CJC Open最新文献

{"title":"Evolving Heart Failure Profiles in Quebec from 1998-2021: Insights from the Vision C+ Database","authors":"Shweta Todkar PhD,&nbsp;Emmanuel Marier-Tétrault NP, PhD,&nbsp;Pierre Yves Turgeon MD,&nbsp;Félix Gélinas-Gascon MSc,&nbsp;Gabriel Couture MSc,&nbsp;Philippe Després PhD,&nbsp;Hugo Lortie MD,&nbsp;Lauren Basmadjian MD,&nbsp;Charaf Eddine Ahnadi PhD,&nbsp;Anique Ducharme MD, MSc,&nbsp;Serge Lepage MD,&nbsp;François Tournoux MD, PhD, FESC,&nbsp;Paul Poirier MD, PhD, FRCP, FACC, FAHA, FCCS,&nbsp;Jacinthe Leclerc PhD, RN, FAHA","doi":"10.1016/j.cjco.2026.04.011","DOIUrl":"10.1016/j.cjco.2026.04.011","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) affects over 750,000 Canadians and remains a major cause of hospitalization. Although specialized HF clinics deliver structured multidisciplinary care, population-level data describing patients followed in these settings are limited. Vision C+, established in 1998, provides a comprehensive dataset to evaluate changes in HF characteristics across Quebec.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional analysis of adults followed in Quebec outpatient HF clinics between 1998 and 2021 using the Vision C+ electronic medical record. Baseline data at inscription were analyzed and compared across periods (1998-2009 and 2010-2021). Analyses were descriptive and were based on available data without imputation.</div></div><div><h3>Results</h3><div>Data of 63,755 patients were analyzed (1998-2009: 14,908; 2010-2021: 48,847), with a median age of 77 years (quartile 1-quartile 3: 67-85), and 65% were male. HF with reduced ejection fraction (left ventricular ejection fraction ≤ 40%) remained predominant (70%), while HF with preserved ejection fraction (left ventricular ejection fraction &gt; 40%) was higher in 2010-2021 (31% vs 26%). New York Heart Association functional class III-IV was higher in 1998-2009 (58% vs 39%), as was ischemic etiology (84% vs 56%). Comorbidities were highly prevalent overall, with small between-period differences observed (all <em>P</em> &lt; 0.001). Cardiac resynchronization therapy with defibrillator use was higher in 2010-2021, whereas coronary revascularization was higher in 1998-2009.</div></div><div><h3>Conclusions</h3><div>This first comprehensive description of the Vision C+ dataset shows outpatient HF populations with higher proportions of HF with preserved ejection fraction, substantial multimorbidity, and lower ischemic disease in the later period.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 1027-1035"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699259","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":"Early Detection and Therapy of Asymptomatic Group 1 Pulmonary Hypertension Following Genetic Testing: A Case Involving Familial KCNK3 Variants","authors":"Julia Rodighiero MB, BCh, BAO,&nbsp;Joshua Durbin MD,&nbsp;Lauren Badalato MD,&nbsp;Stephen L. Archer MD, FRS","doi":"10.1016/j.cjco.2026.04.013","DOIUrl":"10.1016/j.cjco.2026.04.013","url":null,"abstract":"","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 1060-1063"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699169","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":"The Selection of Exercise Testing Protocols in Cardiovascular Rehabilitation Centres: A Pan-Canadian Survey","authors":"Jennie Wong MSc,&nbsp;Matheus Hausen PhD, ACSM-CEP,&nbsp;Lindsay A. Lew PhD,&nbsp;Ariany Marques Vieira PhD,&nbsp;John P. Buckley PhD, FBASES, FHEA,&nbsp;Kristi B. Adamo PhD,&nbsp;Jennifer L. Reed PhD, R. Kin","doi":"10.1016/j.cjco.2026.03.010","DOIUrl":"10.1016/j.cjco.2026.03.010","url":null,"abstract":"<div><h3>Background</h3><div>Cardiorespiratory fitness (CRF) is a strong independent predictor of mortality and is routinely assessed in cardiovascular rehabilitation (CR) using exercise tests. Several protocols for measuring CRF are available, but their selection in CR centres and the decision-making processes guiding these choices remain unclear. This study aimed to identify (i) the most frequently used maximal and submaximal exercise testing protocols in Canadian CR centres, and (ii) the number of protocols used, annual testing volumes, decision-makers, and criteria guiding protocol selection.