Guideline-directed medical therapy (GDMT) for heart failure (HF) is cost-effective and is associated with significant reductions in morbidity and mortality. Yet, GDMT remains under-prescribed. The Canadian Cardiovascular Society’s HF Working Group assessed formulary access to GDMT across Canada to identify differences in reimbursement and review how coverage aligns with evidence-based guidelines.
Methods
An environmental scan was conducted for the period from June 2022 to July 2024 on the formulary coverage of angiotensin receptor–neprilysin inhibitors, beta-blockers, sodium-glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, and sinus node inhibitors in 10 Canadian provinces, 2 territories, and 6 federal programs.
Results
In all provincial and territorial plans, patient eligibility and prior medication use criteria are required for sacubitril-valsartan reimbursement. Sacubitril-valsartan has coverage restrictions based on natriuretic peptides and prescriber qualifications, except in Ontario and Quebec. Carvedilol coverage is not a benefit in Ontario or British Columbia. Bisoprolol and spironolactone have universal coverage. Eplerenone is not listed in British Columbia. Dapagliflozin coverage is a benefit in all plans except Quebec. Ivabradine coverage has patient eligibility and prior medication use criteria in all provinces and territories and prescriber restrictions in certain regions. Two federal plans have universal coverage of GDMT.
Conclusions
Differences in criteria for drug reimbursement create provincial and territorial variation in access to GDMT in Canada. Coverage criteria include prior medication use and prescriber qualifications, which are not supported by evidence-based guidelines. Systemwide changes in the funding of drug reimbursement programs are needed to improve access to GDMT for the more than 750,000 people living with HF in Canada.
{"title":"Prescription Drug Coverage of Guideline-Directed Medical Therapy for People Living with Heart Failure with Reduced Ejection Fraction in Canada","authors":"Simone S. Cowan MD, MSc, BScPhm , Lynette Kosar BSP, MSc (Pharm) , Stephanie Poon MD, MSc , Marc Bains BBA , Jeannine Costigan MScN, NP(Adult) , Anique Ducharme MD, MSc , Mena Gewarges MD , Sharon Groulx BSc , Kendra MacFarlane BSc, MSc , Seema Nagpal BSc Pharm, MSc, PhD , Alexander Singer MB, BCh, BAO , Robert McKelvie MD, PhD","doi":"10.1016/j.cjco.2025.05.018","DOIUrl":"10.1016/j.cjco.2025.05.018","url":null,"abstract":"<div><h3>Background</h3><div>Guideline-directed medical therapy (GDMT) for heart failure (HF) is cost-effective and is associated with significant reductions in morbidity and mortality. Yet, GDMT remains under-prescribed. The Canadian Cardiovascular Society’s HF Working Group assessed formulary access to GDMT across Canada to identify differences in reimbursement and review how coverage aligns with evidence-based guidelines.</div></div><div><h3>Methods</h3><div>An environmental scan was conducted for the period from June 2022 to July 2024 on the formulary coverage of angiotensin receptor–neprilysin inhibitors, beta-blockers, sodium-glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, and sinus node inhibitors in 10 Canadian provinces, 2 territories, and 6 federal programs.</div></div><div><h3>Results</h3><div>In all provincial and territorial plans, patient eligibility and prior medication use criteria are required for sacubitril-valsartan reimbursement. Sacubitril-valsartan has coverage restrictions based on natriuretic peptides and prescriber qualifications, except in Ontario and Quebec. Carvedilol coverage is not a benefit in Ontario or British Columbia. Bisoprolol and spironolactone have universal coverage. Eplerenone is not listed in British Columbia. Dapagliflozin coverage is a benefit in all plans except Quebec. Ivabradine coverage has patient eligibility and prior medication use criteria in all provinces and territories and prescriber restrictions in certain regions. Two federal plans have universal coverage of GDMT.</div></div><div><h3>Conclusions</h3><div>Differences in criteria for drug reimbursement create provincial and territorial variation in access to GDMT in Canada. Coverage criteria include prior medication use and prescriber qualifications, which are not supported by evidence-based guidelines. Systemwide changes in the funding of drug reimbursement programs are needed to improve access to GDMT for the more than 750,000 people living with HF in Canada.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1271-1281"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335044","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}
Information and communication technology (ICT)-supported home-based cardiac rehabilitation (HBCR) has gained prominence because of its potential advantages, including improved patient engagement. However, the long-term effects on patients with heart failure (HF) and physical frailty are unclear. The aim of this study was to determine the effects of HBCR on patients with HF and physical frailty 12 months after the HBCR intervention.
