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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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The 2011 Canadian Cardiovascular Society heart failure management guidelines update: focus on sleep apnea, renal dysfunction, mechanical circulatory support, and palliative care.

https://arctichealth.org/en/permalink/ahliterature134302
Source
Can J Cardiol. 2011 May-Jun;27(3):319-38
Publication Type
Article
Author
Robert S McKelvie
Gordon W Moe
Anson Cheung
Jeannine Costigan
Anique Ducharme
Estrellita Estrella-Holder
Justin A Ezekowitz
John Floras
Nadia Giannetti
Adam Grzeslo
Karen Harkness
George A Heckman
Jonathan G Howlett
Simon Kouz
Kori Leblanc
Elizabeth Mann
Eileen O'Meara
Miroslav Rajda
Vivek Rao
Jessica Simon
Elizabeth Swiggum
Shelley Zieroth
J Malcolm O Arnold
Tom Ashton
Michel D'Astous
Paul Dorian
Haissam Haddad
Debra L Isaac
Marie-Hélène Leblanc
Peter Liu
Bruce Sussex
Heather J Ross
Author Affiliation
Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada. robert.mckelvie@phri.ca
Source
Can J Cardiol. 2011 May-Jun;27(3):319-38
Language
English
Publication Type
Article
Keywords
Canada
Combined Modality Therapy
Comorbidity
Female
Heart Failure - diagnosis - epidemiology - therapy
Heart-Assist Devices
Humans
Kidney Failure, Chronic - diagnosis - epidemiology - therapy
Kidney Function Tests
Male
Palliative Care - standards
Practice Guidelines as Topic
Prognosis
Risk assessment
Sleep Apnea Syndromes - diagnosis - epidemiology - therapy
Societies, Medical
Survival Analysis
Treatment Outcome
Abstract
The 2011 Canadian Cardiovascular Society Heart Failure (HF) Guidelines Focused Update reviews the recently published clinical trials that will potentially impact on management. Also reviewed is the less studied but clinically important area of sleep apnea. Finally, patients with advanced HF represent a group of patients who pose major difficulties to clinicians. Advanced HF therefore is examined from the perspectives of HF complicated by renal failure, the role of palliative care, and the role of mechanical circulatory support (MCS). All of these topics are reviewed from a perspective of practical applications. Important new studies have demonstrated in less symptomatic HF patients that cardiac resynchronization therapy will be of benefit. As well, aldosterone receptor antagonists can be used with benefit in less symptomatic HF patients. The important role of palliative care and the need to address end-of-life issues in advanced HF are emphasized. Physicians need to be aware of the possibility of sleep apnea complicating the course of HF and the role of a sleep study for the proper assessment and management of the conditon. Patients with either acute severe or chronic advanced HF with otherwise good life expectancy should be referred to a cardiac centre capable of providing MCS. Furthermore, patients awaiting heart transplantation who deteriorate or are otherwise not likely to survive until a donor organ is found should be referred for MCS.
Notes
Comment In: Can J Cardiol. 2011 Nov-Dec;27(6):871.e721885242
PubMed ID
21601772 View in PubMed
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Antiarrhythmic use from 1991 to 2007: insights from the Canadian Registry of Atrial Fibrillation (CARAF I and II).

https://arctichealth.org/en/permalink/ahliterature143905
Source
Heart Rhythm. 2010 Sep;7(9):1171-7
Publication Type
Article
Date
Sep-2010
Author
Jason G Andrade
Stuart J Connolly
Paul Dorian
Martin Green
Karin H Humphries
George J Klein
Robert Sheldon
Mario Talajic
Charles R Kerr
Author Affiliation
St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Source
Heart Rhythm. 2010 Sep;7(9):1171-7
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Anti-Arrhythmia Agents - therapeutic use
Atrial Fibrillation - drug therapy - epidemiology - physiopathology
Calcium Channel Blockers - therapeutic use
Canada - epidemiology
Electrocardiography - drug effects
Follow-Up Studies
Heart Rate - drug effects
Humans
Middle Aged
Morbidity - trends
Prospective Studies
Registries
Retrospective Studies
Time Factors
Treatment Outcome
Abstract
The pharmacologic management of atrial fibrillation (AF), the most common sustained cardiac arrhythmia, has been traditionally dichotomized into control of ventricular rate or re-establishment and maintenance of sinus rhythm.
