Pub Date : 2026-02-01Epub Date: 2025-10-27DOI: 10.1016/j.cjco.2025.10.006
Oswald Chen MD , Todd A. Wilson PhD , Matthew T. Bennett MD , Jaimie Manlucu MD , Stephen B. Wilton MD, MSc , AMIQA Canada Investigators
Background
Achieving the target doses of indicated medications after myocardial infarction (MI) is associated with improved outcomes and is a marker of the quality of care. We studied the use and follow-up dosing of core cardiac medications among patients with MI complicated by depressed left ventricular ejection fraction (LVEF). Our objective was to determine whether adherence to evidence-based medication dosing is associated with receipt of follow-up LVEF imaging or progression of LVEF within 6 months of follow-up care.
Methods
The Acute Myocardial Infarction Quality Assurance (AMIQA) Canada study enrolled 501 patients (mean age 63 years; 22.6% female) with acute MI and LVEF ≤ 45%, from 14 Canadian centres. Patients were followed for 6 months to determine their adherence to post-MI follow-up recommendations. We assessed use and dosing of beta-blockers, angiotension-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and statins, and compared changes in LVEF among those taking ≥50% vs < 50% of the target dose in the follow-up period.
Results
At 6 months, the mean percent target dose was ≤ 50% for beta-blockers, angiotension-converting enzyme inhibitors, and angiotensin II receptor blockers, but it was 70.8% ± 46.9% for MRAs, and 86.8% received high-intensity statin. Only use of MRA was associated with follow-up LVEF reassessment (P < 0.001). Receiving ≥ 50% of the target dose was not associated with changes in LVEF.
Conclusions
Except for statins, most patients were not receiving target doses of indicated medications after MI with reduced LVEF. Follow-up dosing was not associated with LVEF reassessment or improvement in LVEF. Future quality-improvement initiatives may require distinct strategies for improving adherence to recommendations for medication dosing vs follow-up imaging.
{"title":"Follow-up Dosing of Guideline-Indicated Medications After Myocardial Infarction: Insights from the Acute Myocardial Infarction Quality Assurance (AMIQA) Canada Study","authors":"Oswald Chen MD , Todd A. Wilson PhD , Matthew T. Bennett MD , Jaimie Manlucu MD , Stephen B. Wilton MD, MSc , AMIQA Canada Investigators","doi":"10.1016/j.cjco.2025.10.006","DOIUrl":"10.1016/j.cjco.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Achieving the target doses of indicated medications after myocardial infarction (MI) is associated with improved outcomes and is a marker of the quality of care. We studied the use and follow-up dosing of core cardiac medications among patients with MI complicated by depressed left ventricular ejection fraction (LVEF). Our objective was to determine whether adherence to evidence-based medication dosing is associated with receipt of follow-up LVEF imaging or progression of LVEF within 6 months of follow-up care.</div></div><div><h3>Methods</h3><div>The Acute Myocardial Infarction Quality Assurance (AMIQA) Canada study enrolled 501 patients (mean age 63 years; 22.6% female) with acute MI and LVEF ≤ 45%, from 14 Canadian centres. Patients were followed for 6 months to determine their adherence to post-MI follow-up recommendations. We assessed use and dosing of beta-blockers, angiotension-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and statins, and compared changes in LVEF among those taking ≥50% vs < 50% of the target dose in the follow-up period.</div></div><div><h3>Results</h3><div>At 6 months, the mean percent target dose was ≤ 50% for beta-blockers, angiotension-converting enzyme inhibitors, and angiotensin II receptor blockers, but it was 70.8% ± 46.9% for MRAs, and 86.8% received high-intensity statin. Only use of MRA was associated with follow-up LVEF reassessment (<em>P</em> < 0.001). Receiving ≥ 50% of the target dose was not associated with changes in LVEF.