Methods
This single-centre, single-arm intervention trial included 30 outpatients with chronic HF and physical frailty or pre-frailty. Participants received a comprehensive ICT-based HBCR intervention, including disease management, exercise, and nutritional guidance for 3 months, followed by a 12-month period of ICT-supported self-management without professional guidance. The primary outcome was the change in 6-minute walking distance (6MWD).
Results
The 6MWD of the patients significantly improved at 3 months, compared with baseline (395.8 ± 16.2 metres [95% confidence interval (CI): 363.0-428.6] vs 445.1 ± 16.3 metres [95% CI, 412.0-478.2]; P < 0.01), but it decreased at 15 months, compared with 3 months (417.7 ± 16.3 metres [95% CI: 384.6-450.8]; P = 0.04). The frailty score also decreased at the 3-month vs the 15-month timepoint. Patients who continued to exercise at 15 months showed sustained improvement in 6MWD.
Conclusions
At 12 months after the intervention, the initial improvements in exercise tolerance and frailty were not maintained in the overall cohort. The ICT-supported self-management approach used in this study was insufficient to promote sustained behavioural change over the long term.
信息和通信技术（ICT）支持的家庭心脏康复（HBCR）因其潜在优势（包括提高患者参与度）而受到重视。然而，对心力衰竭（HF）和身体虚弱患者的长期影响尚不清楚。本研究的目的是确定HBCR干预12个月后对HF和身体虚弱患者的影响。方法该单中心、单臂干预试验纳入30例慢性心力衰竭伴体弱或体弱前期的门诊患者。参与者接受了全面的基于信息通信技术的HBCR干预，包括3个月的疾病管理、运动和营养指导，随后是12个月的信息通信技术支持的自我管理，没有专业指导。主要终点是6分钟步行距离（6MWD）的变化。结果患者的6MWD在3个月时显著改善，与基线相比(395.8±16.2米[95%可信区间（CI）： 363.0-428.6] vs 445.1±16.3米[95% CI， 412.0-478.2]；P < 0.01)，但与3个月相比，15个月时下降（417.7±16.3米[95% CI: 384.6-450.8]; P = 0.04）。在3个月和15个月的时间点上，虚弱评分也有所下降。在15个月时继续锻炼的患者在6MWD方面表现出持续的改善。结论干预12个月后，整个队列在运动耐量和虚弱方面的最初改善并没有维持。本研究中使用的信息通信技术支持的自我管理方法不足以促进长期持续的行为改变。
{"title":"Long-term Effects of 3-Month Home-Based Cardiac Rehabilitation Using Information and Communication Technology for Heart Failure with Physical Frailty","authors":"Yuta Nagatomi , Tomomi Ide MD, PhD , Takeo Fujino MD, PhD , Takeshi Tohyama MD, PhD , Tae Higuchi , Tomoyuki Nezu , Takuya Nagata MD, PhD , Toru Hashimoto MD, PhD , Shouji Matsushima MD, PhD , Keisuke Shinohara MD, PhD , Tomiko Yokoyama , Masataka Ikeda MD, PhD , Shintaro Kinugawa MD, PhD , Hiroyuki Tsutsui MD, PhD , Kohtaro Abe MD, PhD","doi":"10.1016/j.cjco.2025.07.012","DOIUrl":"10.1016/j.cjco.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Information and communication technology (ICT)-supported home-based cardiac rehabilitation (HBCR) has gained prominence because of its potential advantages, including improved patient engagement. However, the long-term effects on patients with heart failure (HF) and physical frailty are unclear. The aim of this study was to determine the effects of HBCR on patients with HF and physical frailty 12 months after the HBCR intervention.</div></div><div><h3>Methods</h3><div>This single-centre, single-arm intervention trial included 30 outpatients with chronic HF and physical frailty or pre-frailty. Participants received a comprehensive ICT-based HBCR intervention, including disease management, exercise, and nutritional guidance for 3 months, followed by a 12-month period of ICT-supported self-management without professional guidance. The primary outcome was the change in 6-minute walking distance (6MWD).</div></div><div><h3>Results</h3><div>The 6MWD of the patients significantly improved at 3 months, compared with baseline (395.8 ± 16.2 metres [95% confidence interval (CI): 363.0-428.6] vs 445.1 ± 16.3 metres [95% CI, 412.0-478.2]; <em>P</em> < 0.01), but it decreased at 15 months, compared with 3 months (417.7 ± 16.3 metres [95% CI: 384.6-450.8]; <em>P</em> = 0.04). The frailty score also decreased at the 3-month vs the 15-month timepoint. Patients who continued to exercise at 15 months showed sustained improvement in 6MWD.</div></div><div><h3>Conclusions</h3><div>At 12 months after the intervention, the initial improvements in exercise tolerance and frailty were not maintained in the overall cohort. The ICT-supported self-management approach used in this study was insufficient to promote sustained behavioural change over the long term.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1390-1397"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334587","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}
In some patients with left ventricular assist devices (LVADs), unloading of the left ventricle (LV) and medical therapy may lead to improvement in LV systolic function, allowing for LVAD weaning. There are no guideline-directed parameters to help identify candidates for weaning and long-term outcomes remain imperfectly documented. In this study we aimed to assess the clinical and echocardiographic characteristics of weaned patients and evaluate their event-free survival after weaning.
