CJC Open最新文献

{"title":"An Optimized Assessment Pathway for Remote Patients: The Vancouver Facilitated Transcatheter Aortic Valve Implantation Program","authors":"","doi":"10.1016/j.cjco.2024.07.001","DOIUrl":"10.1016/j.cjco.2024.07.001","url":null,"abstract":"<div><h3>Background</h3><div>Novel pathways are needed to accommodate the increasing demand for transcatheter aortic valve implantation (TAVI) and ensure equitable access. A single Vancouver Facilitated TAVI program (VFTP) based at St. Paul's and Vancouver General Hospitals was established to streamline the assessment of remote patients with severe aortic stenosis using virtual technologies.</div></div><div><h3>Methods</h3><div>Remote patients with severe aortic stenosis who expressed difficulties traveling to complete their pre-TAVI workup were included and received prospective follow-up. Clinical and echocardiographic parameters were reported per the Valve Academic Research Consortium 3.</div></div><div><h3>Results</h3><div>Between December 2020 and March 2023, a total of 56 remote patients were included in the VFTP. The mean patient age was 79.7 ± 9.1 years. A total of 55 patients (98%) passed the screening for candidacy; 45 patients (80%) were found suitable for transfemoral TAVI, 5 patients (9%) were directed toward surgical aortic valve replacement; 3 (5%) underwent alternative-access TAVI; and 2 patients (4%) were assigned to a watchful waiting strategy. No inpatient mortality, stroke, or major bleeding occurred in the transfemoral TAVI group, and the median hospital stay was 1 day (interquartile range, 1-2 days; range, 1-24 days). Two patients had an access-closure failure requiring surgical intervention; 1 patient had tamponade; and 4 patients had complete heart block requiring permanent pacemaker implantation. No hospital readmission had occurred at 30 days.</div></div><div><h3>Conclusions</h3><div>A simplified assessment pathway to assess TAVI candidacy using virtual technologies is safe and feasible. The VFTP potentially can increase access to TAVI and reduce inequity in TAVI care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Arterial Disease in Nova Scotia: Increased Prevalence, Low Public Awareness, and Poor Edinburgh Claudication Questionnaire Sensitivity","authors":"","doi":"10.1016/j.cjco.2024.07.003","DOIUrl":"10.1016/j.cjco.2024.07.003","url":null,"abstract":"<div><h3>Background</h3><div>This study had the following 3 goals: (i) to assess the prevalence of peripheral arterial disease (PAD) in a Nova Scotian population; (ii) to evaluate the validity of the Edinburgh Claudication Questionnaire (ECQ) in a Nova Scotian context; and (iii) to evaluate Nova Scotian public knowledge about PAD.</div></div><div><h3>Methods</h3><div>Participants were recruited from 8 sites across Nova Scotia. In 2022, they were recruited at Heartland Tour (HLT) sites—a provincial health-promotion campaign. In 2023, they were recruited in communities coinciding with HLT sites (public [PUB]). Participants completed a demographics questionnaire, ECQ, and had an ankle–brachial index (ABI) measurement. An ABI of &lt; 0.9 was considered positive for presence of PAD.</div></div><div><h3>Results</h3><div>A total of 417 participants were recruited, 263 from HLT, and 154 from PUB. A total of 398 participants had ABI scores resulting in a PAD prevalence of 2.81% (249 participants) in the HLT group, and 5.37% (149 participants) in the PUB group. A total of 394 participants had both ABI and ECQ scores, with a found sensitivity of 6.67% (confidence interval 0.17%-31.95%) and specificity of 97.63% (confidence interval 95.54%-98.91%). A total of 75% of participants (311 of 417) did not have prior knowledge of PAD.</div></div><div><h3>Conclusions</h3><div>The PAD prevalences in both cohorts were higher than anticipated, with the PUB cohort being more than double the national average. This finding raises the following question: should specific PAD primary and/or secondary prevention strategies be targeted within the province? Our study demonstrated that a public-awareness campaign would be highly impactful, owing to a low level of awareness of PAD within both cohorts, and that the ECQ was not an effective screening tool when used on the Nova Scotian population.