Pub Date : 2025-10-01DOI: 10.1016/j.cjco.2025.07.002
Katherine Kelemen–Dagg RN , Sandra Wong RN , Haley Emmerson RN , Ruth Coulton RN , Ryan Milne BSc , Roja Gauda MSc , Ademola Opapeju RDCS , Douaa Swar RDCS , Aimee Large RDCS , Samantha Kolupanowicz RDCS , Megan Kirkpatrick RDCS , Kaleki Hill RDCS , Kerri-Anne Mullen PhD , Christele Ferry MD , Kednapa Thavorn PhD, MPharm, BPharm , Gary Small MD , Vincent Chan MD, PhD , Donna Justus , Kelsey Oldland , Kate Macdonald BA , David Messika-Zeitoun MD, PhD
Background
There is a critical need to implement new strategies to combat cardiovascular (CV) disease and more specifically valvular heart disease (VHD). We hypothesize that a community-based, outreach, mobile screening program offering convenient screening for VHD using handheld cardiac ultrasound is feasible. and capable of facilitating early diagnosis and referral in a substantial proportion of patients. We aimed to present our experience and results from the first 18 months of implementation of the program.
Methods
We included individuals aged ≥ 65 years with no known CV disease, residing in Ottawa and its surrounding region (within Canada). We took the opportunity to combine CV risk factor assessment with VHD screening. Potential abnormal findings were triaged according to a predefined algorithm, including an automatic referral process.
Results
We screened 1817 participants (aged 75 ± 7 years; 70% female) during 109 clinics held at 57 different locations between May 2023 and October 2024. VHD abnormalities were observed in 125 participants (7%), and nonvalvular echocardiographic abnormalities were observed in 163 participants (9%). Taking advantage of VHD screening, we identified elevated blood pressure, cholesterol level, or hemoglobin A1C level in 505 participants (28%), with 77% of these cases being newly diagnosed/untreated. Participants with VHD were referred to our valve centre; others were advised to contact their primary care provider or a walk-in clinic for appropriate follow-up care.
Conclusions
In this innovative prevention initiative, we demonstrate the feasibility of an outreach mobile screening program, revealing relatively high rates of VHD, nonvalvular abnormalities, and uncontrolled risk factors. These findings highlight the program's potential to substantially enhance population health outcomes.
{"title":"The Ottawa Mobile Screening Program—Concept and First 18 Months of Experience with a Community-Based Outreach Cardiovascular Prevention Program","authors":"Katherine Kelemen–Dagg RN , Sandra Wong RN , Haley Emmerson RN , Ruth Coulton RN , Ryan Milne BSc , Roja Gauda MSc , Ademola Opapeju RDCS , Douaa Swar RDCS , Aimee Large RDCS , Samantha Kolupanowicz RDCS , Megan Kirkpatrick RDCS , Kaleki Hill RDCS , Kerri-Anne Mullen PhD , Christele Ferry MD , Kednapa Thavorn PhD, MPharm, BPharm , Gary Small MD , Vincent Chan MD, PhD , Donna Justus , Kelsey Oldland , Kate Macdonald BA , David Messika-Zeitoun MD, PhD","doi":"10.1016/j.cjco.2025.07.002","DOIUrl":"10.1016/j.cjco.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>There is a critical need to implement new strategies to combat cardiovascular (CV) disease and more specifically valvular heart disease (VHD). We hypothesize that a community-based, outreach, mobile screening program offering convenient screening for VHD using handheld cardiac ultrasound is feasible. and capable of facilitating early diagnosis and referral in a substantial proportion of patients. We aimed to present our experience and results from the first 18 months of implementation of the program.</div></div><div><h3>Methods</h3><div>We included individuals aged ≥ 65 years with no known CV disease, residing in Ottawa and its surrounding region (within Canada). We took the opportunity to combine CV risk factor assessment with VHD screening. Potential abnormal findings were triaged according to a predefined algorithm, including an automatic referral process.</div></div><div><h3>Results</h3><div>We screened 1817 participants (aged 75 ± 7 years; 70% female) during 109 clinics held at 57 different locations between May 2023 and October 2024. VHD abnormalities were observed in 125 participants (7%), and nonvalvular echocardiographic abnormalities were observed in 163 participants (9%). Taking advantage of VHD screening, we identified elevated blood pressure, cholesterol level, or hemoglobin A1C level in 505 participants (28%), with 77% of these cases being newly diagnosed/untreated. Participants with VHD were referred to our valve centre; others were advised to contact their primary care provider or a walk-in clinic for appropriate follow-up care.</div></div><div><h3>Conclusions</h3><div>In this innovative prevention initiative, we demonstrate the feasibility of an outreach mobile screening program, revealing relatively high rates of VHD, nonvalvular abnormalities, and uncontrolled risk factors. These findings highlight the program's potential to substantially enhance population health outcomes.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1366-1374"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334584","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.2025.09.004