</div></div><div><h3>Conclusions</h3><div>Except for statins, most patients were not receiving target doses of indicated medications after MI with reduced LVEF. Follow-up dosing was not associated with LVEF reassessment or improvement in LVEF. Future quality-improvement initiatives may require distinct strategies for improving adherence to recommendations for medication dosing vs follow-up imaging.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 206-213"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327436","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 : 2026-02-01Epub Date: 2025-10-24DOI: 10.1016/j.cjco.2025.10.005
Racquel K. Brown BKin, MSc , Monica Parry MEd, MSc, NP-Adult, PhD, CCN(C), FAAN, FCAN, FAHA , Paul Oh MD , Lisa Cotie PhD, RKin , Jennifer Harris RPT, BScPT , Mireille Landry RPT, BScPT, MSc, RISPT, CDE, PT , Patrice Lindsay RN, PhD, FWSO , Marilyn MacKay-Lyons PT, PhD , Karen Minden CM, PhD , Kerri-Anne Mullen PhD, MSc , Sharon L. Mulvagh MD, FRCPC, FACC, FASE, FAHA , Tamara Rader MLIS , Jennifer Bethell PhD , Tracey J.F. Colella RN, APN, PhD, FCAN
Background
Cardiovascular disease (CVD) is the leading cause of preventable deaths in Canadian women. Cardiac rehabilitation (CR) is a risk reduction program that can enhance and maintain cardiovascular health through individualized programming. Participation can reduce future events by up to 50%. However, women are less likely to access CR than men. A collaborative research agenda is needed to address women’s priorities for CR, incorporating the input of people with lived and living experience (PWLLE), whose needs are often left unmet. The objective of this study was to engage PWLLE of CVD and clinicians in Canada to identify and prioritize research questions about CR for women.
Methods
James Lind Alliance priority setting partnership was conducted. An initial survey collected questions about women’s CR from PWLLE and clinicians. In a second survey, PWLLE and clinicians shortlisted the questions. The questions were prioritized at in-person workshop.
Results
The first survey collected 1347 questions from 172 respondents: 74.3% women with lived experience of cardiovascular condition(s) and/or procedure(s), 10.5% family, friends, caregivers, and 23.4% clinicians. Out-of-scope submissions were removed. The remaining 715 were grouped and summarized, resulting in 52 summary questions. There were 250 responses to the second survey, which was used to create a shortlist of 25 questions. At the workshop, PWLLE and clinicians (n = 22) identified the top 10 priorities namely, individualization; women-only CR; follow-up; referral criteria; education; optimization; nutritional counselling; rural access; and exercise safety/progression.
Conclusion
These priorities were established through PWLLE-clinician consensus and provide a framework for future CR research in women.
{"title":"Women’s Cardiovascular Health and Cardiac Rehabilitation: a Priority-setting Partnership","authors":"Racquel K. Brown BKin, MSc , Monica Parry MEd, MSc, NP-Adult, PhD, CCN(C), FAAN, FCAN, FAHA , Paul Oh MD , Lisa Cotie PhD, RKin , Jennifer Harris RPT, BScPT , Mireille Landry RPT, BScPT, MSc, RISPT, CDE, PT , Patrice Lindsay RN, PhD, FWSO , Marilyn MacKay-Lyons PT, PhD , Karen Minden CM, PhD , Kerri-Anne Mullen PhD, MSc , Sharon L. Mulvagh MD, FRCPC, FACC, FASE, FAHA , Tamara Rader MLIS , Jennifer Bethell PhD , Tracey J.F. Colella RN, APN, PhD, FCAN","doi":"10.1016/j.cjco.2025.10.005","DOIUrl":"10.1016/j.cjco.