CJC Open最新文献

{"title":"Adverse Drug Events Associated with Optimizing Heart Failure Pharmacotherapy in Older Adults with Frailty: A Qualitative Study","authors":"Mai H. Duong PhD, BScPharm ,&nbsp;Danijela Gnjidic PhD ,&nbsp;Andrew J. McLachlan PhD, BPharm ,&nbsp;Lisa Kouladjian O’Donnell PhD, MPharm ,&nbsp;Ritu Trivedi PhD ,&nbsp;Rebecca Kozor PhD, MD ,&nbsp;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}

{"title":"Continuous Pacing and Recording Technique: A Real-Time Feedback Approach for Left Bundle Branch Pacing","authors":"Jiabo Shen MD ,&nbsp;Longfu Jiang MD ,&nbsp;Hao Wu MD ,&nbsp;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}

{"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 ,&nbsp;May K. Lee MSc ,&nbsp;Rubee Dev MPH, PhD ,&nbsp;Colleen M. Norris BScN, MScN, PhD ,&nbsp;John A. Spertus MD ,&nbsp;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}

{"title":"Takotsubo T Waves---a Diagnostically Useful Electrocardiographic Pattern in 10 Case Presentations","authors":"Everglad Mugutso MBChB, MSc ,&nbsp;Brent M. McGrath MD, MSc, PhD, FACC, FSCAI, FRCPC, DRCPSC","doi":"10.1016/j.cjco.2025.06.010","DOIUrl":"10.1016/j.cjco.2025.06.010","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1198-1200"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061779","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}

{"title":"Complete Heart Block Due to High Vagal Tone in Pregnancy","authors":"Ella Maria Cockburn BCS, MD ,&nbsp;Jessica Yao BBMed, MD ,&nbsp;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}

{"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 ,&nbsp;Denise Kruger II RTR ,&nbsp;Pantea Javaheri MSc ,&nbsp;Todd Wilson PhD ,&nbsp;Winnie Pearson (Patient Partner) ,&nbsp;Wayne Gerber (Patient Partner) ,&nbsp;Loretta Lee (Patient Partner) ,&nbsp;Krystina B. Lewis PhD, RN, CCN(C) ,&nbsp;Michelle M. Graham MD, FRCPC, FCCS ,&nbsp;Stephen B. Wilton MD, MSc ,&nbsp;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 &lt; 65 years; 47% women) and 18 physicians (72% aged &lt; 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}

{"title":"Adiposity and Cardiometabolic Health Among Inuit of Nunavik: A 13-Year Follow-Up Study","authors":"Fannie Lajeunesse-Trempe MD-PhD ,&nbsp;Marie-Eve Piché MD-PhD ,&nbsp;Paul Poirier MD-PhD ,&nbsp;Sarah O’Connor PhD ,&nbsp;André Tchernof PhD ,&nbsp;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/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.</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 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.</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> &lt; 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> &lt; 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}

{"title":"Transcatheter Self-Expanding Valve with a Dual Purpose—Exclusion of a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa and Treatment of Aortic Stenosis","authors":"Antonio Tondo MD ,&nbsp;Alessandro Cafaro MD ,&nbsp;Miriam Albanese MD ,&nbsp;Marco Mussardo MD ,&nbsp;Alessandro Mandurino-Mirizzi MD ,&nbsp;Luca Quarta MD ,&nbsp;Francesco Rizzo MD ,&nbsp;Francesco Germinal RN ,&nbsp;Dionigi Fischetti MD ,&nbsp;Giuseppe Colonna MD","doi":"10.1016/j.cjco.2025.05.019","DOIUrl":"10.1016/j.cjco.2025.05.019","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1266-1270"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061758","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}