</div></div><div><h3>Methods</h3><div>This observational pan-Canadian survey was distributed electronically to all identified CR centres to capture their exercise testing practices, annual testing volumes, protocol frequency, and decision-making criteria.</div></div><div><h3>Results</h3><div>Of 196 centres identified and contacted, 118 completed the survey. Among these, 87 centres (74%) performed exercise testing: 15% used only maximal tests, 47% used only submaximal tests, and 30% used both. The Bruce treadmill protocol was the most used maximal test (86%), and the 6-minute walk test was the most used submaximal test (77%). Approximately 5,575 maximal and 20,105 submaximal tests were performed annually. Physicians were the primary decision-makers in 54% of centres, followed by exercise physiologists (38%). Common selection criteria included staff clinical judgement, patient-specific factors, and standardized centre procedures.</div></div><div><h3>Conclusions</h3><div>Exercise testing practices in Canadian CR centres vary widely, with submaximal protocols favoured. Although the Bruce and 6-minute walk test protocols dominate current practice, variability in their selection underscores the need for standardized guidelines that account for heterogeneity across centres and patient populations. Future research should explore outcomes associated with different protocols to optimize CRF assessment and exercise prescription.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 1088-1099"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699170","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":"Variability in Adoption of Surgical Ablation of Atrial Fibrillation: An International Survey of Cardiac Surgeons","authors":"Renee Fournier BSc,&nbsp;Richard P. Whitlock MD, PhD,&nbsp;William F. McIntyre MD, PhD,&nbsp;Adam Eqbal MD, MSc,&nbsp;Rachel Eikelboom MD, PhD,&nbsp;Philippe Tremblay MD, MSc,&nbsp;Manuel Castella MD, PhD,&nbsp;Yoan Lamarche MD, MSc,&nbsp;Gianluigi Bisleri MD,&nbsp;Eric Charbonneau MD,&nbsp;Saurabh Gupta MD, MSc,&nbsp;Steven Meyer MD, PhD,&nbsp;Ondrej Szarszoi MD, PhD,&nbsp;Emilie P. Belley-Cote MD, PhD","doi":"10.1016/j.cjco.2026.04.002","DOIUrl":"10.1016/j.cjco.2026.04.002","url":null,"abstract":"<div><h3>Background</h3><div>Surgical ablation of atrial fibrillation (AF) during cardiac surgery is a guideline-recommended procedure with demonstrated effectiveness in restoring sinus rhythm. Nonetheless, rates of utilization are relatively low, a situation that needs to be better understood.</div></div><div><h3>Methods</h3><div>This study used an electronically distributed survey to characterize the use, techniques, and clinical indications for concomitant AF ablation among cardiac surgeons.</div></div><div><h3>Results</h3><div>Of the 362 surveys distributed internationally, 79 responses were received (22%). After excluding 3 incomplete responses, 76 surveys were included in the final analysis. A majority of respondents (67 of 76; 88%) reported performing concomitant surgical ablation of AF. Among surgeons who perform AF ablation, practice variation was observed. Pulmonary vein isolation was the most common lesion set (45%), and over half of surgeons (52%) tailored lesion selection to AF type, favouring more extensive ablation for persistent AF. Regarding patient selection, notable deterrents to concomitant ablation included the following: increased left atrial size, more persistent forms of AF, severe left ventricular dysfunction, reoperation, minimally invasive surgeries, and complex cases with long pump times. Among non-ablating surgeons (9 of 76; 12%), common factors reported to help increase future adoption of AF ablation included stronger clinical evidence and more affordable and accessible equipment.