The purpose of this study was to evaluate the use of rate-controlling drugs and antiarrhythmic drugs (AAD) in the Canadian Registry of Atrial Fibrillation (CARAF) over a 16-year period from 1991 through 2007.
1,400 patients with new-onset paroxysmal AF who were enrolled in CARAF were included in this analysis. We assessed trends in ventricular rate-controlling medication use (digoxin, beta-blockers, and calcium channel blockers) and AAD (class IA, IC, and III antiarrhythmic agents) at baseline and follow-up visits as well as by calendar year.
AAD use increased initially from 1991 to 1994 (peak use 42.5%) before steadily declining. Sotalol use decreased (27% to 6%), whereas amiodarone use increased (1.6% to 17.9%). Rate-controlling medication use decreased from 1991 to 1995 (54.1% to 34.1%) due to declining digoxin use (62.9% to 16.3%). After 1999, there was a continued increase in rate-controlling medication use (peak use 52.5% in 2007) due to increased beta-blocker use (17% to 45.7%). Calcium channel blockers use changed little over the duration of the study.
The management of AF has undergone significant shifts since 1990, reflecting the influence of drug development, prevailing belief systems, the impact of large clinical trials, and evidence-based recommendations. Monitoring of pharmacotherapy trends will provide insight into the real-world application of evidence-based guidelines as well as allow the opportunity to identify deficiencies and improve patient care.
PubMed ID
20430112 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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Canadian Cardiovascular Society atrial fibrillation guidelines 2010: rate and rhythm management.

https://arctichealth.org/en/permalink/ahliterature136942
Source
Can J Cardiol. 2011 Jan-Feb;27(1):47-59
Publication Type
Article
Conference/Meeting Material
Author
Anne M Gillis
Atul Verma
Mario Talajic
Stanley Nattel
Paul Dorian
Author Affiliation
University of Calgary/Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada. amgillis@ucalgary.ca
Source
Can J Cardiol. 2011 Jan-Feb;27(1):47-59
Language
English
Publication Type
Article
Conference/Meeting Material
Keywords
Adrenergic beta-Antagonists - adverse effects - therapeutic use
Adult
Aged
Algorithms
Amiodarone - adverse effects - analogs & derivatives - therapeutic use
Anti-Arrhythmia Agents - adverse effects - therapeutic use
Atrial Fibrillation - drug therapy - etiology
Atrial Flutter - drug therapy
Calcium Channel Blockers - adverse effects - therapeutic use
Canada
Cardiac Output, Low - complications - drug therapy
Catheter Ablation
Digoxin - adverse effects - therapeutic use
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Flecainide - adverse effects - therapeutic use
Heart Rate - drug effects
Humans
Middle Aged
Myocardial Infarction - complications - drug therapy
Pacemaker, Artificial
Propafenone - adverse effects - therapeutic use
Referral and Consultation
Sotalol - adverse effects - therapeutic use
Treatment Outcome
Abstract
The goals of atrial fibrillation (AF) and atrial flutter (AFL) arrhythmia management are to alleviate patient symptoms, improve patient quality of life, and minimize the morbidity associated with AF and AFL. Arrhythmia management usually commences with drugs to slow the ventricular rate. The addition of class I or class III antiarrhythmic drugs for restoration or maintenance of sinus rhythm is largely determined by patient symptoms and preferences. For rate control, treatment of persistent or permanent AF and AFL should aim for a resting heart rate of 35%, dronedarone, sotalol, or amiodarone is recommended. In patients with left ventricular ejection fraction
Notes
Erratum In: Can J Cardiol. 2011 May-Jun;27(3):388
PubMed ID
21329862 View in PubMed
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Cardiac resynchronization therapy in patients with permanent atrial fibrillation: results from the Resynchronization for Ambulatory Heart Failure Trial (RAFT).