Phelopater Sedrak MD , Vera Dounaevskaia MD , G.B. John Mancini MD , Shelley Zieroth MD , Robert S. McKelvie MD, PhD , Wynne Chiu MSN, RN, CCN(C) , David Bewick MD , Anique Ducharme MD, MSc , Samer Mansour MD , Serge Lepage MD , Glen J. Pearson PharmD, FCSHP, FCCS , Robert C. Welsh MD , Jacob A. Udell MD, MPH , Kim A. Connelly MBBS, PhD
Vaccination is a crucial preventative strategy, particularly in individuals with cardiovascular (CV) disease (CVD). People living with CVD are at increased risk of morbidity and mortality from vaccine-preventable infections such as influenza, severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2), respiratory syncytial virus (RSV), varicella zoster virus (VZV), and pneumococcal disease. These infections also have been associated with downstream CV complications, including ischemic events and myocarditis. Randomized controlled trials have demonstrated that influenza vaccination reduces major adverse CV events and all-cause mortality, especially in people with CVD. The same has been observed in registry analyses during the SARS-CoV-2 pandemic. Pooling of data from observational and cohort studies also has shown significant benefit of vaccination against RSV, VZV, and pneumococcal disease in older populations and those with CV comorbidities. Despite recommendations from national public health guidelines and immunization programs, vaccination uptake in patients with CVD remains suboptimal. This low uptake is influenced by lack of vaccine information, access issues, and mistrust in the healthcare system, all summarized in the term “vaccine hesitancy.” Vaccination promotion should focus on addressing these gaps in communication and access barriers at the provider, community, and public health levels. Healthcare providers including cardiologists are reminded, through this review, of the importance of emphasizing vaccination recommendations during clinical encounters. Addressing patient misconceptions and providing patient decision aids strongly improves acceptance rates. Continued efforts at the community and public health levels should address barriers to access and advance surveillance methods to target improved clinical outcomes for groups at risk.
{"title":"Vaccination in Patients with Cardiovascular Disease: A Case-Based Approach and Contemporary Review","authors":"Phelopater Sedrak MD , Vera Dounaevskaia MD , G.B. John Mancini MD , Shelley Zieroth MD , Robert S. McKelvie MD, PhD , Wynne Chiu MSN, RN, CCN(C) , David Bewick MD , Anique Ducharme MD, MSc , Samer Mansour MD , Serge Lepage MD , Glen J. Pearson PharmD, FCSHP, FCCS , Robert C. Welsh MD , Jacob A. Udell MD, MPH , Kim A. Connelly MBBS, PhD","doi":"10.1016/j.cjco.2025.09.004","DOIUrl":"10.1016/j.cjco.2025.09.004","url":null,"abstract":"<div><div>Vaccination is a crucial preventative strategy, particularly in individuals with cardiovascular (CV) disease (CVD). People living with CVD are at increased risk of morbidity and mortality from vaccine-preventable infections such as influenza, severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2), respiratory syncytial virus (RSV), varicella zoster virus (VZV), and pneumococcal disease. These infections also have been associated with downstream CV complications, including ischemic events and myocarditis. Randomized controlled trials have demonstrated that influenza vaccination reduces major adverse CV events and all-cause mortality, especially in people with CVD. The same has been observed in registry analyses during the SARS-CoV-2 pandemic. Pooling of data from observational and cohort studies also has shown significant benefit of vaccination against RSV, VZV, and pneumococcal disease in older populations and those with CV comorbidities. Despite recommendations from national public health guidelines and immunization programs, vaccination uptake in patients with CVD remains suboptimal. This low uptake is influenced by lack of vaccine information, access issues, and mistrust in the healthcare system, all summarized in the term “vaccine hesitancy.” Vaccination promotion should focus on addressing these gaps in communication and access barriers at the provider, community, and public health levels. Healthcare providers including cardiologists are reminded, through this review, of the importance of emphasizing vaccination recommendations during clinical encounters. Addressing patient misconceptions and providing patient decision aids strongly improves acceptance rates. Continued efforts at the community and public health levels should address barriers to access and advance surveillance methods to target improved clinical outcomes for groups at risk.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1375-1388"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334585","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.2025.07.003
Keitaro Akita MD, PhD , Ryota Sato MD, PhD , Atsushi Anzai MD, PhD , Rahul Sakhuja MD, MPP, MSC , Michael A. Fifer MD , Yuichi J. Shimada MD, MPH , Yuichiro Maekawa MD, PhD
Background
Alcohol septal ablation (ASA) is an established intervention for patients with drug-refractory obstructive hypertrophic cardiomyopathy. Whereas some patients require ASA with multiple target septal branches due to a residual pressure gradient, the prognostic effect of multiple-branch ablation remains unclear. Thus, we aimed to investigate the association of multiple-branch ablation with cardiovascular (CV) events after ASA.
