Pub Date : 2026-01-01DOI: 10.1016/j.cjco.2025.09.010
Michael Reaume MD, MSc , Mathieu N. Labossière MD , Ricardo Batista MD, PhD , Navdeep Tangri MD, PhD , Claudio Rigatto MD, MSc , Clara Bohm MD, MPH , Denis Prud’homme MD, MSc , Peter Tanuseputro MD, MHSc , Lisa M. Lix PhD
Background
Patient-physician language concordance is associated with better outcomes. However, the mechanism(s) explaining these associations are poorly understood. Our objective was to determine if antihypertensive medication use mediates the association between patient-physician language concordance and major adverse cardiovascular events (MACEs).
Methods
Our population-based, retrospective cohort study used data from the Canadian Community Health Survey (CCHS) from January 1, 2003 to December 31, 2014. We identified Allophone-speaking respondents (ie, the language spoken most often at home is one other than English, French, or an Indigenous language) with self-reported hypertension. We defined patient-physician language concordance as agreement between language spoken most often at home and language spoken with one’s regular medical doctor. Survey responses were linked to hospitalization and mortality records. We identified all MACEs within 5 years after survey completion. The associations between patient-physician language concordance, antihypertensive medication use, and MACEs were explored using multivariable logistic and Cox proportional hazards regression, respectively. The mediating effect of antihypertensive medication use was tested with natural effect models.
Results
We studied 5013 Allophone-speaking patients, including 1708 (34.1%) who received language-concordant care and 3305 (65.9%) who received language-discordant care. Patients who received language-concordant care were 38% less likely to experience a MACE compared to patients who received language-discordant care (hazard ratio 0.62, 95% confidence interval 0.48-0.80). No evidence was found that this association was mediated by antihypertensive medication use.
Conclusions
Patient-physician language concordance was associated with a lower risk of a MACE. However, this association was not mediated by antihypertensive medication use. Further research could explore potentially modifiable mediators of this association.
{"title":"Patient-Physician Language Concordance, Antihypertensive Medications, and Cardiovascular Outcomes Among Allophone-Speaking Patients with Hypertension","authors":"Michael Reaume MD, MSc , Mathieu N. Labossière MD , Ricardo Batista MD, PhD , Navdeep Tangri MD, PhD , Claudio Rigatto MD, MSc , Clara Bohm MD, MPH , Denis Prud’homme MD, MSc , Peter Tanuseputro MD, MHSc , Lisa M. Lix PhD","doi":"10.1016/j.cjco.2025.09.010","DOIUrl":"10.1016/j.cjco.2025.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Patient-physician language concordance is associated with better outcomes. However, the mechanism(s) explaining these associations are poorly understood. Our objective was to determine if antihypertensive medication use mediates the association between patient-physician language concordance and major adverse cardiovascular events (MACEs).</div></div><div><h3>Methods</h3><div>Our population-based, retrospective cohort study used data from the Canadian Community Health Survey (CCHS) from January 1, 2003 to December 31, 2014. We identified Allophone-speaking respondents (ie, the language spoken most often at home is one other than English, French, or an Indigenous language) with self-reported hypertension. We defined patient-physician language concordance as agreement between language spoken most often at home and language spoken with one’s regular medical doctor. Survey responses were linked to hospitalization and mortality records. We identified all MACEs within 5 years after survey completion. The associations between patient-physician language concordance, antihypertensive medication use, and MACEs were explored using multivariable logistic and Cox proportional hazards regression, respectively. The mediating effect of antihypertensive medication use was tested with natural effect models.</div></div><div><h3>Results</h3><div>We studied 5013 Allophone-speaking patients, including 1708 (34.1%) who received language-concordant care and 3305 (65.9%) who received language-discordant care. Patients who received language-concordant care were 38% less likely to experience a MACE compared to patients who received language-discordant care (hazard ratio 0.62, 95% confidence interval 0.48-0.80). No evidence was found that this association was mediated by antihypertensive medication use.</div></div><div><h3>Conclusions</h3><div>Patient-physician language concordance was associated with a lower risk of a MACE. However, this association was not mediated by antihypertensive medication use. Further research could explore potentially modifiable mediators of this association.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 103-114"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145962991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cjco.2025.10.002
Omar Dewidar MSc , Anwar Abdi BSc , Hind Sabri BSc , Haben Dawit MSc , Sarisha Philip MPH , Victoria Barbeau BSc , Pierre Benoit MBA , Paulo Antunes MD , Jonathan Jetté MA , Joël Assaouré MBA , Diane Plourde MSc , Joy Seguin , Roland Sabbagh MD , Elie Skaff MD , Doug Archibald PhD , Vivian Welch PhD , Krystal Kehoe MacLeod PhD
Background
Poor mental health is a recognized risk factor for adverse cardiovascular outcomes, yet depression, anxiety, and stress remain underdiagnosed and undertreated in individuals with cardiovascular disease (CVD). Effective strategies to promote early recognition and management of these conditions are not well established. We conducted a rapid scoping review to identify interventions aimed at improving mental health recognition and management in adult CVD population without diagnosed mental health conditions.