Methods
This investigation was a single-center retrospective study of patients who underwent a second- or third-generation LVAD implantation between 2009 and 2021.
Results
Ninety-eight patients were included. Fourteen patients (14%) with LV recovery underwent LVAD weaning after a median support time of 309 days. Heart failure etiologies in weaned patients included toxic (recreational drugs) (n = 8, 57%), toxic (medication) (n = 2, 14%), ischemic (n = 2, 14%), or idiopathic dilated (n = 2, 14%) cardiomyopathy. In unweaned patients, heart failure was mostly attributed to ischemic (n = 35, 42%) and idiopathic dilated (n = 27, 32%) cardiomyopathy. Three months after implantation, patients who were eventually weaned had a higher LV ejection fraction (LVEF) (35% vs 19%, P = 0.001) and lower left ventricular end-diastolic diameter (LVEDD) (52 vs 60 mm, P = 0.03) than unweaned patients. At last follow-up after weaning, mean LVEF was 44 ± 6% and no death nor heart transplant had occurred.
Conclusions
LVADs can induce LV reverse remodeling leading to myocardial recovery in a significant proportion of patients, especially those with toxic and nonischemic cardiomyopathies. Early reverse remodeling with decreasing LVEDD and improving LVEF at 3 months after implantation may suggest potential candidacy for LVAD weaning. Weaned patients maintain satisfactory LVEF recovery after weaning and have good long-term event-free survival.
背景：在一些使用左心室辅助装置（LVAD）的患者中，左心室（LV）的卸载和药物治疗可能导致左心室收缩功能的改善，从而允许左心室辅助装置脱机。目前还没有指导参数来帮助确定断奶的候选人，长期结果也没有完整的记录。在这项研究中，我们旨在评估断奶患者的临床和超声心动图特征，并评估他们在断奶后的无事件生存。方法本研究是一项单中心回顾性研究，研究对象是2009年至2021年间接受第二代或第三代LVAD植入的患者。结果共纳入98例患者。14例（14%）LVAD恢复患者在中位支持时间为309天后进行了LVAD脱机。断奶患者的心力衰竭病因包括毒性（娱乐性药物）（n = 8, 57%）、毒性（药物）（n = 2, 14%）、缺血性（n = 2, 14%）或特发性扩张型心肌病（n = 2, 14%）。在未断奶的患者中，心力衰竭主要归因于缺血性心肌病（n = 35, 42%）和特发性扩张型心肌病（n = 27, 32%）。植入3个月后，最终断奶的患者左室射血分数（LVEF）较高（35% vs 19%, P = 0.001），左室舒张末期内径（LVEDD）较低（52 vs 60 mm, P = 0.03）。断奶后随访，平均LVEF为44±6%，无死亡和心脏移植发生。结论slvads可诱导相当比例的左室反向重构，使心肌恢复，尤其是中毒性和非缺血性心肌病患者。植入后3个月LVEDD降低和LVEF改善的早期反向重塑可能提示LVAD的潜在断奶候选。断奶患者在断奶后维持满意的LVEF恢复，并具有良好的长期无事件生存。
{"title":"Myocardial Recovery After Left Ventricular Assist Device Weaning in Patients With Predominantly Toxic Cardiomyopathy: A Single-center Experience","authors":"Jean-Simon Lalancette MD , Alexander Beaulieu-Shearer MD , Émile Voisine MD , Maxime Laflamme MD , David Belzile MD , Pierre-Yves Turgeon MD , Kim O’Connor MD , Dimitri Kalavrouziotis MD , Christine Bourgault MD , Joëlle Morin MD , Marie-Christine Blais MD , Marie-Ève Komlosy BSc , Claudine Laliberté BSc , Mathieu Bernier MD , Éric Charbonneau MD , Mario Sénéchal MD","doi":"10.1016/j.cjco.2025.06.022","DOIUrl":"10.1016/j.cjco.2025.06.022","url":null,"abstract":"<div><h3>Background</h3><div>In some patients with left ventricular assist devices (LVADs), unloading of the left ventricle (LV) and medical therapy may lead to improvement in LV systolic function, allowing for LVAD weaning. There are no guideline-directed parameters to help identify candidates for weaning and long-term outcomes remain imperfectly documented. In this study we aimed to assess the clinical and echocardiographic characteristics of weaned patients and evaluate their event-free survival after weaning.</div></div><div><h3>Methods</h3><div>This investigation was a single-center retrospective study of patients who underwent a second- or third-generation LVAD implantation between 2009 and 2021.