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141704762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Prehospital Digital Electrocardiogram Transmission on Revascularization Delays and Mortality in ST-Elevation Myocardial Infarction Patients: Systematic Review and Meta-Analysis","authors":"","doi":"10.1016/j.cjco.2024.06.012","DOIUrl":"10.1016/j.cjco.2024.06.012","url":null,"abstract":"<div><h3>Background</h3><div>Prehospital transmission of the 12-lead electrocardiogram (ECG) to the interventional cardiologist has become the standard of care in many ST-elevation myocardial infarction (STEMI) networks but has not been adopted universally. In this systematic review and meta-analysis, we assess the effect of prehospital digital ECG transmission in STEMI patients on door-to-device times, first medical contact-to-device times, and mortality.</div></div><div><h3>Methods</h3><div>We performed a systematic review of all English-language studies in MEDLINE, Embase, and CENTRAL (from inception to July 24, 2023), comparing the effect of prehospital digital ECG transmission to that of no ECG transmission in STEMI patients. We performed a random-effects meta-analysis.</div></div><div><h3>Results</h3><div>We included 17 observational studies totalling 4306 patients. Door-to-device times were reduced by 33.3 minutes in patients with prehospital digital ECG transmission (95% confidence intervals [CIs] -50.5, -16.2 minutes; <em>P</em> &lt; 0.001; I² 99%). First-medical-contact-to-device time also was reduced with prehospital digital ECG transmission (mean difference, -24.7 minutes; 95% CI -37.1, -12.3 minutes; <em>P</em> &lt; 0.001; I² 96%). Prehospital digital ECG transmissions was associated with a 47% reduction in mortality compared to no prehospital digital ECG transmission (117 of 1322 (8.9%) vs 181 of 1322 (13.7%), odds ratio 0.53, 95% CI 0.40, 0.69; <em>P</em> &lt; 0.001; I² = 0%).</div></div><div><h3>Conclusions</h3><div>Prehospital ECG transmission in STEMI patients, coupled with a systems of care reduced door-to-device times, first-medical-contact-to-device times, and mortality. STEMI networks should consider these findings to advocate for prehospital ECG transmission within their systems of care.</div></div><div><h3>Study Registration</h3><div>CRD42024509271 (PROSPERO).</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Era in High-Risk Tricuspid Valve Reoperation","authors":"","doi":"10.1016/j.cjco.2024.06.011","DOIUrl":"10.1016/j.cjco.2024.06.011","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergent Alcohol Septal Ablation for Left Ventricular Tract Obstruction in 2 Patients","authors":"","doi":"10.1016/j.cjco.2024.06.008","DOIUrl":"10.1016/j.cjco.2024.06.008","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional Disparities in Atrial Fibrillation Management: An IMPACT-AF Substudy","authors":"","doi":"10.1016/j.cjco.2024.06.010","DOIUrl":"10.1016/j.cjco.2024.06.010","url":null,"abstract":"<div><h3>Background</h3><div>In rural regions, atrial fibrillation (AF) management is performed predominately by local primary care professionals (PCPs). Prior work has suggested that a disparity in outcomes in AF occurs for those patients living in a rural, vs urban, location.</div></div><div><h3>Methods</h3><div>This post hoc analysis of the cluster randomized trial Integrated Management Program Advancing Community Treatment of Atrial Fibrillation (IMPACT-AF) compared a clinical decision support system to standard of care. Patients were classified as living in a rural (population &lt; 10,000) or urban location. The outcomes were as follows: AF-related emergency department (ED) visits, unplanned cardiovascular (CV) hospitalizations, AF-related referrals and guideline adherence for AF treatment.</div></div><div><h3>Results</h3><div>A total of 1133 patients were enrolled from 2016 to 2018; 54.1% (n = 613) were classified as living in a rural location. No differences were present in age (mean, 72 ± 9.63 vs 72.5 ± 10.42 years) or <strong>C</strong>ongestive Heart Failure, <strong>H</strong>ypertension, <strong>A</strong>ge, <strong>D</strong>iabetes, <strong>S</strong>troke/Transient Ischemic Attack (CHADS₂) score (mean, 2.1 ± 1.36 vs 2.16 ± 1.34). Referral rates to general internists were higher in the rural population (13.4% vs 3.9%, <em>P</em> &lt; 0.001), whereas the rate of cardiology referrals was higher in the urban population (10% vs 15%, <em>P</em> = 0.0098). At 12 months, no difference in the composite outcome of AF-related ED visits and CV hospitalizations was seen. Fewer recurrent AF-related ED visits and CV hospitalizations occurred in the urban group (incidence rate ratio [IRR], 0.65 [95% confidence interval (0.44, 0.95), <em>P</em> = 0.0262). The incidence of guideline adherence was similar between the rural (IRR, 3.7 ± 1.2) and urban (IRR, 3.6 ± 1.2; <em>P</em> = 0.11) groups.