Methods
We systematically searched MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, Web of Science, and Epistemonikos for articles published between January 1, 2014, and December 28, 2024.
Results
Of 11,645 screened studies, 24 met inclusion criteria: 12 systematic reviews and meta-analyses, and 12 randomized controlled trials (RCTs). Most focused on coronary artery disease or stroke patients. Interventions included mindfulness interventions (n = 9), routine screening (n = 2), interactive mHealth education (n = 2), psychosocial interventions (n = 4), caregiver education (n = 4), self-care (n = 1), and integrated care (n = 1). Interventions were multimodal pairing patient education with structured clinical encounters. Reporting of delivery methods was inconsistent and fewer than half assessed adherence. Only two RCTs involved patients in intervention design. Primary outcomes included changes in psychological distress symptoms and quality-of-life measures.
Conclusion
A variety of interventions target early recognition and management of mental health symptoms in CVD patients. The approach of combining self-management with clinician check-ins aligns with contemporary models of integrated care. Standardized reporting and greater interest-holder engagement are needed to improve intervention development, implementation, and evaluation.
{"title":"Interventions to Enhance Early Recognition and Management of Mental Health Symptoms in Patients with Cardiovascular Disease: A Rapid Scoping Review","authors":"Omar Dewidar MSc , Anwar Abdi BSc , Hind Sabri BSc , Haben Dawit MSc , Sarisha Philip MPH , Victoria Barbeau BSc , Pierre Benoit MBA , Paulo Antunes MD , Jonathan Jetté MA , Joël Assaouré MBA , Diane Plourde MSc , Joy Seguin , Roland Sabbagh MD , Elie Skaff MD , Doug Archibald PhD , Vivian Welch PhD , Krystal Kehoe MacLeod PhD","doi":"10.1016/j.cjco.2025.10.002","DOIUrl":"10.1016/j.cjco.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Poor mental health is a recognized risk factor for adverse cardiovascular outcomes, yet depression, anxiety, and stress remain underdiagnosed and undertreated in individuals with cardiovascular disease (CVD). Effective strategies to promote early recognition and management of these conditions are not well established. We conducted a rapid scoping review to identify interventions aimed at improving mental health recognition and management in adult CVD population without diagnosed mental health conditions.</div></div><div><h3>Methods</h3><div>We systematically searched MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, Web of Science, and Epistemonikos for articles published between January 1, 2014, and December 28, 2024.</div></div><div><h3>Results</h3><div>Of 11,645 screened studies, 24 met inclusion criteria: 12 systematic reviews and meta-analyses, and 12 randomized controlled trials (RCTs). Most focused on coronary artery disease or stroke patients. Interventions included mindfulness interventions (n = 9), routine screening (n = 2), interactive mHealth education (n = 2), psychosocial interventions (n = 4), caregiver education (n = 4), self-care (n = 1), and integrated care (n = 1). Interventions were multimodal pairing patient education with structured clinical encounters. Reporting of delivery methods was inconsistent and fewer than half assessed adherence. Only two RCTs involved patients in intervention design. Primary outcomes included changes in psychological distress symptoms and quality-of-life measures.</div></div><div><h3>Conclusion</h3><div>A variety of interventions target early recognition and management of mental health symptoms in CVD patients. The approach of combining self-management with clinician check-ins aligns with contemporary models of integrated care. Standardized reporting and greater interest-holder engagement are needed to improve intervention development, implementation, and evaluation.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 82-92"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cjco.2025.09.006
Gabriela Uriarte Zavala MD , Basilio Angulo-Lara MD , Daniel García Rodríguez MD , Isabel Dolores Poveda Pinedo MD , Susana Villar García MD
{"title":"Life-Threatening Left Atrial Thrombi: A Case Report and Review of Diagnosis and Management Approaches","authors":"Gabriela Uriarte Zavala MD , Basilio Angulo-Lara MD , Daniel García Rodríguez MD , Isabel Dolores Poveda Pinedo MD , Susana Villar García MD","doi":"10.1016/j.cjco.2025.09.006","DOIUrl":"10.1016/j.cjco.2025.09.006","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 20-23"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cjco.2025.09.016
Rubani S. Suri BHSc , Emilie P. Belley-Côté MD, PhD , Siobhan M. Baigent CCPA , Nicole P. Veloce CCPA , Muneeb Ahmed MD , P.J. Devereaux MD, PhD , Jeff S. Healey MD, MSc , Richard P. Whitlock MD, PhD , William F. McIntyre MD, PhD
Background
New-onset postoperative atrial fibrillation (POAF) complicates 30% of cardiac surgeries. Although POAF is often transient, structured follow-up care of patients with POAF may identify those with paroxysmal or persistent atrial fibrillation (AF) who will benefit from evidence-based therapies.