</div></div><div><h3>Results</h3><div>Ninety-eight patients were included. Fourteen patients (14%) with LV recovery underwent LVAD weaning after a median support time of 309 days. Heart failure etiologies in weaned patients included toxic (recreational drugs) (n = 8, 57%), toxic (medication) (n = 2, 14%), ischemic (n = 2, 14%), or idiopathic dilated (n = 2, 14%) cardiomyopathy. In unweaned patients, heart failure was mostly attributed to ischemic (n = 35, 42%) and idiopathic dilated (n = 27, 32%) cardiomyopathy. Three months after implantation, patients who were eventually weaned had a higher LV ejection fraction (LVEF) (35% vs 19%, <em>P</em> = 0.001) and lower left ventricular end-diastolic diameter (LVEDD) (52 vs 60 mm, <em>P</em> = 0.03) than unweaned patients. At last follow-up after weaning, mean LVEF was 44 ± 6% and no death nor heart transplant had occurred.</div></div><div><h3>Conclusions</h3><div>LVADs can induce LV reverse remodeling leading to myocardial recovery in a significant proportion of patients, especially those with toxic and nonischemic cardiomyopathies. Early reverse remodeling with decreasing LVEDD and improving LVEF at 3 months after implantation may suggest potential candidacy for LVAD weaning. Weaned patients maintain satisfactory LVEF recovery after weaning and have good long-term event-free survival.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1290-1300"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335046","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 : 2025-10-01DOI: 10.1016/j.cjco.2025.06.019
Mai H. Duong PhD, BScPharm , Danijela Gnjidic PhD , Andrew J. McLachlan PhD, BPharm , Lisa Kouladjian O’Donnell PhD, MPharm , Ritu Trivedi PhD , Rebecca Kozor PhD, MD , Sarah N. Hilmer PhD, MD
Background
Adverse drug events (ADEs) from heart failure (HF) pharmacotherapy are common in older people with frailty, but evidence as to how to optimize HF pharmacotherapy is unclear. This qualitative study explores consumer and healthcare professional (HCP) perspectives on ADEs and adverse drug withdrawal effects (ADWEs) related to HF pharmacotherapy to inform key domains of a conceptual model.
Methods
A purposive and snowball sample of participants were contacted directly or recruited across Australia and New Zealand to participate in qualitative semistructured interviews and focus groups. Frailty was explained as a measure of cumulative deficits and consumers (caregivers or individuals aged ≥ 65 years with HF and frailty) and HCPs caring for older patients with HF and frailty were invited according to their self-perception or evaluation of frailty. General inductive analysis identified themes and a hypothesis-generating conceptual model.
Results
Thirty-two participants were recruited (consumers [n = 4), cardiologists and other physicians [n = 9], nurses [n = 8], and pharmacists [n = 11]). Three main themes and 8 subthemes related to individual factors, medications, and access to healthcare services were identified. Consumers stated that they want support to maintain their quality of life but have complex medical issues. Most HCP participants perceived the benefits of HF pharmacotherapy to outweigh the risks of ADEs and are hesitant to deprescribe. Participants wanted improved coordination of multidisciplinary teams and patient access to healthcare services.
Conclusions
Perspectives unique to HF pharmacotherapy in older people with frailty characterize how the interplay of HF treatment, ADEs, and ADWEs contributes to individuals’ well-being. Future research is needed to further develop the conceptual model.