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) is the leading cause of preventable deaths in Canadian women. Cardiac rehabilitation (CR) is a risk reduction program that can enhance and maintain cardiovascular health through individualized programming. Participation can reduce future events by up to 50%. However, women are less likely to access CR than men. A collaborative research agenda is needed to address women’s priorities for CR, incorporating the input of people with lived and living experience (PWLLE), whose needs are often left unmet. The objective of this study was to engage PWLLE of CVD and clinicians in Canada to identify and prioritize research questions about CR for women.</div></div><div><h3>Methods</h3><div>James Lind Alliance priority setting partnership was conducted. An initial survey collected questions about women’s CR from PWLLE and clinicians. In a second survey, PWLLE and clinicians shortlisted the questions. The questions were prioritized at in-person workshop.</div></div><div><h3>Results</h3><div>The first survey collected 1347 questions from 172 respondents: 74.3% women with lived experience of cardiovascular condition(s) and/or procedure(s), 10.5% family, friends, caregivers, and 23.4% clinicians. Out-of-scope submissions were removed. The remaining 715 were grouped and summarized, resulting in 52 summary questions. There were 250 responses to the second survey, which was used to create a shortlist of 25 questions. At the workshop, PWLLE and clinicians (n = 22) identified the top 10 priorities namely, individualization; women-only CR; follow-up; referral criteria; education; optimization; nutritional counselling; rural access; and exercise safety/progression.</div></div><div><h3>Conclusion</h3><div>These priorities were established through PWLLE-clinician consensus and provide a framework for future CR research in women.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 2","pages":"Pages 239-248"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147327562","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}
Patients with hereditary transthyretin amyloid cardiomyopathy (hATTR-CM), can show neurologic signs that lead to the eventual onset of polyneuropathy (PN). Detection of PN among patients with hATTR-CM can identify candidates for disease-modifying therapies that could significantly reduce the incidence of mortality and morbidity for these complex patients. The purpose of this study is to determine the prevalence of PN among patients with hATTR-CM.
Methods
Sixty patients with hATTR-CM were enrolled in this prospective study, from the Amyloidosis Clinic at the University Health Network in Toronto, Ontario, Canada. All patients (average age: 69.12 ± 11.82 years; 51.7% male; 48.3% female) were referred to neurology programs specialized in hATTR PN. Comprehensive neurologic assessments were conducted, including a physical examination and nerve conduction studies (NCSs). NCSs were performed on the upper and lower extremities.
Results
Thirty patients (50.0%) displayed clinical and NCS abnormalities. Six patients (10.0%) did not display any neurologic abnormalities on the physical examination, but did have abnormalities on the NCSs, suggesting the presence of transthyretin-PN. The abnormalities on the NCSs were more indicative of sensory PN than of motor polyneuropathy. Twenty-four patients (40.0%) did not display any clinical or NCS abnormalities. Based on the systematic neurologic assessment, 36 patients in our study were identified as having a mixed hATTR phenotype, and they are to receive specific disease-modifying therapies, either patisiran or inotersen.
Conclusion
Patients with hATTR-CM should be systematically referred to a specialized neurologist for routine assessment, especially patients who report neurologic symptoms (ie, numbness and burning sensation in extremities).