</div></div><div><h3>Conclusions</h3><div>Our findings reveal that surgical ablation of AF is performed by the majority of research-active cardiac surgeons, yet meaningful variation persists in how and when it is applied. These findings underscore the need for a well designed, definitive trial to guide future care and address the gap between recommendations and practice.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 1100-1108"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699249","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":"Socioeconomic Burden of Pulmonary Arterial Hypertension in Patients and Caregivers: A Canadian Cross-Sectional Study","authors":"Brandon Budhram MD,&nbsp;Jamie Myrah BA,&nbsp;Cynthia M. Westerhout PhD,&nbsp;Courtney Gubbels BA,&nbsp;Wendimagegn Alemayehu PhD,&nbsp;Evelyn Budd MA,&nbsp;Theodore Abraham PhD,&nbsp;Jason Weatherald MD, MSc","doi":"10.1016/j.cjco.2026.04.001","DOIUrl":"10.1016/j.cjco.2026.04.001","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary arterial hypertension (PAH) is a serious condition that can impair daily functioning, employment, and quality of life for working-age individuals. We evaluated the real-world socioeconomic burden of PAH on patients and their caregivers.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional survey of adult Canadian patients between August15, 2023 and October 9, 2023. Using the Work Productivity and Activity Impairment Questionnaire, the EQ-5D Visual Analogue Scale, and additional survey items, we assessed employment status, work limitations, changes in work patterns, quality of life, and perceived caregiver burden. Predictors of employment were identified using multivariate logistic regression.</div></div><div><h3>Results</h3><div>Among 217 participants, 61 (28%) were employed. Working participants reported high presenteeism—that is, impairment while working, due to PAH (50%, interquartile range [IQR] 10, 70). Older age (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.54-0.72, <em>P</em> &lt; 0.001), worse functional class (III-IV compared to I-II; OR 0.38, 95% CI 0.17-0.82, <em>P</em> = 0.014), increased time from PAH diagnosis (OR 0.72, 95% CI 0.54-0.95, <em>P</em> = 0.022), and parenteral prostanoids (OR 0.30, 95% CI 0.09-1.00, <em>P</em> = 0.050) were associated with lower odds of employment, while being in a living-together relationship (OR 3.58, 95% CI 1.40-9.17, <em>P</em> = 0.008) was associated with being employed. Caregiver support was required by 92 patients (45%), with caregivers contributing a perceived median of 15 hours (IQR 6, 35) per week and losing an estimated 4 hours (IQR 0, 10) of potential work hours per week.</div></div><div><h3>Conclusions</h3><div>PAH imposes a substantial socioeconomic burden on patients and caregivers. Patients with PAH experience low rates of employment, high presenteeism, and significant caregiver work loss. These findings highlight an underrecognized aspect of PAH care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 1041-1051"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699257","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":"Sex-Focused Evaluation of Income and Education and the Risk of Atherosclerotic Cardiovascular Diseases Within a Universal Healthcare Context","authors":"Kate Haichin MD,&nbsp;David Alter MD, PhD,&nbsp;Paul Poirier MD, PhD,&nbsp;Jiayi Ni MSc,&nbsp;Jean-Claude Tardif MD,&nbsp;Shaun G. Goodman MD,&nbsp;Andrew Yan MD,&nbsp;Dennis Ko MD, MSc,&nbsp;Marc-André d’Entremont MD, MPH,&nbsp;Patrick R. Lawler MD, MPH,&nbsp;Marco Spaziano MD, MSc,&nbsp;Abhinav Sharma MD, PhD,&nbsp;George Thanassoulis MD, MSc,&nbsp;Jean-Pierre Dery MD,&nbsp;Michel Nguyen MD,&nbsp;Samer Mansour MD,&nbsp;Douglas S. Lee MD, PhD,&nbsp;Erick Schampaert MD,&nbsp;Thao Huynh MD, PhD","doi":"10.1016/j.cjco.2026.03.014","DOIUrl":"10.1016/j.cjco.2026.03.014","url":null,"abstract":"<div><h3>Background</h3><div>Although education and income are established determinants of atherosclerotic cardiovascular disease (ASCVD), whether sex differences in ASCVD risk are associated with these factors within a universal public healthcare system is unclear. We examined the independent associations of income and educational attainment with incident ASCVD and their potential variations by sex in Quebec, Canada.