{"title":"Adverse Drug Events Associated with Optimizing Heart Failure Pharmacotherapy in Older Adults with Frailty: A Qualitative Study","authors":"Mai H. Duong PhD, BScPharm , Danijela Gnjidic PhD , Andrew J. McLachlan PhD, BPharm , Lisa Kouladjian O’Donnell PhD, MPharm , Ritu Trivedi PhD , Rebecca Kozor PhD, MD , Sarah N. Hilmer PhD, MD","doi":"10.1016/j.cjco.2025.06.019","DOIUrl":"10.1016/j.cjco.2025.06.019","url":null,"abstract":"<div><h3>Background</h3><div>Adverse drug events (ADEs) from heart failure (HF) pharmacotherapy are common in older people with frailty, but evidence as to how to optimize HF pharmacotherapy is unclear. This qualitative study explores consumer and healthcare professional (HCP) perspectives on ADEs and adverse drug withdrawal effects (ADWEs) related to HF pharmacotherapy to inform key domains of a conceptual model.</div></div><div><h3>Methods</h3><div>A purposive and snowball sample of participants were contacted directly or recruited across Australia and New Zealand to participate in qualitative semistructured interviews and focus groups. Frailty was explained as a measure of cumulative deficits and consumers (caregivers or individuals aged ≥ 65 years with HF and frailty) and HCPs caring for older patients with HF and frailty were invited according to their self-perception or evaluation of frailty. General inductive analysis identified themes and a hypothesis-generating conceptual model.</div></div><div><h3>Results</h3><div>Thirty-two participants were recruited (consumers [n = 4), cardiologists and other physicians [n = 9], nurses [n = 8], and pharmacists [n = 11]). Three main themes and 8 subthemes related to individual factors, medications, and access to healthcare services were identified. Consumers stated that they want support to maintain their quality of life but have complex medical issues. Most HCP participants perceived the benefits of HF pharmacotherapy to outweigh the risks of ADEs and are hesitant to deprescribe. Participants wanted improved coordination of multidisciplinary teams and patient access to healthcare services.</div></div><div><h3>Conclusions</h3><div>Perspectives unique to HF pharmacotherapy in older people with frailty characterize how the interplay of HF treatment, ADEs, and ADWEs contributes to individuals’ well-being. Future research is needed to further develop the conceptual model.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1301-1313"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335047","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}
Left bundle branch pacing demonstrates significant clinical value in both prevention of right ventricular pacing-induced cardiomyopathy and resynchronization therapy following left bundle branch block. The current intermittent recording technique requires repeated interruptions during implantation to test parameters, increasing procedural complexity and time. In recent years, the application of stylet-driven leads and rotatable connectors combined with lumenless leads has enabled a continuous pacing and recording technique. This approach facilitates beat-by-beat monitoring of electrocardiograms and intracardiac electrograms during lead implantation, with real-time electrophysiological feedback provided to assist operators in precisely determining lead positioning and confirming left bundle branch capture. This technological innovation not only enhances procedural precision but also substantially improves operational safety. In addition, the continuous recording technique offers novel perspectives for electrophysiological research, potentially bridging cardiac pacing to advanced electrophysiological therapeutic strategies.
{"title":"Continuous Pacing and Recording Technique: A Real-Time Feedback Approach for Left Bundle Branch Pacing","authors":"Jiabo Shen MD , Longfu Jiang MD , Hao Wu MD , Hengdong Li MD","doi":"10.1016/j.cjco.2025.07.008","DOIUrl":"10.1016/j.cjco.2025.07.008","url":null,"abstract":"<div><div>Left bundle branch pacing demonstrates significant clinical value in both prevention of right ventricular pacing-induced cardiomyopathy and resynchronization therapy following left bundle branch block. The current intermittent recording technique requires repeated interruptions during implantation to test parameters, increasing procedural complexity and time. In recent years, the application of stylet-driven leads and rotatable connectors combined with lumenless leads has enabled a continuous pacing and recording technique. This approach facilitates beat-by-beat monitoring of electrocardiograms and intracardiac electrograms during lead implantation, with real-time electrophysiological feedback provided to assist operators in precisely determining lead positioning and confirming left bundle branch capture. This technological innovation not only enhances procedural precision but also substantially improves operational safety. In addition, the continuous recording technique offers novel perspectives for electrophysiological research, potentially bridging cardiac pacing to advanced electrophysiological therapeutic strategies.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1357-1365"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334552","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 : 2025-10-01DOI: 10.1016/j.cjco.2025.07.001
Ricky D. Turgeon BSc(Pharm), ACPR, PharmD , May K. Lee MSc , Rubee Dev MPH, PhD , Colleen M. Norris BScN, MScN, PhD , John A. Spertus MD , Karin H. Humphries DSc
Background
Guidelines emphasize individualized care in the management of stable coronary artery disease (CAD). We aimed to develop and validate clinical prediction models for major adverse cardiovascular events (MACEs) and health status among patients with stable CAD to support individualized, shared decision-making.