Methods
This retrospective study includes patients seen in a clinic dedicated to patients with POAF after cardiac surgery between 2020 and 2024. Per the clinic’s operating procedure, patients wore a 14-day continuous ambulatory electrocardiogram (ECG) monitor fpr 2 months after surgery and were assessed thereafter in clinic. The primary outcome was recurrent AF lasting ≥ 30 seconds, captured by 14-day continuous ambulatory ECG or during clinical care.
Results
The cohort included 881 patients, with a mean age of 68 ± 9 years, and a median Congestive Heart Failure, Hypertension, Age ≥ 75 Years, Diabetes Mellitus, Stroke, Vascular Disease, Age 65 to 74 Years, Sex Category (CHA2DS2-VASc) score of 2 (interquartile range [IQR] 1-3); 529 patients (60.0%) underwent isolated coronary artery bypass grafting. At discharge, 798 patients (90.6%) were prescribed amiodarone, and 435 (49.4%) were prescribed oral anticoagulation. The mean time between discharge and 14-day continuous ambulatory ECG monitor was 72 days (IQR 61-84). AF recurrence was detected in 94 patients (10.7%); 30 patients (36.1%) were not receiving oral anticoagulation at the time of recurrence. Among patients with recurrence detected by 14-day continuous ambulatory ECG, the median duration was 10 hours (IQR 2-253). Left atrial volume index was the only independent predictor of AF recurrence. Following the clinic visit, oral anticoagulation was continued in 122 patients (28.2%).
Conclusions
Among patients with POAF following cardiac surgery, 1 in 10 have AF recurrence, as determined by a structured 14-day continuous ambulatory ECG monitor utilized 2-3 months postoperatively.
{"title":"Recurrence of Postoperative Atrial Fibrillation After Cardiac Surgery: Insights from a Tertiary Follow-Up Clinic","authors":"Rubani S. Suri BHSc , Emilie P. Belley-Côté MD, PhD , Siobhan M. Baigent CCPA , Nicole P. Veloce CCPA , Muneeb Ahmed MD , P.J. Devereaux MD, PhD , Jeff S. Healey MD, MSc , Richard P. Whitlock MD, PhD , William F. McIntyre MD, PhD","doi":"10.1016/j.cjco.2025.09.016","DOIUrl":"10.1016/j.cjco.2025.09.016","url":null,"abstract":"<div><h3>Background</h3><div>New-onset postoperative atrial fibrillation (POAF) complicates 30% of cardiac surgeries. Although POAF is often transient, structured follow-up care of patients with POAF may identify those with paroxysmal or persistent atrial fibrillation (AF) who will benefit from evidence-based therapies.</div></div><div><h3>Methods</h3><div>This retrospective study includes patients seen in a clinic dedicated to patients with POAF after cardiac surgery between 2020 and 2024. Per the clinic’s operating procedure, patients wore a 14-day continuous ambulatory electrocardiogram (ECG) monitor fpr 2 months after surgery and were assessed thereafter in clinic. The primary outcome was recurrent AF lasting ≥ 30 seconds, captured by 14-day continuous ambulatory ECG or during clinical care.</div></div><div><h3>Results</h3><div>The cohort included 881 patients, with a mean age of 68 ± 9 years, and a median <strong>C</strong>ongestive Heart Failure, <strong>H</strong>ypertension, <strong>A</strong>ge ≥ 75 Years, <strong>D</strong>iabetes Mellitus, <strong>S</strong>troke, <strong>V</strong>ascular Disease, <strong>A</strong>ge 65 to 74 Years, <strong>S</strong>ex <strong>C</strong>ategory (CHA<sub>2</sub>DS<sub>2</sub>-VASc) score of 2 (interquartile range [IQR] 1-3); 529 patients (60.0%) underwent isolated coronary artery bypass grafting. At discharge, 798 patients (90.6%) were prescribed amiodarone, and 435 (49.4%) were prescribed oral anticoagulation. The mean time between discharge and 14-day continuous ambulatory ECG monitor was 72 days (IQR 61-84). AF recurrence was detected in 94 patients (10.7%); 30 patients (36.1%) were not receiving oral anticoagulation at the time of recurrence. Among patients with recurrence detected by 14-day continuous ambulatory ECG, the median duration was 10 hours (IQR 2-253). Left atrial volume index was the only independent predictor of AF recurrence. Following the clinic visit, oral anticoagulation was continued in 122 patients (28.2%).</div></div><div><h3>Conclusions</h3><div>Among patients with POAF following cardiac surgery, 1 in 10 have AF recurrence, as determined by a structured 14-day continuous ambulatory ECG monitor utilized 2-3 months postoperatively.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 24-30"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.cjco.2025.06.020
Kevin Haddad MD, MSc , Andrei Lucian Ionescu MD , Radbod Pilehvar MD , Laurie-Anne Boivin-Proulx MD, MSc , Giovanni Romanelli MD , Brian J. Potter MDCM, SM , Alexis Matteau MD, SM , Mohamad J. Mansour MD , Samer Mansour MD
Background
Stress echocardiography (SE) is a well established method for diagnosing and assessing coronary artery disease (CAD). However, accurately identifying high-risk patients remains a challenge. The aim of the study is to explore the potential of novel predictors to enhance the diagnostic precision of SE for detecting left-main or triple-vessel CAD.