</div></div><div><h3>Methods</h3><div>CARTaGENE is an ongoing prospective cohort study. We completed Cox models to estimate hazard ratios (HRs) for incident ASCVD, stratified by annual household income and educational attainment, among female and male participants without prior ASCVD. The primary endpoint was time to first ASCVD event.</div></div><div><h3>Results</h3><div>There were 17,626 participants with a mean age of 54 ± 8 years (52% female), followed for a median of 6.6 years (2009-2016). Females with the lowest level of education, without collegiate education, had a 61% increase in the hazard of incident ASCVD compared to females with the highest level of education, with university studies (hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.15, 2.26). Compared to those with an annual household income of ≥ $CAD100,000, males with an annual household income of &lt; $CAD50,000 had a 61% increase in the hazard of incident ASCVD (HR:1.61; 95% CI: 1.23, 2.11).</div></div><div><h3>Conclusions</h3><div>Within a public healthcare system and with relatively affordable medication coverage, we still observed inequalities in ASCVD risk associated with educational attainment and household income. Future research is needed to confirm the potential sex differences in the impacts of educational attainment and income on the risk of ASCVD.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 8","pages":"Pages 999-1009"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148699304","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":"Prognostic Impact of Residual Renal Congestion at Discharge After Transcatheter Aortic Valve Implantation","authors":"Yutaro Sato MD,&nbsp;Akihiko Sato MD, PhD,&nbsp;Kazuya Sakamoto MD,&nbsp;Yuuki Muto MD, PhD,&nbsp;Yu Sato MD, PhD,&nbsp;Tetsuro Yokokawa MD, PhD,&nbsp;Takeshi Shimizu MD, PhD,&nbsp;Tomofumi Misaka MD, PhD,&nbsp;Masayoshi Oikawa MD, PhD,&nbsp;Atsushi Kobayashi MD, PhD,&nbsp;Akiomi Yoshihisa MD, PhD,&nbsp;Yasuchika Takeishi MD, PhD","doi":"10.1016/j.cjco.2026.02.016","DOIUrl":"10.1016/j.cjco.2026.02.016","url":null,"abstract":"<div><h3>Background</h3><div>Residual pulmonary congestion after transcatheter aortic valve implantation (TAVI) has been linked to adverse outcomes. However, whether renal congestion, assessed by intrarenal venous flow (IRVF), is associated with outcomes remains unclear.</div></div><div><h3>Methods</h3><div>This study enrolled 164 patients with aortic stenosis who underwent TAVI, and assessed IRVF before TAVI and at discharge (48-72 hours before discharge). The IRVF patterns were categorized as continuous (non-congestive) or discontinuous (congestive). The primary endpoint was a composite of all-cause death or heart failure rehospitalization.</div></div><div><h3>Results</h3><div>Before TAVI, 126 patients (76.8%) had a continuous pattern, and 38 (23.2%) had a discontinuous pattern; at discharge, the numbers were 134 (81.7%) and 30 (18.3%), respectively. Over a median follow-up of 698 days, the primary endpoint occurred in 37 patients (22.6%). A discontinuous pattern at discharge was associated with a higher incidence of events than a continuous pattern (log-rank <em>P</em> = 0.005), whereas the pre-TAVI IRVF pattern did not stratify risk. In an analysis of changes in IRVF patterns (continuous–continuous, continuous–discontinuous, discontinuous–continuous, and discontinuous–discontinuous), event rates were 20 of 114 (17.5%), 5 of 12 (41.7%), 4 of 20 (20.0%), and 8 of 18 (44.4%), respectively, and the risk was higher in patients discharged with a discontinuous pattern—continuous–discontinuous (hazard ratio [HR], 3.26, 95% confidence interval [CI] 1.19-8.92; <em>P</em> = 0.022) and discontinuous–discontinuous (HR, 2.34, 95% CI 1.08-5.37; <em>P</em> = 0.045)—compared with those in the continuous–continuous group.