Methods
For model development and internal validation, we used registries of outpatients with obstructive CAD on coronary angiography in British Columbia (2004-2015) and Alberta (2004-2020). Models were externally validated in ISCHEMIA trial participants with obstructive CAD on coronary computed tomography angiography. Outcomes included MACE (death, myocardial infarction, or stroke) within 3 years, angina-free status, and good-to-excellent physical functioning at 1 year, based on the Seattle Angina Questionnaire.
Results
Median age was of study patients was 66-67 years, and 77% were male in both the MACE (n = 34,990) and health status (n = 13,312) model development cohorts. MACEs occurred in 9% (2026 patients) at 3 years. A 14-variable model had a C statistic of 0.68, calibration slope of 0.98, and positive net benefit in decision-curve analysis. At baseline, 41% were angina-free and 21% had good-to-excellent physical functioning, which increased to 64.5% and 72% at 1 year, respectively. C statistics for the angina-free and physical functioning models were 0.67 and 0.78, respectively, and calibration slopes were 0.98-0.99. In external validation, discrimination was modestly reduced and all models slightly underpredicted their respective outcomes, yet the MACE model retained positive net benefit.
Conclusions
The CR-DECIDE models had moderate ability to predict MACEs and health status in patients with stable CAD and warrant further assessment of their impact at the point of care.
{"title":"Development and Validation of the CR-DECIDE Models to Predict Major Adverse Cardiovascular Events and Health Status in Stable Coronary Artery Disease","authors":"Ricky D. Turgeon BSc(Pharm), ACPR, PharmD , May K. Lee MSc , Rubee Dev MPH, PhD , Colleen M. Norris BScN, MScN, PhD , John A. Spertus MD , Karin H. Humphries DSc","doi":"10.1016/j.cjco.2025.07.001","DOIUrl":"10.1016/j.cjco.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines emphasize individualized care in the management of stable coronary artery disease (CAD). We aimed to develop and validate clinical prediction models for major adverse cardiovascular events (MACEs) and health status among patients with stable CAD to support individualized, shared decision-making.</div></div><div><h3>Methods</h3><div>For model development and internal validation, we used registries of outpatients with obstructive CAD on coronary angiography in British Columbia (2004-2015) and Alberta (2004-2020). Models were externally validated in ISCHEMIA trial participants with obstructive CAD on coronary computed tomography angiography. Outcomes included MACE (death, myocardial infarction, or stroke) within 3 years, angina-free status, and good-to-excellent physical functioning at 1 year, based on the Seattle Angina Questionnaire.</div></div><div><h3>Results</h3><div>Median age was of study patients was 66-67 years, and 77% were male in both the MACE (n = 34,990) and health status (n = 13,312) model development cohorts. MACEs occurred in 9% (2026 patients) at 3 years. A 14-variable model had a C statistic of 0.68, calibration slope of 0.98, and positive net benefit in decision-curve analysis. At baseline, 41% were angina-free and 21% had good-to-excellent physical functioning, which increased to 64.5% and 72% at 1 year, respectively. C statistics for the angina-free and physical functioning models were 0.67 and 0.78, respectively, and calibration slopes were 0.98-0.99. In external validation, discrimination was modestly reduced and all models slightly underpredicted their respective outcomes, yet the MACE model retained positive net benefit.</div></div><div><h3>Conclusions</h3><div>The CR-DECIDE models had moderate ability to predict MACEs and health status in patients with stable CAD and warrant further assessment of their impact at the point of care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1398-1406"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334588","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 : 2025-09-01DOI: 10.1016/j.cjco.2025.06.001
Ella Maria Cockburn BCS, MD , Jessica Yao BBMed, MD , Robert Anderson BMedSci (Hons), MBBS (Hons), PhD, FRACP
{"title":"Complete Heart Block Due to High Vagal Tone in Pregnancy","authors":"Ella Maria Cockburn BCS, MD , Jessica Yao BBMed, MD , Robert Anderson BMedSci (Hons), MBBS (Hons), PhD, FRACP","doi":"10.1016/j.cjco.2025.06.001","DOIUrl":"10.1016/j.cjco.2025.06.001","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1263-1265"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061757","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 : 2025-09-01DOI: 10.1016/j.cjco.2025.06.004
Julie Babione MSc , Denise Kruger II RTR , Pantea Javaheri MSc , Todd Wilson PhD , Winnie Pearson (Patient Partner) , Wayne Gerber (Patient Partner) , Loretta Lee (Patient Partner) , Krystina B. Lewis PhD, RN, CCN(C) , Michelle M. Graham MD, FRCPC, FCCS , Stephen B. Wilton MD, MSc , Matthew T. James MD, PhD, FRCPC
Background
Coronary artery disease (CAD) commonly accompanies chronic kidney disease (CKD) and carries unique management considerations for people with CKD. Shared decision-making (SDM) is a collaborative approach in which patients and physicians make decisions together based on a shared understanding of the health condition, treatment options and attributes, patient values and preferences, and risk tolerance. Our objective was to support SDM by creating a decision aid for patients with CKD and physicians addressing invasive vs conservative CAD treatment options, which included personalized risk estimates for treatment option attributes, and identification of patient values and preferences.