{"title":"Detecting Polyneuropathy in Patients with Hereditary Transthyretin Amyloid Cardiomyopathy","authors":"Priya Arivalagan MSc , Rodrigo Carrasco Loza MD, PhD , Natalia Nugaeva MSc, PhD , Hans Katzberg MD, MSc , Jamsheed Desai MD , Vincenzo Santo Basile MD , Vera Bril MD , Diego Delgado MD, MSc","doi":"10.1016/j.cjco.2025.09.015","DOIUrl":"10.1016/j.cjco.2025.09.015","url":null,"abstract":"<div><h3>Background</h3><div>Patients with hereditary transthyretin amyloid cardiomyopathy (hATTR-CM), can show neurologic signs that lead to the eventual onset of polyneuropathy (PN). Detection of PN among patients with hATTR-CM can identify candidates for disease-modifying therapies that could significantly reduce the incidence of mortality and morbidity for these complex patients. The purpose of this study is to determine the prevalence of PN among patients with hATTR-CM.</div></div><div><h3>Methods</h3><div>Sixty patients with hATTR-CM were enrolled in this prospective study, from the Amyloidosis Clinic at the University Health Network in Toronto, Ontario, Canada. All patients (average age: 69.12 ± 11.82 years; 51.7% male; 48.3% female) were referred to neurology programs specialized in hATTR PN. Comprehensive neurologic assessments were conducted, including a physical examination and nerve conduction studies (NCSs). NCSs were performed on the upper and lower extremities.</div></div><div><h3>Results</h3><div>Thirty patients (50.0%) displayed clinical and NCS abnormalities. Six patients (10.0%) did not display any neurologic abnormalities on the physical examination, but did have abnormalities on the NCSs, suggesting the presence of transthyretin-PN. The abnormalities on the NCSs were more indicative of sensory PN than of motor polyneuropathy. Twenty-four patients (40.0%) did not display any clinical or NCS abnormalities. Based on the systematic neurologic assessment, 36 patients in our study were identified as having a mixed hATTR phenotype, and they are to receive specific disease-modifying therapies, either patisiran or inotersen.</div></div><div><h3>Conclusion</h3><div>Patients with hATTR-CM should be systematically referred to a specialized neurologist for routine assessment, especially patients who report neurologic symptoms (ie, numbness and burning sensation in extremities).</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 9-15"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963119","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 : 2026-01-01Epub Date: 2025-09-23DOI: 10.1016/j.cjco.2025.09.009
Thibaut Moulin MD, MSc , Nicolas Lellouche MD, PhD , Estelle Gandjbakhch MD, PhD , Mikael Laredo MD, PhD
Background
Electrocardiogram (ECG) interpretation is a critical skill for medical students that requires regular practice to achieve competency. Microlearning is an emerging pedagogical trend that offers students repetitive, short, and focused e-learning sessions. This study aimed to assess the feasibility of a 6-week, daily, digital ECG training program based on microlearning principles among undergraduate medical students.
Methods
We conducted a bicentric noncontrolled pilot study. Volunteer medical students received a daily (from Monday to Friday) ECG quiz via commonly used digital platforms, followed by immediate feedback, for 6 weeks. The primary endpoint was the daily participation rate. Skill improvement was evaluated through a baseline test and a final test (20 questions, score ranging from 0-20). Student satisfaction and self-assessment of progression were measured.
Results
A total of 47 students were included. The median daily participation rate was high, at 80.9% (iinterquartile range 73.9-86.2), but it tended to decrease over time (weeks 1-2, 87.2%; weeks 3-4, 81.2%; weeks 5-6, 70.2%). A comparison of baseline and final test scores showed a significant improvement, of 1.1 points (95% confidence interval 0.15-2.1; P = 0.03), after the program. No significant correlation was found between individual participation rate and score improvement. Overall, 93% of students subjectively perceived progression, and 93% were satisfied with the training program.
Conclusions
Daily quiz-based microlearning is a feasible method to support ECG training, with high initial adherence. Future controlled studies are required to evaluate the impact of integrating this approach with traditional teaching methods and assess its long-term efficacy and sustainability.