Methods
This multicentre trans-Pacific study enrolled patients who underwent ASA at 4 institutions in the US and Japan. Patients were categorized into single- and multiple-branch ablation groups. CV events, defined as a composite of CV death, repeated septal reduction therapy, and heart failure hospitalization, were compared in 2 groups within 1 year after ASA was performed. To address potential confounding, inverse probability of treatment weighting (IPTW) was performed, based on the propensity scores for multiple-branch ablation. Odds ratios (ORs) were examined for CV events before and after the IPTW was performed.
Results
This study enrolled 151 patients who underwent ASA (single-branch, n = 66; multiple-branch, n = 85). The multiple-branch ablation group had higher peak gradients, which became comparable after ASA was performed. CV events were significantly lower in the multiple-branch ablation group, both before the IPTW (OR 0.33, 95% confidence interval [CI] 0.10-0.96, P = 0.049) and after the IPTW (OR 0.27, 95% CI 0.10-0.68, P = 0.01) was performed. The effect of the reduced incidence was primarily due to a decrease in heart failure hospitalization.
Conclusions
This study demonstrated that ASA with multiple target branches may be an effective treatment option for reducing CV events in morphologically and hemodynamically eligible patients with obstructive hypertrophic cardiomyopathy.
背景：酒精室间隔消融术（ASA）是药物难治性梗阻性肥厚性心肌病患者的一种既定干预措施。然而，由于残余压力梯度，一些患者需要多目标间隔分支的ASA，多分支消融的预后影响尚不清楚。因此，我们的目的是研究ASA后多分支消融与心血管事件的关系。方法：这项跨太平洋的多中心研究纳入了在美国和日本的4家机构接受ASA治疗的患者。患者分为单支和多支消融组。心血管事件，定义为心血管死亡、重复间隔缩小治疗和心力衰竭住院的复合，比较两组在ASA后1年内的心血管事件。为了解决潜在的混淆，基于多分支消融的倾向评分，进行了治疗加权逆概率（IPTW）。在IPTW前后检查CV事件的比值比（ORs）。结果本研究纳入151例接受ASA治疗的患者（单支，66例；多支，85例）。多支消融组有更高的峰值梯度，ASA后具有可比性。在IPTW术前（OR 0.33, 95%可信区间[CI] 0.10-0.96, P = 0.049）和IPTW术后（OR 0.27, 95% CI 0.10-0.68, P = 0.01），多支消融组的CV事件均显著降低。降低发病率的影响主要是由于心力衰竭住院治疗的减少。结论：本研究表明，在形态学和血流动力学符合条件的阻塞性肥厚性心肌病患者中，多靶点分支ASA可能是减少心血管事件的有效治疗选择。
{"title":"Multiple-Branch Alcohol Septal Ablation Is Associated with Reduced Cardiovascular Events: Insights from a Trans-Pacific Multicentre Registry","authors":"Keitaro Akita MD, PhD , Ryota Sato MD, PhD , Atsushi Anzai MD, PhD , Rahul Sakhuja MD, MPP, MSC , Michael A. Fifer MD , Yuichi J. Shimada MD, MPH , Yuichiro Maekawa MD, PhD","doi":"10.1016/j.cjco.2025.07.003","DOIUrl":"10.1016/j.cjco.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Alcohol septal ablation (ASA) is an established intervention for patients with drug-refractory obstructive hypertrophic cardiomyopathy. Whereas some patients require ASA with multiple target septal branches due to a residual pressure gradient, the prognostic effect of multiple-branch ablation remains unclear. Thus, we aimed to investigate the association of multiple-branch ablation with cardiovascular (CV) events after ASA.</div></div><div><h3>Methods</h3><div>This multicentre trans-Pacific study enrolled patients who underwent ASA at 4 institutions in the US and Japan. Patients were categorized into single- and multiple-branch ablation groups. CV events, defined as a composite of CV death, repeated septal reduction therapy, and heart failure hospitalization, were compared in 2 groups within 1 year after ASA was performed. To address potential confounding, inverse probability of treatment weighting (IPTW) was performed, based on the propensity scores for multiple-branch ablation. Odds ratios (ORs) were examined for CV events before and after the IPTW was performed.