Methods
Applying human-centred design, informed by the International Patient Decision Aid Standard and Ottawa Decision Support Framework, we created a personalized shared decision aid. A concurrent mixed-methods study involved patients and physicians evaluating content, features, implementation contexts, and guided design. Survey data analysis used descriptive statistics, and interview transcripts were analyzed using deductive content analysis.
Results
Thirty-two patients (47% aged < 65 years; 47% women) and 18 physicians (72% aged < 50 years; 22% women) evaluated successive decision-aid iterations, providing design and implementation perspectives. Most received decision-aid content positively, and the design was refined over 3 development iterations. Overarching development-informing themes were as follows: (i) facilitating patient-physician interactions and knowledge-sharing to enable SDM; (ii) responding to contextual end-user needs for decision-making; and (iii) supporting flexible workflow use and integration. The decision aid is available at: https://myheartandckd.ca.
Conclusions
Human-centred design processes effectively guided creation of a decision aid for patients with CKD and physicians making shared CAD treatment decisions. Findings will inform future clinical implementation strategies.
{"title":"Human-Centred Design & Development of a Shared Decision Aid for Patients with Chronic Kidney Disease Facing Treatment for Coronary Heart Disease","authors":"Julie Babione MSc , Denise Kruger II RTR , Pantea Javaheri MSc , Todd Wilson PhD , Winnie Pearson (Patient Partner) , Wayne Gerber (Patient Partner) , Loretta Lee (Patient Partner) , Krystina B. Lewis PhD, RN, CCN(C) , Michelle M. Graham MD, FRCPC, FCCS , Stephen B. Wilton MD, MSc , Matthew T. James MD, PhD, FRCPC","doi":"10.1016/j.cjco.2025.06.004","DOIUrl":"10.1016/j.cjco.2025.06.004","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery disease (CAD) commonly accompanies chronic kidney disease (CKD) and carries unique management considerations for people with CKD. Shared decision-making (SDM) is a collaborative approach in which patients and physicians make decisions together based on a shared understanding of the health condition, treatment options and attributes, patient values and preferences, and risk tolerance. Our objective was to support SDM by creating a decision aid for patients with CKD and physicians addressing invasive vs conservative CAD treatment options, which included personalized risk estimates for treatment option attributes, and identification of patient values and preferences.</div></div><div><h3>Methods</h3><div>Applying human-centred design, informed by the International Patient Decision Aid Standard and Ottawa Decision Support Framework, we created a personalized <em>shared</em> decision aid. A concurrent mixed-methods study involved patients and physicians evaluating content, features, implementation contexts, and guided design. Survey data analysis used descriptive statistics, and interview transcripts were analyzed using deductive content analysis.</div></div><div><h3>Results</h3><div>Thirty-two patients (47% aged < 65 years; 47% women) and 18 physicians (72% aged < 50 years; 22% women) evaluated successive decision-aid iterations, providing design and implementation perspectives. Most received decision-aid content positively, and the design was refined over 3 development iterations. Overarching development-informing themes were as follows: (i) facilitating patient-physician interactions and knowledge-sharing to enable SDM; (ii) responding to contextual end-user needs for decision-making; and (iii) supporting flexible workflow use and integration. The decision aid is available at: <span><span>https://myheartandckd.ca</span><svg><path></path></svg></span>.</div></div><div><h3>Conclusions</h3><div>Human-centred design processes effectively guided creation of a decision aid for patients with CKD and physicians making shared CAD treatment decisions. Findings will inform future clinical implementation strategies.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1244-1262"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061756","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 : 2025-09-01DOI: 10.1016/j.cjco.2025.05.016
Fannie Lajeunesse-Trempe MD-PhD , Marie-Eve Piché MD-PhD , Paul Poirier MD-PhD , Sarah O’Connor PhD , André Tchernof PhD , Pierre Ayotte PhD
Background
Obesity (body mass index [BMI] ≥ 30 kg/m2) is a major determinant of cardiometabolic health, yet the clinical impact of weight changes on cardiometabolic health in the Canadian Inuit population remains unclear.