{"title":"Daily Quiz-Based Microlearning Program to Support Electrocardiogram Interpretation Training for Medical Students: A Feasibility Study","authors":"Thibaut Moulin MD, MSc , Nicolas Lellouche MD, PhD , Estelle Gandjbakhch MD, PhD , Mikael Laredo MD, PhD","doi":"10.1016/j.cjco.2025.09.009","DOIUrl":"10.1016/j.cjco.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Electrocardiogram (ECG) interpretation is a critical skill for medical students that requires regular practice to achieve competency. Microlearning is an emerging pedagogical trend that offers students repetitive, short, and focused e-learning sessions. This study aimed to assess the feasibility of a 6-week, daily, digital ECG training program based on microlearning principles among undergraduate medical students.</div></div><div><h3>Methods</h3><div>We conducted a bicentric noncontrolled pilot study. Volunteer medical students received a daily (from Monday to Friday) ECG quiz via commonly used digital platforms, followed by immediate feedback, for 6 weeks. The primary endpoint was the daily participation rate. Skill improvement was evaluated through a baseline test and a final test (20 questions, score ranging from 0-20). Student satisfaction and self-assessment of progression were measured.</div></div><div><h3>Results</h3><div>A total of 47 students were included. The median daily participation rate was high, at 80.9% (iinterquartile range 73.9-86.2), but it tended to decrease over time (weeks 1-2, 87.2%; weeks 3-4, 81.2%; weeks 5-6, 70.2%). A comparison of baseline and final test scores showed a significant improvement, of 1.1 points (95% confidence interval 0.15-2.1; <em>P</em> = 0.03), after the program. No significant correlation was found between individual participation rate and score improvement. Overall, 93% of students subjectively perceived progression, and 93% were satisfied with the training program.</div></div><div><h3>Conclusions</h3><div>Daily quiz-based microlearning is a feasible method to support ECG training, with high initial adherence. Future controlled studies are required to evaluate the impact of integrating this approach with traditional teaching methods and assess its long-term efficacy and sustainability.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 43-50"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963103","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}
Early identification of coronary artery disease (CAD) in patients newly diagnosed with heart failure (HF) has prognostic and therapeutic implications. We evaluated frequency and predictors of CAD testing in Alberta between April 1, 2004 and March 31, 2023.
Methods
Population-level retrospective cohort study using linked administrative health datasets and previously validated case definitions.
Results
Of 166,447 adults with newly diagnosed HF, 64.2% first presented in the outpatient setting. Within the first month of diagnosis, patients were most likely to be seen by a primary care physician only (PCP, 41.8%); co-management with PCP and a specialist was the second most common management strategy (31.6%). Within 6-months of diagnosis, 46,143 (27.7%) patients had at least one diagnostic evaluation for CAD; coronary catheterization was more common in patients diagnosed in hospital while non-invasive imaging was more common in non-hospitalized patients. Testing was strongly associated with specialist involvement: 54.4% if co-managed with PCP [aOR 5.19, 95% confidence interval 4.96-5.43], 39.6% if saw specialist alone [aOR 2.86, 2.75- 2.97], and 13.8% if managed by PCP alone [referent]). Although frequency of echocardiography and CAD non-invasive imaging rose sharply in 2017, the majority of patients with new HF in all years were not tested for CAD.
Conclusion
Despite its prognostic importance, CAD testing is performed in a minority of patients with newly diagnosed heart failure and is heavily influenced by specialist involvement. Optimizing CAD testing patterns for all patients newly diagnosed with HF should be a priority for clinicians and policy makers.