</div></div><div><h3>Conclusions</h3><div>AF patients living in rural locations had higher rates of recurrent AF-related ED visits and unplanned CV hospitalizations. Further research to optimize AF-related outcomes is needed to ensure equitable delivery of care to all Canadians, irrespective of geography.</div></div><div><h3>Clinical Trial Registration</h3><div><span><span>NCT01927367</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141690133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention and Management of Cardiovascular Disease in Primary Care: A Comment on the PEER Simplified Lipid Guideline","authors":"","doi":"10.1016/j.cjco.2024.06.006","DOIUrl":"10.1016/j.cjco.2024.06.006","url":null,"abstract":"<div><h3>Background</h3><div>In Canada, 2 guidelines provide guidance for the management of dyslipidemia. The Patients, Experience, Evidence, Research simplified lipid guidelines, intended for primary care practitioners, and the Canadian Cardiovascular Society guidelines, intended for all practitioners, are based on differing methodologies with distinct priorities and preferences. The disparate approaches may contribute to confusion among family practitioners and their co-managed patients, with the potential for compromised care, differing standards for training in the fundamentals of lipidology, and differing criteria that might be used in practice audits to evaluate quality of care.</div></div><div><h3>Methods</h3><div>The Patients, Experience, Evidence, Research (PEER) recommendations were considered by primary authors of the Canadian Cardiovascular Society guideline to identify areas of concordance, discordance, or agreement with qualifications.</div></div><div><h3>Results</h3><div>Discordance between the guidelines is greatest with respect to interpretation of the cholesterol profile, the implications of elevated triglyceride, the utility of apolipoprotein B and non-high-density lipoprotein-cholesterol measurements, the role of nonstatin medications, and the importance of assuring adherence and avoiding undertreatment through follow-up measurement of lipid profiles. The disparate importance attached to identification of patients with enhanced risk due to an elevated lipoprotein (a) level is also apparent.</div></div><div><h3>Conclusions</h3><div>This comparison attempts to reconcile key principles of practice, to foster both high quality of care and fully informed patient-centred decision-making.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Cardiac Testing and Cardiovascular Outcomes for Low-Risk Chest Pain in the Emergency Department: A Systematic Review and Meta-Analysis","authors":"","doi":"10.1016/j.cjco.2024.06.009","DOIUrl":"10.1016/j.cjco.2024.06.009","url":null,"abstract":"<div><h3>Background</h3><div>With the widespread adoption of high-sensitivity troponin testing, recent guidelines no longer recommend urgent noninvasive cardiac testing for suspected cardiac disease in low-risk emergency department (ED) patients. We conducted a meta-analysis to determine whether urgent noninvasive testing, compared to no testing, is associated with improved cardiovascular outcomes in low-risk patients.</div></div><div><h3>Methods</h3><div>We searched databases for studies of adults evaluated in the ED for low-risk acute chest pain based on clinical criteria, diagnostic testing, or risk scores. Outcomes were all-cause death or myocardial infarction (MI), and revascularization alone, at 90 days and 1 year.</div></div><div><h3>Results</h3><div>A total of 1.5 million patients were included from 17 observational and 2 randomized studies. The overall rate of death or MI was 0.3% at 90 days, and 0.4% at 1 year. The odds of death or MI were not significantly different at 90 days (9 studies with 144,447 participants; odds ratio [OR] = 0.92 [0.48-1.76]) or 1 year (13 studies with 146,563 participants; OR = 0.92 [0.63-1.35]) between the tested and nontested groups. The odds of revascularization were significantly higher in tested groups at 90 days (12 studies with 513,862 participants; OR = 2.21 [1.17-4.17]) and 1 year (16 studies with 1,441,693 participants; OR = 2.61 [1.95-3.48]).</div></div><div><h3>Conclusions</h3><div>Noninvasive testing for low-risk chest pain in the ED was not associated with lower odds of death or MI, but it was associated with more than twice the odds of revascularization. This finding supports current guidelines recommending against universal noninvasive testing for ED patients with low-risk chest pain.