{"title":"From Wrist to Precision: Enhanced Atrial Flutter Detection with Modified Smartwatch Single-Lead Electrocardiogram Placement","authors":"Yuval Avidan MD ,&nbsp;Amir Aker MD ,&nbsp;Razi Khoury MD ,&nbsp;Sameha Zahra MD ,&nbsp;Nissan Ben Dov MD ,&nbsp;Jorge E. Schliamser MD ,&nbsp;Asaf Danon MD, MSc","doi":"10.1016/j.cjco.2025.05.015","DOIUrl":"10.1016/j.cjco.2025.05.015","url":null,"abstract":"<div><h3>Background</h3><div>Smartwatches, such as the Apple Watch (AW), are well-established tools for detecting atrial fibrillation (AF). We hypothesize that atrial flutter (AFL) is frequently misdiagnosed using traditional single-lead electrocardiogram configurations and that modified device positioning could substantially improve diagnostic accuracy.</div></div><div><h3>Methods</h3><div>Standard smartwatch lead-I (AW-I) recordings were obtained from 75 patients, including 25 with AFL, 25 with AF, and 25 with sinus rhythm. Additionally, modified lead-II (AW-II) recordings were collected for all AFL cases, resulting in a total of 100 tracings. Twenty blinded physicians from 4 different specialties independently analyzed all recordings.</div></div><div><h3>Results</h3><div>Physicians’ ability to detect AFL using the AW-I lead was poor, with only 11.6% of cases correctly identified (<em>P</em> = 0.362). AFL was most often misdiagnosed as AF (55.6%), undetermined (21%), or sinus rhythm (11.8%). Diagnostic accuracy improved significantly with the AW-II lead, exceeding 80% among electrophysiologists, cardiologists, and primary care physicians (<em>P</em> = 0.001). Variable atrioventricular conduction was associated strongly with correct diagnosis exclusively through the AW-II lead (odds ratio 1.85, 95% confidence interval 1.14-3.0, <em>P</em> = 0.012).</div></div><div><h3>Conclusions</h3><div>The standard lead-I configuration used by smartwatches is prone to misclassifying AF as AFL, particularly in the setting of variable conduction. A simple modification to lead-II positioning significantly enhances diagnostic accuracy. This adjustment may be especially valuable during post–pulmonary vein isolation surveillance and in broader clinical scenarios in which precise rhythm identification can influence therapeutic decision-making.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1149-1156"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060784","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}

{"title":"Patient- and Family-Centered Care Recommendations in Cardiology Guidelines: An AI-Driven Systematic Review","authors":"Sarah A. Beydoun BSc, MSc (candidate) ,&nbsp;Catherine Gagné BSc ,&nbsp;Noah S. Neubarth BSc ,&nbsp;Jean-Pierre Abdallah BSc, MSc ,&nbsp;Jillian Kifell BSc, MSc ,&nbsp;Michael Goldfarb MD, MSc","doi":"10.1016/j.cjco.2025.05.017","DOIUrl":"10.1016/j.cjco.2025.05.017","url":null,"abstract":"<div><h3>Background</h3><div>Patient- and family-centred care (PFCC) is recognized as a critical component of cardiovascular care, but its integration into cardiology society guidelines has not been described. The objective of this study is to review PFCC language use and recommendations within major cardiology society guidelines.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of guidelines and statements from the American College of Cardiology (ACC), the American Heart Association (AHA), the Canadian Cardiovascular Society (CCS), and the European Society of Cardiology (ESC) for the period 2013-2023. PFCC-related key terms were identified using an artificial intelligence–based natural language processing algorithm, and recommendations were categorized into 8 dimensions of PFCC. The inclusion of PFCC recommendations across societies and trends over time were examined.</div></div><div><h3>Results</h3><div>A total of 260 guidelines and statements were analyzed. The most frequent PFCC dimensions overall were Health Transitions (23.5 per 100 pages), Shared Decision-Making (11.1 per 100 pages), and Care Access (9.9 per 100 pages). The least commonly identified dimensions across all journals were Care Coordination (6.5 per 100 pages), Emotional Support (4.0 per 100 pages), and Familial Support (1.0 per 100 pages). The CCS, ACC, and AHA had more recommendations using PFCC key terms than the ESC per 100 pages (17.3, 12.0, 10.3 vs 4.6, respectively, <em>P</em> &lt; 0.01). PFCC language usage increased markedly over the 10-year period for the ACC, AHA, and ESC, but it decreased for the CCS (all <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>PFCC language and recommendations are being included increasingly in cardiology society guidelines. Differences exist in PFCC language use across these societies. Future research is needed to evaluate the impact of these guideline recommendations on clinical practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"7 9","pages":"Pages 1218-1225"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061752","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}