Discharge - statistics & numerical data
Patient Readmission - statistics & numerical data
Abstract
The Canadian Cardiovascular Atlas project, an initiative of the Canadian Cardiovascular Outcomes Research Team (CCORT), will be published as a series of 20 articles in future issues of the Canadian Journal of Cardiology. Through a wide range of data sources and analyses from a number of collaborators across Canada, the CCORT Atlas will provide a comprehensive overview of the current state of cardiac care and disease in Canada. Administrative data, clinical registries and community survey data will be analyzed at the provincial and health region levels. The purposes of this article are to 1) provide an overview of the data types and sources used in the Atlas project, 2) give a general description of the methods and analyses used to report Atlas data and 3) describe how Atlas maps were created and how they can be interpreted.
PubMed ID
12772015 View in PubMed
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Association of blood pressure at hospital discharge with mortality in patients diagnosed with heart failure.

https://arctichealth.org/en/permalink/ahliterature147318
Source
Circ Heart Fail. 2009 Nov;2(6):616-23
Publication Type
Article
Date
Nov-2009
Author
Douglas S Lee
Nina Ghosh
John S Floras
Gary E Newton
Peter C Austin
Xuesong Wang
Peter P Liu
Thérèse A Stukel
Jack V Tu
Author Affiliation
Institute for Clinical Evaluative Sciences, Ontario, Canada. dlee@ices.on.ca
Source
Circ Heart Fail. 2009 Nov;2(6):616-23
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Blood pressure
Female
Heart Failure - diagnosis - mortality - physiopathology - therapy
Humans
Kaplan-Meier Estimate
Life expectancy
Male
Middle Aged
Ontario - epidemiology
Patient Discharge - statistics & numerical data
Proportional Hazards Models
Registries
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Abstract
Higher blood pressure in acute heart failure has been associated with improved survival; however, the relationship between blood pressure and survival in stabilized patients at hospital discharge has not been established.
In 7448 patients with heart failure (75.2+/-11.5 years; 49.9% men) discharged from the hospital in Ontario, Canada, we examined the association of systolic blood pressure (SBP) and diastolic blood pressure with long-term survival. Parametric survival analysis was performed, and survival time ratios were determined according to discharge blood pressure group. A total of 25 427 person-years of follow-up were examined. In those with left ventricular ejection fraction or =160 mm Hg, respectively. In those with left ventricular ejection fraction >40%, survival time ratios were 0.69 (95% CI, 0.51 to 0.93), 0.83 (95% CI, 0.71 to 0.99), 0.95 (95% CI, 0.80 to 1.14), and 0.76 (95% CI, 0.61 to 0.95) for discharge SBPs or =160 mm Hg, respectively.
In this long-term population-based study of patients with heart failure, the association of discharge SBP with mortality followed a U-shaped distribution. Survival was shortened in those with reduced or increased values of discharge SBP.
PubMed ID
19919987 View in PubMed
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Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994-2005.

https://arctichealth.org/en/permalink/ahliterature143630
Source
JAMA. 2010 May 12;303(18):1841-7
Publication Type
Article
Date
May-12-2010
Author
Harindra C Wijeysundera
Márcio Machado
Farah Farahati
Xuesong Wang
William Witteman
Gabrielle van der Velde
Jack V Tu
Douglas S Lee
Shaun G Goodman
Robert Petrella
Martin O'Flaherty
Murray Krahn
Simon Capewell
Author Affiliation
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. wijeysundera@gmail.com
Source
JAMA. 2010 May 12;303(18):1841-7
Date
May-12-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Blood pressure
Cholesterol - blood
Coronary Disease - mortality - therapy
Evidence-Based Medicine
Female
Humans
Male
Middle Aged
Models, Theoretical
Mortality - trends
Ontario - epidemiology
Prospective Studies
Risk factors
Abstract
Coronary heart disease (CHD) mortality has declined substantially in Canada since 1994.
To determine what proportion of this decline was associated with temporal trends in CHD risk factors and advancements in medical treatments.
Prospective analytic study of the Ontario, Canada, population aged 25 to 84 years between 1994 and 2005, using an updated version of the validated IMPACT model, which integrates data on population size, CHD mortality, risk factors, and treatment uptake changes. Relative risks and regression coefficients from the published literature quantified the relationship between CHD mortality and (1) evidence-based therapies in 8 distinct CHD subpopulations (acute myocardial infarction [AMI], acute coronary syndromes, secondary prevention post-AMI, chronic coronary artery disease, heart failure in the hospital vs in the community, and primary prevention for hyperlipidemia or hypertension) and (2) population trends in 6 risk factors (smoking, diabetes mellitus, systolic blood pressure, plasma cholesterol level, exercise, and obesity).
The number of deaths prevented or delayed in 2005; secondary outcome measures were improvements in medical treatments and trends in risk factors.
Between 1994 and 2005, the age-adjusted CHD mortality rate in Ontario decreased by 35% from 191 to 125 deaths per 100,000 inhabitants, translating to an estimated 7585 fewer CHD deaths in 2005. Improvements in medical and surgical treatments were associated with 43% (range, 11% to 124%) of the total mortality decrease, most notably in AMI (8%; range, -5% to 40%), chronic stable coronary artery disease (17%; range, 7% to 35%), and heart failure occurring while in the community (10%; range, 6% to 31%). Trends in risk factors accounted for 3660 fewer CHD deaths prevented or delayed (48% of total; range, 28% to 64%), specifically, reductions in total cholesterol (23%; range, 10% to 33%) and systolic blood pressure (20%; range, 13% to 26%). Increasing diabetes prevalence and body mass index had an inverse relationship associated with higher CHD mortality of 6% (range, 4% to 8%) and 2% (range, 1% to 4%), respectively.
Between 1994 and 2005, there was a decrease in CHD mortality rates in Ontario that was associated primarily with trends in risk factors and improvements in medical treatments, each explaining about half of the decrease.
PubMed ID
20460623 View in PubMed
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168 records – page 1 of 17.