</div></div><div><h3>Conclusions</h3><div>A discontinuous IRVF pattern at discharge, indicating residual renal congestion after TAVI, was associated with an adverse prognosis.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 7","pages":"Pages 831-841"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546745","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":"Non-Physician-Led Models of Care for Heart Failure Medication Optimization: A Scoping Review","authors":"Blair J. MacDonald PharmD,&nbsp;Nathaniel M. Hawkins MBChB, MD, MPH,&nbsp;Fritha Munday MPH,&nbsp;Kelly Mackay MA,&nbsp;Ricky D. Turgeon BSc(Pharm), ACPR, PharmD","doi":"10.1016/j.cjco.2026.02.021","DOIUrl":"10.1016/j.cjco.2026.02.021","url":null,"abstract":"<div><h3>Background</h3><div>Non-physician-led models of care may improve utilization of heart failure (HF) medication therapy. Characterizing these models may help guide their implementation.</div></div><div><h3>Methods</h3><div>We searched MEDLINE (National Library of Medicine), Embase (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for studies published between January 2005 and October 2024. We included studies evaluating non-physician-led models of HFmedication management conducted at least partially in the outpatient setting. Study quality was assessed using the Oxford Centre for Evidence-Based Medicine levels of evidence, ranging from level 1 (systematic review of randomized trials) to level 5 (mechanism-based reasoning or expert opinion).</div></div><div><h3>Results</h3><div>From 5330 records, we included 39 reports describing 31 studies with a total of 16,921 participants. All 31 studies included patients with HF with reduced ejection fraction, and 17 also included those with an ejection fraction &gt; 40%. The levels of evidence classification in these studies were 2 (n = 2), 3 (n = 11), and 4 (n = 18).</div><div>The most frequently studied professional roles were pharmacist (n = 26 studies) and nurse practitioners or clinicians (n = 9). Medication management was conducted in-person (n = 19), remotely (n = 6), and through a hybrid approach (n = 6). Median appointment frequency and duration were every 2 weeks (range: every 1-4 weeks) and 30 minutes (range: 15-60 minutes). Although non-physician-led models of care were associated with increased HF medication use compared to baseline, evidence was mixed regarding how these non-physician-led models compare to usual care in terms of improving use of guideline-directed medical therapy.</div></div><div><h3>Conclusions</h3><div>Non-physician-led models of care are associated with improved HF medication use compared to baseline; however, substantial heterogeneity is present in implementation strategies and the impact of these improvements, compared to usual care.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 7","pages":"Pages 777-786"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546780","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":"Risk Factors of a Serious Underlying Cause of Palpitations Among Patients Attending an Emergency Department","authors":"Frederic Balen MD, PhD,&nbsp;Stephanie Louisot MD,&nbsp;Venkatesh Thiruganasambandamoorthy MBBS, CCFP-EM, MD, MSc,&nbsp;Xavier Dubucs MD, MSc,&nbsp;Sandrine Charpentier MD, PhD","doi":"10.1016/j.cjco.2026.02.015","DOIUrl":"10.1016/j.cjco.2026.02.015","url":null,"abstract":"<div><h3>Background</h3><div>Palpitations are a common reason for calling 911 or visiting the emergency department (ED). The objective of this study was to identify risk factors of a serious underlying cause of palpitations that can be evaluated without an electrocardiogram (ECG).</div></div><div><h3>Methods</h3><div>This observational cohort study took place from January 1 to June 30, 2019 in an academic ED. Patients aged &gt; 18 years who visited the ED for palpitations were included. The primary outcome was a final diagnosis of a serious underlying cause of palpitations at ED discharge. We used backward stepwise logistic regression to identify independent risk factors of a serious cause of palpitations.