{"title":"Testing for Coronary Artery Disease in Patients Newly Diagnosed with Heart Failure in Alberta, Canada","authors":"Amlish Munir MD, MSc , Luan Manh Chu PhD , Padma Kaul PhD , Justin Ezekowitz MB, BCh, MSc , Finlay A. McAlister MD, MSc","doi":"10.1016/j.cjco.2025.09.008","DOIUrl":"10.1016/j.cjco.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Early identification of coronary artery disease (CAD) in patients newly diagnosed with heart failure (HF) has prognostic and therapeutic implications. We evaluated frequency and predictors of CAD testing in Alberta between April 1, 2004 and March 31, 2023.</div></div><div><h3>Methods</h3><div>Population-level retrospective cohort study using linked administrative health datasets and previously validated case definitions.</div></div><div><h3>Results</h3><div>Of 166,447 adults with newly diagnosed HF, 64.2% first presented in the outpatient setting. Within the first month of diagnosis, patients were most likely to be seen by a primary care physician only (PCP, 41.8%); co-management with PCP and a specialist was the second most common management strategy (31.6%). Within 6-months of diagnosis, 46,143 (27.7%) patients had at least one diagnostic evaluation for CAD; coronary catheterization was more common in patients diagnosed in hospital while non-invasive imaging was more common in non-hospitalized patients. Testing was strongly associated with specialist involvement: 54.4% if co-managed with PCP [aOR 5.19, 95% confidence interval 4.96-5.43], 39.6% if saw specialist alone [aOR 2.86, 2.75- 2.97], and 13.8% if managed by PCP alone [referent]). Although frequency of echocardiography and CAD non-invasive imaging rose sharply in 2017, the majority of patients with new HF in all years were not tested for CAD.</div></div><div><h3>Conclusion</h3><div>Despite its prognostic importance, CAD testing is performed in a minority of patients with newly diagnosed heart failure and is heavily influenced by specialist involvement. Optimizing CAD testing patterns for all patients newly diagnosed with HF should be a priority for clinicians and policy makers.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 1-8"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963118","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 : 2026-01-01Epub Date: 2025-09-20DOI: 10.1016/j.cjco.2025.09.007
Katherine L. Mason BSc , Katherine S. Allan PhD , June Carroll MD , Arnon Adler MD , Julie Rutberg MSc, CGC , Sheldon Cheskes MD , Steve Lin MSc, MDCM , Erik K. Mont MD , Joel A. Kirsh MSc, MD, MHCM, LLM , Lindsay J. Denis BScN, RN , Kris Cunningham MD, PhD , Jodi Garner MSc , Liz Siydock MEd, MACP , Katie N. Dainty PhD , Matthew Bowes MD , Karolyn Yee RN , Paul Dorian MSc, MD , Krystina B. Lewis RN, MN, PhD
Background
Sudden cardiac death (SCD) is a leading global cause of mortality and is often attributable to heritable cardiac conditions in the young (aged 2-45 years). Death investigators are responsible for determining the cause of death and communicating the risk of heritable conditions with the families of victims. Families often struggle to comprehend this information. This study explores how death investigators communicate with families of young SCD victims who die from suspected heritable causes about the cause of death and their risk for SCD.
Methods
We conducted an explanatory sequential mixed-methods study, collecting quantitative data, via a web-based survey, and qualitative data, via telephone interviews, to investigate how death investigators in Ontario and Nova Scotia, Canada, communicate with family members of SCD victims. We used descriptive statistics to analyze quantitative data, and thematic analysis to analyze qualitative data. We triangulated the data at multiple levels.
Results
Between October 2022 and July 2023, we surveyed 78 death investigators and interviewed a subset of these (n = 20). Participants (40%; n = 31) reported that SCDs due to heritable cardiac conditions were more difficult to investigate, requiring a higher frequency of communication with families. Participants (96.1%; n = 75) reported contacting family members via phone. Strategies to achieve their communication goals were influenced by family characteristics; involvement of other professionals; characteristics of the investigation, access to resources, and system-level barriers.
Conclusions
SCD investigations in the young who die due to suspected heritable cardiac conditions are challenging and require a high frequency of communication. Further research should examine how systematic changes can improve communication among death investigators and families.