https://arctichealth.org/en/permalink/ahliterature121574
Source
Circ Heart Fail. 2012 Sep 1;5(5):566-70
Publication Type
Article
Date
Sep-1-2012
Author
Jeff S Healey
Stefan H Hohnloser
Derek V Exner
David H Birnie
Ratika Parkash
Stuart J Connolly
Andrew D Krahn
Chris S Simpson
Bernard Thibault
Magdy Basta
Francois Philippon
Paul Dorian
Girish M Nair
Soori Sivakumaran
Elizabeth Yetisir
George A Wells
Anthony S L Tang
Author Affiliation
Population Health Research Institute, Hamilton, Ontario, Canada.
Source
Circ Heart Fail. 2012 Sep 1;5(5):566-70
Date
Sep-1-2012
Language
English
Publication Type
Article
Keywords
Action Potentials
Aged
Atrial Fibrillation - complications - diagnosis - mortality - physiopathology
Canada
Cardiac Resynchronization Therapy - adverse effects - mortality
Cardiac Resynchronization Therapy Devices
Defibrillators, Implantable
Electric Countershock - adverse effects - instrumentation - mortality
Exercise Test
Female
Heart Failure - complications - diagnosis - mortality - physiopathology - therapy
Hospitalization
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Questionnaires
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Abstract
Cardiac resynchronization (CRT) prolongs survival in patients with systolic heart failure and QRS prolongation. However, most trials excluded patients with permanent atrial fibrillation.
The Resynchronization for Ambulatory Heart Failure Trial (RAFT) randomized patients to an implantable cardioverter defibrillator (ICD) or ICD+CRT, stratified by the presence of permanent atrial fibrillation. Patients with permanent atrial fibrillation were randomized to CRT-ICD (n=114) or ICD (n=115). Patients receiving a CRT-ICD were similar to those receiving an ICD: age (71.6±7.3 versus 70.4±7.7 years), left ventricular ejection fraction (22.9±5.3% versus 22.3±5.1%), and QRS duration (151.0±23.6 versus 153.4±24.7 ms). There was no difference in the primary outcome of death or heart failure hospitalization between those assigned to CRT-ICD versus ICD (hazard ratio, 0.96; 95% CI, 0.65-1.41; P=0.82). Cardiovascular death was similar between treatment arms (hazard ratio, 0.97; 95% CI, 0.55-1.71; P=0.91); however, there was a trend for fewer heart failure hospitalizations with CRT-ICD (hazard ratio, 0.58; 95% CI, 0.38-1.01; P=0.052). The change in 6-minute hall walk duration between baseline and 12 months was not different between treatment arms (CRT-ICD: 19±84 m versus ICD: 16±76 m; P=0.88). Patients treated with CRT-ICD showed a trend for a greater improvement in Minnesota Living with Heart Failure score between baseline and 6 months (CRT-ICD: 41±21 to 31±21; ICD: 33±20 to 28±20; P=0.057).
Patients with permanent atrial fibrillation who are otherwise CRT candidates appear to gain minimal benefit from CRT-ICD compared with a standard ICD.
Notes
Comment In: Circ Heart Fail. 2013 Mar;6(2):e2223513051
Comment In: Circ Heart Fail. 2012 Sep 1;5(5):547-922991403
PubMed ID
22896584 View in PubMed
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Effect of pacing mode on health-related quality of life in the Canadian Trial of Physiologic Pacing.

https://arctichealth.org/en/permalink/ahliterature186110
Source
Am Heart J. 2003 Mar;145(3):430-7
Publication Type
Article
Date
Mar-2003
Author
David Newman
Ching Lau
Anthony S L Tang
Jane Irvine
Miney Paquette
Kirsten Woodend
Paul Dorian
Michael Gent
Charles Kerr
Stuart J Connolly
Author Affiliation
Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. newmand@smh.toronto.on.ca
Source
Am Heart J. 2003 Mar;145(3):430-7
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Aged
Atrioventricular Node - physiology
Bradycardia - therapy
Canada
Cardiac Pacing, Artificial - methods
Female
Health status
Heart Rate - physiology
Humans
Male
Pacemaker, Artificial - statistics & numerical data
Quality of Life
Questionnaires
Sinoatrial Node - physiology
Syncope - therapy
Treatment Outcome
Abstract
Both "physiologic" (dual-chamber or atrial only) or ventricular-pacing-only permanent pacemakers provide chronotropic competence, with unknown health-related quality of life (QOL) differences between these options. The QOL studies within the Canadian Trial of Physiologic Pacing were performed to assess whether QOL differences exist in patients randomized to these 2 pacing modes.