</div></div><div><h3>Results</h3><div>A total fo 215 patients were analyzed, including 80 (37%) with a serious underlying cause of palpitations. Four independent risk factors were associated with significant arrhythmia: age ≥ 50 years (odds ratio [OR] = 7.6; 95% confidence interval [CI] = 3.5-16.4), history of heart disease (OR = 4.7; 95% CI = 2.3-9.6), syncope as an associated symptom (OR = 11; 95% CI = 1.4-84.1), and tachycardia ≥ 100 beats per minute (OR = 3.8; 95% CI = 1.8-8.1). A total of 54 patients (25%) had no risk factors. Absence of a risk factor had a sensitivity of 96% (95% CI = 89%-99%), and a specificity of 38% (95% CI = 30%-46%).</div></div><div><h3>Conclusions</h3><div>We found 4 independent risk factors associated with a serious underlying cause of palpitations at ED triage.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 7","pages":"Pages 796-799"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546778","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":"Inequitable Access to Catheter Ablation for Atrial Fibrillation and Adverse Outcomes in a Publicly Funded Healthcare System","authors":"Nada El Tobgy MD,&nbsp;Flora Au MA,&nbsp;Amity Quinn PhD,&nbsp;Roopinder Sandhu MD, MPH,&nbsp;Stephen B. Wilton MD, MSc,&nbsp;Braden J. Manns MD, MSc,&nbsp;Christopher Cheung MD, MPH,&nbsp;Elissa Rennert-May MD, MSc,&nbsp;Robert J.H. Miller MD,&nbsp;F. Russell Quinn BM, BCh, PhD,&nbsp;Lucy Lei MD, MSc,&nbsp;Derek S. Chew MD, MSc","doi":"10.1016/j.cjco.2026.02.020","DOIUrl":"10.1016/j.cjco.2026.02.020","url":null,"abstract":"<div><h3>Background</h3><div>Although all Canadians have universal coverage for hospital-based care, only limited data describe the determinants of access to catheter ablation for atrial fibrillation (AF) in Canada.</div></div><div><h3>Methods</h3><div>This population-based cohort study from Alberta, Canada (2013-2020) included adults (age ≥ 18 years) with new-onset AF in whom a rhythm-control strategy was desired. Factors associated with ablation within 5 years were identified using multivariable logistic regression models. The association between ablation and outcomes was assessed in a propensity score–matched cohort using Cox proportional hazard models; the time to ablation was treated as a time-varying covariate to mitigate immortal time bias.</div></div><div><h3>Results</h3><div>Of 11,844 patients, 8.7% (n = 1014) received ablation within 5 years of diagnosis. The mean cohort age was 64.6 ± 14.0 years; 35.1% were female; and the mean <strong>C</strong>hronic Heart Failure, <strong>H</strong>ypertension, <strong>A</strong>ge ≥ 75 Years, <strong>D</strong>iabetes Mellitus, <strong>S</strong>troke, <strong>V</strong>ascular Disease, <strong>A</strong>ge 65 to 74 Years, <strong>S</strong>ex <strong>C</strong>ategory (CHA₂DS₂-VASc) score was 2.6 ± 1.9. Patients were less likely to receive ablation if they were older, were female, or had hypertension, heart failure, or kidney disease. Ablation was more common in patients with higher socioeconomic status. In the propensity score–matched cohort, ablation was associated with a lower risk of AF recurrence (hazard ratio [HR] 0.59; 95% confidence interval 0.48-0.72; <em>P</em> &lt; 0.001) and a nonstatistically significant lower risk of all-cause mortality (HR 0.63; 95% CI 0.38-1.03; <em>P</em> = 0.06).</div></div><div><h3>Conclusion</h3><div>There are disparities in ablation rates based on demographic and socioeconomic factors. Lack of access to ablation is associated with poorer clinical outcomes at 5 years. Our results support the importance of equity-driven health services planning and advocacy to ensure fair access to ablation.</div></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"8 7","pages":"Pages 800-807"},"PeriodicalIF":2.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148546746","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}