Methods
We included consecutive patients who underwent invasive coronary angiography within 6 months of SE between January 2018 and April 2022. Traditional high-risk SE features included extensive wall-motion abnormalities, a reduction in left ventricular ejection fraction 10% or left ventricular dilation at peak stress, and low ischemic threshold. Wall-motion score index and global longitudinal strain (GLS) at rest and peak stress, as well as the change in each from rest to peak were considered as potential additional indicators of high-risk anatomy, defined as significant stenoses in the left main and/or triple-vessel CAD.
Results
Of the 257 patients (mean age 66 ± 9 years) included in the analysis, 53 (21%) had high-risk CAD. Multivariate analyses identified traditional high-risk SE features, as well as ≥ 5% absolute reduction in GLS, as independent predictors of high-risk anatomy. Integrating GLS ≥ 5% into standard stress echocardiography evaluation significantly improved sensitivity from 69% to 90% (P = 0.003), with an associated specificity of 72%; also improved was the area under the curve of SE, increasing from 0.77 to 0.81 for detection of high-risk CAD.
Conclusions
In a real-world cohort, adding the change in GLS with exercise stress can improve the performance of SE for the detection of high-risk CAD.
{"title":"Improving Stress Echocardiography for Enhanced Detection of Left Main and Multivessel Coronary Artery Disease","authors":"Kevin Haddad MD, MSc , Andrei Lucian Ionescu MD , Radbod Pilehvar MD , Laurie-Anne Boivin-Proulx MD, MSc , Giovanni Romanelli MD , Brian J. Potter MDCM, SM , Alexis Matteau MD, SM , Mohamad J. Mansour MD , Samer Mansour MD","doi":"10.1016/j.cjco.2025.06.020","DOIUrl":"10.1016/j.cjco.2025.06.020","url":null,"abstract":"<div><h3>Background</h3><div>Stress echocardiography (SE) is a well established method for diagnosing and assessing coronary artery disease (CAD). However, accurately identifying high-risk patients remains a challenge. The aim of the study is to explore the potential of novel predictors to enhance the diagnostic precision of SE for detecting left-main or triple-vessel CAD.</div></div><div><h3>Methods</h3><div>We included consecutive patients who underwent invasive coronary angiography within 6 months of SE between January 2018 and April 2022. Traditional high-risk SE features included extensive wall-motion abnormalities, a reduction in left ventricular ejection fraction <span><math><mrow><mo>≥</mo></mrow></math></span> 10% or left ventricular dilation at peak stress, and low ischemic threshold. Wall-motion score index and global longitudinal strain (GLS) at rest and peak stress, as well as the change in each from rest to peak were considered as potential additional indicators of high-risk anatomy, defined as significant stenoses in the left main and/or triple-vessel CAD.</div></div><div><h3>Results</h3><div>Of the 257 patients (mean age 66 ± 9 years) included in the analysis, 53 (21%) had high-risk CAD. Multivariate analyses identified traditional high-risk SE features, as well as ≥ 5% absolute reduction in GLS, as independent predictors of high-risk anatomy. Integrating <span><math><mrow><mo>Δ</mo></mrow></math></span> GLS ≥ 5% into standard stress echocardiography evaluation significantly improved sensitivity from 69% to 90% (<em>P</em> = 0.003), with an associated specificity of 72%; also improved was the area under the curve of SE, increasing from 0.77 to 0.81 for detection of high-risk CAD.</div></div><div><h3>Conclusions</h3><div>In a real-world cohort, adding the change in GLS with exercise stress can improve the performance of SE for the detection of high-risk CAD.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 93-102"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cjco.2025.08.015
Gabrielle Viscardi BSc, RD , Sahba Eskandari BSc , Alyssa Chen PharmD , Nicholas Chiang PharmD, MD , Meaghan E. Kavanagh MSc, PhD , Songhee Back BSc , Micheal Vallis PhD , Mary J. Scourboutakos PhD, MD , Vasanti S. Malik ScD , Cyril W.C. Kendall PhD , David J.A. Jenkins MD, PhD , John L. Sievenpiper MD, PhD , Laura Chiavaroli MSc, PhD
Background
Cardiovascular disease (CVD) remains a leading cause of death in Canada. Although the Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is supported by CVD clinical practice guidelines, its uptake in clinical practice remains limited. This study assessed the content and face validity of a healthcare provider (HCP)-facing toolkit (infographic and video), designed to support implementation of the Portfolio Diet.