</div></div><div><h3>Results</h3><div>This study enrolled 151 patients who underwent ASA (single-branch, n = 66; multiple-branch, n = 85). The multiple-branch ablation group had higher peak gradients, which became comparable after ASA was performed. CV events were significantly lower in the multiple-branch ablation group, both before the IPTW (OR 0.33, 95% confidence interval [CI] 0.10-0.96, <em>P</em> = 0.049) and after the IPTW (OR 0.27, 95% CI 0.10-0.68, <em>P</em> = 0.01) was performed. The effect of the reduced incidence was primarily due to a decrease in heart failure hospitalization.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that ASA with multiple target branches may be an effective treatment option for reducing CV events in morphologically and hemodynamically eligible patients with obstructive hypertrophic cardiomyopathy.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1324-1331"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335048","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.2025.07.004
Vatsal Singh MBBS , George D. Veenhuyzen MD , Satish R. Raj MD, MSCI
{"title":"Pacemaker Failure to Capture Caused by a Pneumothorax","authors":"Vatsal Singh MBBS , George D. Veenhuyzen MD , Satish R. Raj MD, MSCI","doi":"10.1016/j.cjco.2025.07.004","DOIUrl":"10.1016/j.cjco.2025.07.004","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1354-1356"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145334551","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.2025.06.012
Jocelyn Chai MD , Matthew Cheung MD , Jeffrey Yim MD , Lu Kun Chen MD , Ahmad Didi MD , Shane J.T. Balthazaar PhD, RDCS , Darwin Yeung MD , Daniel Worsley MD , Margot K. Davis MD, MSc
Background
Transthyretin cardiac amyloidosis (ATTR-CM) is an underdiagnosed infiltrative cardiomyopathy. Diagnosis is based on Technetium-99m-pyrophosphate-bone-scintigraphy scans (Tc-99m-PYP) with grades 2 to 3 classified as positive. The clinical significance of grade 1 (classified equivocal by American Society of Nuclear Cardiology) is unclear. We aimed to describe the differences in clinical/imaging characteristics among those with equivocal vs positive Tc-99m-PYP and to describe outcomes of further investigations.
Methods
We performed a retrospective study of patients who underwent Tc-99m-PYP at 2 institutions between January 2017 and November 2022. Baseline demographics, laboratory, and imaging data were collected.
Results
A total of 502 Tc-99m-PYP were performed with single-photon emission computed tomography (SPECT) 3 hours post-tracer injection: 347 (69%) negative, 46 (9%) equivocal, and 109 (22%) positive. In the latter 2 groups, the median age was 78 (interquartile range [IQR]: 72-84) years, and 38 (25%) were female. Average follow-up was 19.7 ± 14.6 months. No patients with equivocal scans were diagnosed with ATTR-CM. Equivocal scans had lower intraventricular septal diameters (11 mm [IQR: 10-11] vs 15 mm [IQR: 12-17]), larger left ventricular end-diastolic dimension (50 mm [IQR: 44-56] vs 43 mm [IQR: 40-50]), and more negative global longitudinal strain (–18.7 [IQR: –22.2 to –18.7] vs –13.8 [IQR: –17.9 to –10.9] %). Only 12 (26%) patients with equivocal scans underwent further imaging or biopsy. Of 2 patients with monoclonal gammopathy, 1 had AL-amyloidosis.
Conclusions
Our patients with equivocal grade 1 scans were not diagnosed with ATTR-CM. They exhibited distinct imaging compared to positive scans. Our findings suggest that ATTR-CM phenotype and equivocal scans may represent early ATTR-CM (ie, false negative) or false positives and should undergo further workup. Further research is needed to determine the significance of equivocal studies.