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Device-Related Thrombus After Left Atrial Appendage Occlusion: TED-F2 Score","authors":"","doi":"10.1016/j.cjco.2024.05.015","DOIUrl":"10.1016/j.cjco.2024.05.015","url":null,"abstract":"<div><h3>Background</h3><div>Left atrial appendage (LAA) occlusion (LAAO) is performed to prevent LAA thrombus in patients with atrial fibrillation (AF). The risk of device-related thrombus (DRT) on the atrial side of the LAAO device is approximately 4%. Identifying patients at high risk of DRT would enable closer surveillance and more-aggressive anticoagulation to prevent post-LAAO DRT-related stroke.</div></div><div><h3>Methods</h3><div>From the LAAO registry at The University of Kansas Medical Center, we identified patients who developed DRT. We chose 3 unmatched controls per DRT case from LAAO recipients without DRT. Predictor variables were obtained from transesophageal echocardiogram reports and/or images, transthoracic echocardiogram reports, and chart review. Implant depth was measured from the limbus of the left atrial ridge to the centre of the atrial aspect of the LAAO device, on a 45° transesophageal echocardiogram view.</div></div><div><h3>Results</h3><div>We identified 26 patients with DRT (aged 77.7 ± 9.7 years; 34.6% female) and selected 78 unmatched controls without DRT. Univariate predictors of DRT, comprising a novel TED-F₂ score, included history of venous <strong>T</strong>hromboembolism (23.1% vs 5.1%, <em>P</em> = 0.01), an LAA <strong>E</strong>mptying velocity ≤ 20 cm/s (45.8% vs 18.9%, <em>P</em> = 0.01), an implant <strong>D</strong>epth &gt; 2 cm (34.6% vs 12.8%, <em>P</em> = 0.02), and presence of A<strong>F</strong> rhythm at time of device implantation (50.0 % vs 11.5%, <em>P</em> = 0.0001). A TED-F₂ score of ≥ 3 was very strongly associated with DRT—odds ratio 12.5 (95% confidence interval, 3.8-41.1, <em>P</em> &lt; 0.0001).</div></div><div><h3>Conclusions</h3><div>We propose a novel risk score to predict development of DRT after LAAO, comprising history of venous <strong>T</strong>hromboembolism, LAA <strong>E</strong>mptying velocity ≤ 20 cm/s, implant <strong>D</strong>epth &gt; 2 cm (1 point each), and an A<strong>F</strong> rhythm at implantation (2 points). A TED-F₂ risk score of ≥ 3 identified patients who are at greatly elevated risk of developing DRT.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141399756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short Survey on Cardiopulmonary Resuscitation and Automated External Defibrillator Training in Rural British Columbia Schools: Preliminary Findings and Hypothesis-Generating Insights","authors":"","doi":"10.1016/j.cjco.2024.07.006","DOIUrl":"10.1016/j.cjco.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><div>British Columbia (BC) faces more than 7000 out-of-hospital cardiac arrests annually, which disproportionately affect rural areas, owing to their slower emergency medical service response and limited specialized care. Despite the known benefits of automated external defibrillator (AED) access and cardiopulmonary resuscitation (CPR) training, their status in rural BC schools is poorly documented.</div></div><div><h3>Methods</h3><div>We used an online survey of principals and vice-principals of rural schools in BC. The survey assessed AED accessibility, prevalence of CPR and AED training, and obstacles to implementing such training. Questions covered school demographics, AED installation, and CPR and/or AED training for staff and students.</div></div><div><h3>Results</h3><div>We recruited 23 elementary schools (kindergarten-grade 7; 46%), 6 middle schools (grades 6-8; 12%), and 21 high schools (grades 8- 12; 42%). A total of 72% (36 of 50) had at least one AED installed; 46% required staff CPR training; and 24% provided student CPR training. Significant gaps in training were noted for elementary and middle school students, compared to the training for high schools (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Disparities in AED and CPR training across rural schools in BC exist, highlighting a need for policy improvements and innovative solutions to enhance first-aid education. Barriers to implementing CPR and AED training included lack of funding, curricular priority, time constraints, and limited resources. Despite a 10.3% response rate, this study reveals significant disparities in AED and CPR training across school levels in rural BC, underscoring the need for targeted policies and educational strategies to enhance emergency preparedness and improve cardiac arrest outcomes in underserved areas.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}