Methods
HCPs were recruited for a 2-round evaluation. They assessed the toolkit using a questionnaire. Content validity of the infographic was assessed using a 4-point Likert scale (1 = irrelevant to 4 = extremely relevant) and face validity of the infographic and video was assessed using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Content-validity indices (CVIs) and face-validity indices (FVIs) were calculated, with ≥ 0.70/1.0 indicating validity. Qualitative feedback informed revisions made between rounds.
Results
In round 1 (N = 21), all but one section of the infographic met the CVI threshold, and all FVI values exceeded 0.70. Feedback highlighted the need for explicit food examples, an improved layout, and reduced use of jargon. In round 2 (N = 28), CVI (0.86-1.0) and FVI (0.79-1.0, infographic; 0.89-1.0, video) improved. HCPs reported that the toolkit increased their knowledge, their confidence in recommending the Portfolio Diet and PortfolioDiet.app to patients, and their confidence in recommending the toolkit to other clinicians (FVIinfographic = 0.89 to 1.0; FVIvideo = 0.89).
Conclusions
The toolkit demonstrated strong content and face validity. Repeated assessments and refinement guided by end-user feedback enhanced the toolkit, supporting HCPs in implementing the Portfolio Diet for CVD prevention and management in practice.
{"title":"Translating Cardiovascular Clinical Practice Guidelines on Nutrition Therapy: Validation of the Portfolio Diet Toolkit for Healthcare Providers","authors":"Gabrielle Viscardi BSc, RD , Sahba Eskandari BSc , Alyssa Chen PharmD , Nicholas Chiang PharmD, MD , Meaghan E. Kavanagh MSc, PhD , Songhee Back BSc , Micheal Vallis PhD , Mary J. Scourboutakos PhD, MD , Vasanti S. Malik ScD , Cyril W.C. Kendall PhD , David J.A. Jenkins MD, PhD , John L. Sievenpiper MD, PhD , Laura Chiavaroli MSc, PhD","doi":"10.1016/j.cjco.2025.08.015","DOIUrl":"10.1016/j.cjco.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) remains a leading cause of death in Canada. Although the Portfolio Diet, a dietary pattern of cholesterol-lowering foods, is supported by CVD clinical practice guidelines, its uptake in clinical practice remains limited. This study assessed the content and face validity of a healthcare provider (HCP)-facing toolkit (infographic and video), designed to support implementation of the Portfolio Diet.</div></div><div><h3>Methods</h3><div>HCPs were recruited for a 2-round evaluation. They assessed the toolkit using a questionnaire. Content validity of the infographic was assessed using a 4-point Likert scale (1 = irrelevant to 4 = extremely relevant) and face validity of the infographic and video was assessed using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Content-validity indices (CVIs) and face-validity indices (FVIs) were calculated, with ≥ 0.70/1.0 indicating validity. Qualitative feedback informed revisions made between rounds.</div></div><div><h3>Results</h3><div>In round 1 (N = 21), all but one section of the infographic met the CVI threshold, and all FVI values exceeded 0.70. Feedback highlighted the need for explicit food examples, an improved layout, and reduced use of jargon. In round 2 (N = 28), CVI (0.86-1.0) and FVI (0.79-1.0, infographic; 0.89-1.0, video) improved. HCPs reported that the toolkit increased their knowledge, their confidence in recommending the Portfolio Diet and PortfolioDiet.app to patients, and their confidence in recommending the toolkit to other clinicians (FVI<sub>infographic</sub> = 0.89 to 1.0; FVI<sub>video</sub> = 0.89).</div></div><div><h3>Conclusions</h3><div>The toolkit demonstrated strong content and face validity. Repeated assessments and refinement guided by end-user feedback enhanced the toolkit, supporting HCPs in implementing the Portfolio Diet for CVD prevention and management in practice.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT05915455.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1662-1671"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cjco.2025.07.014
Margarida Pujol-López MD, PhD , Ander Regueiro MD, PhD , Freddy R. Graterol MD , Cora Garcia-Ribas MD, PhD , Laura Uribe MD , Rafael Jiménez-Arjona MD , Roger Borràs MSc , Eduard Guasch MD, PhD , J. Baptiste Guichard MD, PhD , Lidia Carballeira MD , Pasquale Valerio Falzone MD , Mariona Regany-Closa MSc , Raquel Casal RN , Marina Poza RN , Elena Arbelo MD, PhD , Andreu Porta-Sánchez MD, PhD , Ivo Roca-Luque MD, PhD , Marta Sitges MD, PhD , Adelina Doltra MD, PhD , José M. Tolosana MD, PhD , Lluís Mont MD, PhD
Background
There is currently no evidence of the best pacing mode for high-degree atrioventricular (AV) block occurring after transcatheter aortic valve implantation (TAVI). The objective of this pilot study was to compare a clinical combined endpoint achieved by left bundle branch pacing (LBBP) vs right ventricular (RV) pacing in patients with preserved left ventricular ejection fraction (LVEF) post-TAVI at 12-month follow-up.