Two QOL protocols were performed: 1) a substudy of 269 patients with detailed QOL measures (The Medical Outcomes Study, Short-Form [SF-36], the Pacemaker Syndrome Scale, an activity scale, and a pacemaker-specific scale) at baseline and 6 months after implantation; and 2) a parent study assessment of QOL in 1721 patients with a 12-item QOL instrument package (SF-6, "ladder of life," and pacemaker syndrome scale) given 6 months after implantation only.
In the substudy, pacing was associated with an average significant (P
PubMed ID
12660665 View in PubMed
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Evaluation of early complications related to De Novo cardioverter defibrillator implantation insights from the Ontario ICD database.

https://arctichealth.org/en/permalink/ahliterature145304
Source
J Am Coll Cardiol. 2010 Feb 23;55(8):774-82
Publication Type
Article
Date
Feb-23-2010
Author
Douglas S Lee
Andrew D Krahn
Jeffrey S Healey
David Birnie
Eugene Crystal
Paul Dorian
Christopher S Simpson
Yaariv Khaykin
Douglas Cameron
Amir Janmohamed
Raymond Yee
Peter C Austin
Zhongliang Chen
Judy Hardy
Jack V Tu
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Toronto General Hospital, Toronto, Ontario, Canada. dlee@ices.on.ca
Source
J Am Coll Cardiol. 2010 Feb 23;55(8):774-82
Date
Feb-23-2010
Language
English
Publication Type
Article
Keywords
Aged
Cause of Death
Defibrillators, Implantable - adverse effects
Female
Humans
Male
Middle Aged
Ontario
Registries
Risk factors
Treatment Outcome
Abstract
This study examined the predictors of early complications after defibrillator implantation.
Although implantable cardioverter-defibrillators are widely used, predictors of procedural complications and the consequences of these events have not been determined.
In a prospective, multicenter, population-based clinical outcomes registry of all newly implanted defibrillator patients at 18 centers in Ontario, Canada, we examined 45-day complications and all-cause mortality from February 2007 to May 2009. Complications were determined longitudinally and were categorized as direct implant-related or indirect events.
Among 3,340 patients (mean age 63.8 +/- 12.5 years, 78.5% men), major complications occurred in 4.1% of de novo procedures. Compared with those undergoing a single-chamber device, implantation of a cardiac resynchronization defibrillator (adjusted hazard ratio [HR]: 2.17, 95% confidence interval [CI]: 1.38 to 3.43, p
PubMed ID
20170816 View in PubMed
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Evaluation of resynchronization therapy for heart failure in patients with a QRS duration greater than 120 ms (GREATER-EARTH) trial: rationale, design, and baseline characteristics.

https://arctichealth.org/en/permalink/ahliterature132672
Source
Can J Cardiol. 2011 Nov-Dec;27(6):779-86
Publication Type
Article
Author
Bernard Thibault
François Harel
Anique Ducharme
Michel White
Nancy Frasure-Smith
Denis Roy
François Philippon
Paul Dorian
Mario Talajic
Marc Dubuc
Pierre Gagné
Peter G Guerra
Laurent Macle
Léna Rivard
Paul Khairy
Author Affiliation
Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada. ablation2000@bellnet.ca
Source
Can J Cardiol. 2011 Nov-Dec;27(6):779-86
Language
English
Publication Type
Article
Keywords
Canada
Cardiac Resynchronization Therapy - methods
Cross-Over Studies
Double-Blind Method
Electrocardiography
Exercise Tolerance - physiology
Female
Heart Failure - physiopathology - therapy
Humans
Male
Middle Aged
Research Design
Treatment Outcome
Ventricular Function, Left - physiology
Abstract
Heart failure is considered an epidemic of the modern era. In selected candidates on optimal medical therapy, cardiac resynchronization therapy (CRT) has emerged as a valuable adjunctive treatment. Despite its demonstrated salutary effects on clinical evolution, left ventricular (LV) function, and overall survival, at least 30% of patients fail to respond to CRT.