{"title":"“I Am a Quarterback”: A Mixed-Methods Study of Death Investigators’ Communication with Family Members of Young Sudden Cardiac Death Victims","authors":"Katherine L. Mason BSc , Katherine S. Allan PhD , June Carroll MD , Arnon Adler MD , Julie Rutberg MSc, CGC , Sheldon Cheskes MD , Steve Lin MSc, MDCM , Erik K. Mont MD , Joel A. Kirsh MSc, MD, MHCM, LLM , Lindsay J. Denis BScN, RN , Kris Cunningham MD, PhD , Jodi Garner MSc , Liz Siydock MEd, MACP , Katie N. Dainty PhD , Matthew Bowes MD , Karolyn Yee RN , Paul Dorian MSc, MD , Krystina B. Lewis RN, MN, PhD","doi":"10.1016/j.cjco.2025.09.007","DOIUrl":"10.1016/j.cjco.2025.09.007","url":null,"abstract":"<div><h3>Background</h3><div>Sudden cardiac death (SCD) is a leading global cause of mortality and is often attributable to heritable cardiac conditions in the young (aged 2-45 years). Death investigators are responsible for determining the cause of death and communicating the risk of heritable conditions with the families of victims. Families often struggle to comprehend this information. This study explores how death investigators communicate with families of young SCD victims who die from suspected heritable causes about the cause of death and their risk for SCD.</div></div><div><h3>Methods</h3><div>We conducted an explanatory sequential mixed-methods study, collecting quantitative data, via a web-based survey, and qualitative data, via telephone interviews, to investigate how death investigators in Ontario and Nova Scotia, Canada, communicate with family members of SCD victims. We used descriptive statistics to analyze quantitative data, and thematic analysis to analyze qualitative data. We triangulated the data at multiple levels.</div></div><div><h3>Results</h3><div>Between October 2022 and July 2023, we surveyed 78 death investigators and interviewed a subset of these (n = 20). Participants (40%; n = 31) reported that SCDs due to heritable cardiac conditions were more difficult to investigate, requiring a higher frequency of communication with families. Participants (96.1%; n = 75) reported contacting family members via phone. Strategies to achieve their communication goals were influenced by family characteristics; involvement of other professionals; characteristics of the investigation, access to resources, and system-level barriers.</div></div><div><h3>Conclusions</h3><div>SCD investigations in the young who die due to suspected heritable cardiac conditions are challenging and require a high frequency of communication. Further research should examine how systematic changes can improve communication among death investigators and families.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 35-42"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963102","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 : 2026-01-01Epub Date: 2025-09-29DOI: 10.1016/j.cjco.2025.09.011
Valdano Manuel MD, PhD , Ana Olga Mocumbi MD, PhD , Liesl Zühlke MD, PhD
Rheumatic heart disease (RHD) remains a major cause of preventable morbidity and premature death, affecting over 40 million people worldwide and causing more than 300,000 deaths annually, predominantly in low- and middle-income countries. Children and adolescents bear a substantial burden, with 1-year mortality rates up to 17%, primarily from heart failure, especially among those with poor adherence to benzathine penicillin prophylaxis. RHD is entirely preventable through timely diagnosis and secondary prophylaxis, yet access to prevention, medical therapy, and surgical care remains inconsistent. Girls and women face delayed diagnosis, high maternal mortality, and inequitable access to gender-sensitive care. Fewer than 10 African countries have implemented national or pilot RHD programs, and despite the 2018 World Health Assembly Resolution 71.14, progress remains slow. Sustainable, African-led programs integrated into national healthcare systems are urgently needed to reduce RHD-related mortality and achieve its long-term elimination.
{"title":"Rheumatic Heart Disease: Global Failure in Tackling a Common Killer","authors":"Valdano Manuel MD, PhD , Ana Olga Mocumbi MD, PhD , Liesl Zühlke MD, PhD","doi":"10.1016/j.cjco.2025.09.011","DOIUrl":"10.1016/j.cjco.2025.09.011","url":null,"abstract":"<div><div>Rheumatic heart disease (RHD) remains a major cause of preventable morbidity and premature death, affecting over 40 million people worldwide and causing more than 300,000 deaths annually, predominantly in low- and middle-income countries. Children and adolescents bear a substantial burden, with 1-year mortality rates up to 17%, primarily from heart failure, especially among those with poor adherence to benzathine penicillin prophylaxis. RHD is entirely preventable through timely diagnosis and secondary prophylaxis, yet access to prevention, medical therapy, and surgical care remains inconsistent. Girls and women face delayed diagnosis, high maternal mortality, and inequitable access to gender-sensitive care. Fewer than 10 African countries have implemented national or pilot RHD programs, and despite the 2018 World Health Assembly Resolution 71.14, progress remains slow. Sustainable, African-led programs integrated into national healthcare systems are urgently needed to reduce RHD-related mortality and achieve its long-term elimination.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 1","pages":"Pages 59-64"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145963106","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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