Methods
Consecutive patients post-TAVI with high-degree AV block and LVEF ≥ 50% were randomized to LBBP or RV pacing. The primary endpoint was survival with an improvement of ≥ 1 point in New York Heart Association functional class or a ≥ 25% increase in distance covered on the 6-minute walking test. Secondary endpoints were change in LVEF, septal flash, mitral regurgitation, N-terminal pro–brain natriuretic peptide, heart failure hospitalization, score on symptoms, and QRS duration.
Results
Twenty-four patients were included in the study, 12 in each arm. Both groups showed a similar incidence of the primary endpoint: 33.3% (n = 4) in the LBBP group vs 25% (n = 3) in the RV group (P = 1.0). In relation to secondary endpoints, significant shortening in the QRS was observed in the LBBP group compared with the RV group (median: −39 ms vs 0 ms, P < 0.001). Septal flash excursion was significantly lower for the LBBP group (median: 0 mm vs 2 mm, P = 0.03). There was no difference between groups on any other endpoint.
Conclusions
Similar midterm outcomes were obtained with LBBP and RV pacing in an elderly population with high-degree AV block and preserved LVEF after TAVI. The pilot Phys-TAVI trial showed the feasibility of LBBP in this population. Larger randomized clinical trials with longer follow-up are needed to test for differential clinical outcomes between pacing modalities.
Clinical Trial Registration
NCT04482816
目前还没有证据表明经导管主动脉瓣植入术（TAVI）后发生高度房室（AV）传导阻滞的最佳起搏模式。本初步研究的目的是比较左束支起搏（LBBP）和右心室起搏（RV）在tavi后保留左心室射血分数（LVEF）的患者12个月随访时达到的临床联合终点。方法将tavi术后高度房室传导阻滞且LVEF≥50%的患者随机分为LBBP组和RV组。主要终点是纽约心脏协会功能分级改善≥1分或6分钟步行测试距离增加≥25%的生存期。次要终点是LVEF、室间隔闪光、二尖瓣反流、n端脑利钠肽前体、心力衰竭住院、症状评分和QRS持续时间的变化。结果共纳入24例患者，每组12例。两组的主要终点发生率相似：LBBP组为33.3% (n = 4)，而RV组为25% (n = 3) （P = 1.0）。相对次要终点，与RV组相比，LBBP组QRS显著缩短（中位数：- 39 ms vs 0 ms， P < 0.001）。LBBP组的间隔闪移明显较低（中位数：0 mm vs 2 mm， P = 0.03）。在任何其他终点上，两组之间没有差异。结论LBBP和RV起搏在TAVI后高度房室传导阻滞并保留LVEF的老年人群中获得了相似的中期结果。物理- tavi试点试验表明LBBP在这一人群中的可行性。需要更大规模、随访时间更长的随机临床试验来检验不同起搏方式的临床结果差异。临床试验注册号nct04482816
{"title":"Left Bundle Branch Versus Apical Pacing in Atrioventricular Block and Normal Cardiac Function Post-transcatheter Aortic Valve Implantation: PhysTAVI Trial","authors":"Margarida Pujol-López MD, PhD , Ander Regueiro MD, PhD , Freddy R. Graterol MD , Cora Garcia-Ribas MD, PhD , Laura Uribe MD , Rafael Jiménez-Arjona MD , Roger Borràs MSc , Eduard Guasch MD, PhD , J. Baptiste Guichard MD, PhD , Lidia Carballeira MD , Pasquale Valerio Falzone MD , Mariona Regany-Closa MSc , Raquel Casal RN , Marina Poza RN , Elena Arbelo MD, PhD , Andreu Porta-Sánchez MD, PhD , Ivo Roca-Luque MD, PhD , Marta Sitges MD, PhD , Adelina Doltra MD, PhD , José M. Tolosana MD, PhD , Lluís Mont MD, PhD","doi":"10.1016/j.cjco.2025.07.014","DOIUrl":"10.1016/j.cjco.2025.07.014","url":null,"abstract":"<div><h3>Background</h3><div>There is currently no evidence of the best pacing mode for high-degree atrioventricular (AV) block occurring after transcatheter aortic valve implantation (TAVI). The objective of this pilot study was to compare a clinical combined endpoint achieved by left bundle branch pacing (LBBP) vs right ventricular (RV) pacing in patients with preserved left ventricular ejection fraction (LVEF) post-TAVI at 12-month follow-up.