甲状腺素型心脏淀粉样变性（atr - cm）是一种未确诊的浸润性心肌病。诊断基于锝-99m焦磷酸盐骨显像扫描（Tc-99m-PYP）， 2至3级为阳性。1级的临床意义尚不清楚（美国核心脏病学会的分类是模棱两可的）。我们的目的是描述Tc-99m-PYP不明确与阳性患者临床/影像学特征的差异，并描述进一步研究的结果。方法：我们对2017年1月至2022年11月期间在2家机构接受Tc-99m-PYP治疗的患者进行了回顾性研究。收集基线人口统计学、实验室和影像学数据。结果502例Tc-99m-PYP患者在注射示踪剂3 h后进行单光子发射计算机断层扫描（SPECT），其中347例（69%）阴性，46例（9%）模糊，109例（22%）阳性。后两组患者年龄中位数为78岁（四分位数间距[IQR]: 72-84），女性38例（25%）。平均随访19.7±14.6个月。没有模棱两可的患者被诊断为atr - cm。模棱两可扫描显示室间隔直径较低（11 mm [IQR: 10-11] vs 15 mm [IQR: 12-17]），左心室舒张末期尺寸较大（50 mm [IQR: 44-56] vs 43 mm [IQR: 40-50]），整体纵向应力负（-18.7 [IQR: -22.2至-18.7]vs -13.8 [IQR: -17.9至-10.9]%）。只有12例（26%）扫描结果不明确的患者接受了进一步的成像或活检。2例单克隆γ病患者中，1例有al -淀粉样变性。结论有模棱两可的1级扫描的sour患者未被诊断为atr - cm。与阳性扫描相比，它们表现出明显的成像。我们的研究结果表明，atr - cm表型和模棱两可的扫描可能代表早期atr - cm（即假阴性）或假阳性，应该进行进一步的检查。需要进一步的研究来确定模棱两可研究的意义。
{"title":"Equivocal vs Positive Technetium-99m-Pyrophosphate Scintigraphy for Transthyretin Amyloid Cardiomyopathy: Comparing Outcomes, Demographics, and Imaging","authors":"Jocelyn Chai MD , Matthew Cheung MD , Jeffrey Yim MD , Lu Kun Chen MD , Ahmad Didi MD , Shane J.T. Balthazaar PhD, RDCS , Darwin Yeung MD , Daniel Worsley MD , Margot K. Davis MD, MSc","doi":"10.1016/j.cjco.2025.06.012","DOIUrl":"10.1016/j.cjco.2025.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Transthyretin cardiac amyloidosis (ATTR-CM) is an underdiagnosed infiltrative cardiomyopathy. Diagnosis is based on Technetium-99m-pyrophosphate-bone-scintigraphy scans (Tc-99m-PYP) with grades 2 to 3 classified as positive. The clinical significance of grade 1 (classified equivocal by American Society of Nuclear Cardiology) is unclear. We aimed to describe the differences in clinical/imaging characteristics among those with equivocal vs positive Tc-99m-PYP and to describe outcomes of further investigations.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of patients who underwent Tc-99m-PYP at 2 institutions between January 2017 and November 2022. Baseline demographics, laboratory, and imaging data were collected.</div></div><div><h3>Results</h3><div>A total of 502 Tc-99m-PYP were performed with single-photon emission computed tomography (SPECT) 3 hours post-tracer injection: 347 (69%) negative, 46 (9%) equivocal, and 109 (22%) positive. In the latter 2 groups, the median age was 78 (interquartile range [IQR]: 72-84) years, and 38 (25%) were female. Average follow-up was 19.7 ± 14.6 months. No patients with equivocal scans were diagnosed with ATTR-CM. Equivocal scans had lower intraventricular septal diameters (11 mm [IQR: 10-11] vs 15 mm [IQR: 12-17]), larger left ventricular end-diastolic dimension (50 mm [IQR: 44-56] vs 43 mm [IQR: 40-50]), and more negative global longitudinal strain (–18.7 [IQR: –22.2 to –18.7] vs –13.8 [IQR: –17.9 to –10.9] %). Only 12 (26%) patients with equivocal scans underwent further imaging or biopsy. Of 2 patients with monoclonal gammopathy, 1 had AL-amyloidosis.</div></div><div><h3>Conclusions</h3><div>Our patients with equivocal grade 1 scans were not diagnosed with ATTR-CM. They exhibited distinct imaging compared to positive scans. Our findings suggest that ATTR-CM phenotype and equivocal scans may represent early ATTR-CM (ie, false negative) or false positives and should undergo further workup. Further research is needed to determine the significance of equivocal studies.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 10","pages":"Pages 1282-1289"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145335045","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}
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}
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