The Greater Evaluation of Resychronization Therapy for Heart Failure (GREATER-EARTH) (ClinicalTrials.gov Identifier NCT00901212) is a randomized, double-blind, multicentre study involving 11 centres across Canada and compares LV CRT with biventricular CRT in patients with severe LV dysfunction and a QRS duration>120 ms.
This article describes the rationale and design of the study and presents the baseline characteristics of all randomized patients. The primary outcome consists of the effects of CRT on submaximal exercise tolerance (treadmill test), and secondary outcomes explore mechanisms of asynchrony and effects of CRT on asynchrony and LV function.
The study was initiated in November 2003, with the last patient randomized on February 12, 2009. As expected, follow-up was in February 2010 and the results are presently being analyzed in March 2010.
PubMed ID
21791363 View in PubMed
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A knowledge translation collaborative to improve the use of therapeutic hypothermia in post-cardiac arrest patients: protocol for a stepped wedge randomized trial.

https://arctichealth.org/en/permalink/ahliterature137893
Source
Implement Sci. 2011;6:4
Publication Type
Article
Date
2011
Author
Katie N Dainty
Damon C Scales
Steve C Brooks
Dale M Needham
Paul Dorian
Niall Ferguson
Gordon Rubenfeld
Randy Wax
Merrick Zwarenstein
Kevin Thorpe
Laurie J Morrison
Author Affiliation
RESCU Research Program, Keenan Research Centre, Li Ka Shing Knowledge Institute, St, Michael's Hospital Toronto, Canada. morrisonl@smh.ca.
Source
Implement Sci. 2011;6:4
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Female
Humans
Hypothermia, Induced - methods
Intervention Studies
Male
Middle Aged
Ontario - epidemiology
Out-of-Hospital Cardiac Arrest - mortality - therapy
Registries
Research Design
Retrospective Studies
Survival Rate
Translational Medical Research
Treatment Outcome
Abstract
Advances in resuscitation science have dramatically improved survival rates following cardiac arrest. However, about 60% of adults that regain spontaneous circulation die before leaving the hospital. Recently it has been shown that inducing hypothermia in cardiac arrest survivors immediately following their arrival in hospital can dramatically improve both overall survival and neurological outcomes. Despite the strong evidence for its efficacy and the apparent simplicity of this intervention, recent surveys show that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay.
This study will evaluate a multi-faceted knowledge translation strategy designed to increase the utilization rate of induced hypothermia in survivors of cardiac arrest across a network of 37 hospitals in Southwestern Ontario, Canada. The study is designed as a stepped wedge randomized trial lasting two years. Individual hospitals will be randomly assigned to four different wedges that will receive the active knowledge translation strategy according to a sequential rollout over a number of time periods. By the end of the study, all hospitals will have received the intervention. The primary aim is to measure the effectiveness of a multifaceted knowledge translation plan involving education, reminders, and audit-feedback for improving the use of induced hypothermia in survivors of cardiac arrest presenting to the emergency department. The primary outcome is the proportion of eligible OHCA patients that are cooled to a body temperature of 32 to 34?C within six hours of arrival in the hospital. Secondary outcomes will include process of care measures and clinical outcomes.
Inducing hypothermia in cardiac arrest survivors immediately following their arrival to hospital has been shown to dramatically improve both overall survival and neurological outcomes. However, this lifesaving treatment is frequently not applied in practice. If this trial is positive, our results will have broad implications by showing that a knowledge translation strategy shared across a collaborative network of hospitals can increase the number of patients that receive this lifesaving intervention in a timely manner.
ClinicalTrials.gov Trial Identifier: NCT00683683.
Notes
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PubMed ID
21235799 View in PubMed
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17 records – page 1 of 2.