</div></div><div><h3>Methods</h3><div>Consecutive patients post-TAVI with high-degree AV block and LVEF ≥ 50% were randomized to LBBP or RV pacing. The primary endpoint was survival with an improvement of ≥ 1 point in New York Heart Association functional class or a ≥ 25% increase in distance covered on the 6-minute walking test. Secondary endpoints were change in LVEF, septal flash, mitral regurgitation, N-terminal pro–brain natriuretic peptide, heart failure hospitalization, score on symptoms, and QRS duration.</div></div><div><h3>Results</h3><div>Twenty-four patients were included in the study, 12 in each arm. Both groups showed a similar incidence of the primary endpoint: 33.3% (n = 4) in the LBBP group vs 25% (n = 3) in the RV group (<em>P</em> = 1.0). In relation to secondary endpoints, significant shortening in the QRS was observed in the LBBP group compared with the RV group (median: −39 ms vs 0 ms, <em>P</em> < 0.001). Septal flash excursion was significantly lower for the LBBP group (median: 0 mm vs 2 mm, <em>P</em> = 0.03). There was no difference between groups on any other endpoint.</div></div><div><h3>Conclusions</h3><div>Similar midterm outcomes were obtained with LBBP and RV pacing in an elderly population with high-degree AV block and preserved LVEF after TAVI. The pilot Phys-TAVI trial showed the feasibility of LBBP in this population. Larger randomized clinical trials with longer follow-up are needed to test for differential clinical outcomes between pacing modalities.</div></div><div><h3>Clinical Trial Registration</h3><div>NCT04482816</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1610-1620"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Periprocedural myocardial injury (PMI) is a concern in transcatheter aortic valve implantation (TAVI), with rapid pacing (RP) suspected to be a contributing factor. PMI is defined by elevated troponin levels. In this study we determined the net effect of RP on PMI after excluding patients with severe renal dysfunction by evaluating troponin elevation after TAVI.
Methods
We included 137 patients who underwent TAVI between September 2023 and January 2025. The association between renal function and cardiac troponin T (cTnT) level was investigated. Patients were categorized according to the RP time (RPT) to investigate its association with cTnT elevation, PMI, and short-term outcomes. The 100 patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min per 1.73 m2 were divided into 2 groups: short (< 18 seconds, n = 49) and long (≥ 18 seconds, n = 51) RPT. The primary endpoint was PMI/troponin levels, whereas the secondary endpoints were 30-day all-cause death and major adverse cardiovascular events (MACE).
Results
The eGFR inversely correlated with cTnT levels (P < 0.001). The long RPT group had significantly higher cTnT values (P = 0.026) and PMI rates (14.2% vs 33.3%, P = 0.034) vs the short RPT group. The 30-day prognosis did not differ between the short and long RPT groups. Patients with PMI exhibited a trend toward higher MACE (P = 0.051) vs those without PMI. ΔcTnT independently predicted 30-day MACE (P = 0.043).
Conclusions
A longer RPT significantly increased troponin levels, indicating PMI, which was associated with worse short-term prognosis of cardiovascular events. However, other factors, such as renal dysfunction, rather than only longer RPT, are also associated with increased troponin level.