Methods
Data were collected from 302 individuals (107 men and 195 women) who participated in the Qanuippitaa? 2004 and Qanuilirpitaa? 2017 Nunavik Inuit health surveys. Anthropometric indices (weight, BMI, waist circumference, and waist-to-height ratio, percentage of body fat, and fat-freemass), metabolic biomarkers, and hemodynamics were measured. Anthropometric characteristics and cardiometabolic risk factors were compared between 2017 and 2004 using Student paired t tests or the χ2 test, adjusted for medication. The impact of adiposity changes on cardiometabolic risk factors (blood pressure, lipid profile, and glucose homeostasis parameters) was assessed using adjusted multivariate linear regression analysis.
Results
Inuit men and women (mean baseline age: 37.1 and 36.4 years) showed a significant increase in age-standardized percentage of body fat, despite having similar BMI in 2004 and 2017. Inuit women had significant rises in age-standardized waist circumference and waist-to-height ratio (P < 0.05), whereas men’s remained stable. Increased abdominal fat was linked to adverse changes in some lipid (high-density lipoprotein cholesterol [HDL-C], total cholesterol/HDL-C ratio, apolipoprotein B) and glucose homeostasis (Homeostatic Model Assessment of Insulin Resistance) parameters (P < 0.05), but not low-density lipoprotein cholesterol, triglycerides, non-HDL-C, fasting glucose, or blood pressure.
Conclusions
Adiposity phenotypes and cardiometabolic risk factors are evolving among Nunavik Inuit, but increased abdominal fat is not linked to certain lipid parameters, fasting glucose, or blood pressure. Further research is needed to understand ethnicity-specific traits and improve management of weight-related complications.
{"title":"Adiposity and Cardiometabolic Health Among Inuit of Nunavik: A 13-Year Follow-Up Study","authors":"Fannie Lajeunesse-Trempe MD-PhD , Marie-Eve Piché MD-PhD , Paul Poirier MD-PhD , Sarah O’Connor PhD , André Tchernof PhD , Pierre Ayotte PhD","doi":"10.1016/j.cjco.2025.05.016","DOIUrl":"10.1016/j.cjco.2025.05.016","url":null,"abstract":"<div><h3>Background</h3><div>Obesity (body mass index [BMI] ≥ 30 kg/m<sup>2</sup>) is a major determinant of cardiometabolic health, yet the clinical impact of weight changes on cardiometabolic health in the Canadian Inuit population remains unclear.</div></div><div><h3>Methods</h3><div>Data were collected from 302 individuals (107 men and 195 women) who participated in the <em>Qanuippitaa?</em> 2004 and <em>Qanuilirpitaa?</em> 2017 Nunavik Inuit health surveys. Anthropometric indices (weight, BMI, waist circumference, and waist-to-height ratio, percentage of body fat, and fat-freemass), metabolic biomarkers, and hemodynamics were measured. Anthropometric characteristics and cardiometabolic risk factors were compared between 2017 and 2004 using Student paired <em>t</em> tests or the χ<sup>2</sup> test, adjusted for medication. The impact of adiposity changes on cardiometabolic risk factors (blood pressure, lipid profile, and glucose homeostasis parameters) was assessed using adjusted multivariate linear regression analysis.</div></div><div><h3>Results</h3><div>Inuit men and women (mean baseline age: 37.1 and 36.4 years) showed a significant increase in age-standardized percentage of body fat, despite having similar BMI in 2004 and 2017. Inuit women had significant rises in age-standardized waist circumference and waist-to-height ratio (<em>P</em> < 0.05), whereas men’s remained stable. Increased abdominal fat was linked to adverse changes in some lipid (high-density lipoprotein cholesterol [HDL-C], total cholesterol/HDL-C ratio, apolipoprotein B) and glucose homeostasis (Homeostatic Model Assessment of Insulin Resistance) parameters (<em>P</em> < 0.05), but not low-density lipoprotein cholesterol, triglycerides, non-HDL-C, fasting glucose, or blood pressure.</div></div><div><h3>Conclusions</h3><div>Adiposity phenotypes and cardiometabolic risk factors are evolving among Nunavik Inuit, but increased abdominal fat is not linked to certain lipid parameters, fasting glucose, or blood pressure. Further research is needed to understand ethnicity-specific traits and improve management of weight-related complications.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1226-1235"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061753","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号