{"title":"Impact of Rapid Pacing Time on Myocardial Injury in Transcatheter Aortic Valve Implantation for Non–End-stage Renal Disease Patients","authors":"Keisuke Matsuo MD, PhD , Takahide Arai MD, PhD , Mitsunobu Nagai MD , Yuto Hori MD , Hiroki Hoya MD , Yodo Gatate MD, PhD , Akihiro Yoshitake MD, PhD , Shintaro Nakano MD, PhD","doi":"10.1016/j.cjco.2025.08.011","DOIUrl":"10.1016/j.cjco.2025.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Periprocedural myocardial injury (PMI) is a concern in transcatheter aortic valve implantation (TAVI), with rapid pacing (RP) suspected to be a contributing factor. PMI is defined by elevated troponin levels. In this study we determined the net effect of RP on PMI after excluding patients with severe renal dysfunction by evaluating troponin elevation after TAVI.</div></div><div><h3>Methods</h3><div>We included 137 patients who underwent TAVI between September 2023 and January 2025. The association between renal function and cardiac troponin T (cTnT) level was investigated. Patients were categorized according to the RP time (RPT) to investigate its association with cTnT elevation, PMI, and short-term outcomes. The 100 patients with an estimated glomerular filtration rate (eGFR) ≥ 30 mL/min per 1.73 m<sup>2</sup> were divided into 2 groups: short (< 18 seconds, n = 49) and long (≥ 18 seconds, n = 51) RPT. The primary endpoint was PMI/troponin levels, whereas the secondary endpoints were 30-day all-cause death and major adverse cardiovascular events (MACE).</div></div><div><h3>Results</h3><div>The eGFR inversely correlated with cTnT levels (<em>P</em> < 0.001). The long RPT group had significantly higher cTnT values (<em>P</em> = 0.026) and PMI rates (14.2% vs 33.3%, <em>P</em> = 0.034) vs the short RPT group. The 30-day prognosis did not differ between the short and long RPT groups. Patients with PMI exhibited a trend toward higher MACE (<em>P</em> = 0.051) vs those without PMI. ΔcTnT independently predicted 30-day MACE (<em>P</em> = 0.043).</div></div><div><h3>Conclusions</h3><div>A longer RPT significantly increased troponin levels, indicating PMI, which was associated with worse short-term prognosis of cardiovascular events. However, other factors, such as renal dysfunction, rather than only longer RPT, are also associated with increased troponin level.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1592-1601"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.cjco.2025.07.016
Kaitlyn E. Watson , Isabella M. Thomas , Andrea M. Patey PhD , Sandra Robertshaw , Karen Moffat , Ross T. Tsuyuki BSc(Pharm), PharmD, MSc , Jeremy Grimshaw MBChB PhD
Background
Hypertension in women is an important precursor to heart disease, and even when they are on antihypertensive medications, women have higher blood pressure, compared to men. This study aimed to use a theory-informed approach to understand the experiences of women living with hypertension in managing their condition within the primary care setting.
Methods
We conducted virtual semistructured interviews, in February-June 2023, with Canadian women aged > 40 years who self-identified as experiencing hypertension. The interview guide was developed based on the Common-Sense Self-Regulation Model to explore the perceptions/experiences of women living with hypertension. Additionally, intersectionality questions were added. A deductive approach using the dimensions of the model was applied, and an inductive approach was used to identify themes within the dimensions. Two patient partners were involved in this study throughout the research.
Results
The women interviewed had a good understanding of the causes of hypertension, and they strongly emphasized stress-induced causes. Their coping strategies included changing their diet and lifestyle choices, taking medications, measuring their blood pressure at home, and visiting their physician. Strong experiences were shared by the participants—of being dismissed as having “white coat” hypertension or nonadherence to medicines, and ageism. Many felt they had to be “armed with proof” and had to strongly advocate for themselves in order to not be dismissed.
Conclusions
Women with hypertension expressed feelings of not being taken seriously, and the need to provide evidence to advocate for their management. Hypertension interventions need to be tailored to women and account for their intersectionality experiences.
{"title":"A Qualitative Study Exploring Women’s Understanding and Experiences of Managing Hypertension in Primary Care","authors":"Kaitlyn E. Watson , Isabella M. Thomas , Andrea M. Patey PhD , Sandra Robertshaw , Karen Moffat , Ross T. Tsuyuki BSc(Pharm), PharmD, MSc , Jeremy Grimshaw MBChB PhD","doi":"10.1016/j.cjco.2025.07.016","DOIUrl":"10.1016/j.cjco.2025.07.016","url":null,"abstract":"<div><h3>Background</h3><div>Hypertension in women is an important precursor to heart disease, and even when they are on antihypertensive medications, women have higher blood pressure, compared to men. This study aimed to use a theory-informed approach to understand the experiences of women living with hypertension in managing their condition within the primary care setting.</div></div><div><h3>Methods</h3><div>We conducted virtual semistructured interviews, in February-June 2023, with Canadian women aged > 40 years who self-identified as experiencing hypertension. The interview guide was developed based on the Common-Sense Self-Regulation Model to explore the perceptions/experiences of women living with hypertension. Additionally, intersectionality questions were added. A deductive approach using the dimensions of the model was applied, and an inductive approach was used to identify themes within the dimensions. Two patient partners were involved in this study throughout the research.</div></div><div><h3>Results</h3><div>The women interviewed had a good understanding of the causes of hypertension, and they strongly emphasized stress-induced causes. Their coping strategies included changing their diet and lifestyle choices, taking medications, measuring their blood pressure at home, and visiting their physician. Strong experiences were shared by the participants—of being dismissed as having “white coat” hypertension or nonadherence to medicines, and ageism. Many felt they had to be “armed with proof<em>”</em> and had to strongly advocate for themselves in order to not be dismissed.</div></div><div><h3>Conclusions</h3><div>Women with hypertension expressed feelings of not being taken seriously, and the need to provide evidence to advocate for their management. Hypertension interventions need to be tailored to women and account for their intersectionality experiences.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 12","pages":"Pages 1629-1637"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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