Marginalized Neighborhoods and Health Outcomes in Younger Myocardial Infarction Survivors.

Importance: Neighborhood characteristics may be independently associated with survival after acute myocardial infarction (AMI).

Objective: To examine the association of living in a marginalized neighborhood with mortality and care for younger AMI survivors (aged <65 years) in a universal health care system.

Design, Setting, And Participants: Population-based retrospective cohort using clinical and administrative databases in Ontario, Canada.

The Dynamic Nature of the Socioeconomic Determinants of Cardiovascular Health: A Narrative Review.

Despite decades of social epidemiologic research, health inequities remain pervasive and ubiquitous in Canada and elsewhere. One reason may be our use of socioeconomic measurement, which has often relied on single point-in-time exposures. To explore the extent to which researchers have incorporated dynamic socioeconomic measurement into cardiovascular health outcome evaluations, we performed a narrative review.

Association of Neighborhood-Level Marginalization With Health Care Use and Clinical Outcomes Following Hospital Discharge in Patients Who Underwent Coronary Catheterization for Acute Myocardial Infarction in a Single-Payer Health Care System.

Background: Canadian data suggest that patients of lower socioeconomic status with acute myocardial infarction receive less beneficial therapy and have worse clinical outcomes, raising questions regarding care disparities even in universal health care systems. We assessed the contemporary association of marginalization with clinical outcomes and health services use.

Methods: Using clinical and administrative databases in Ontario, Canada, we conducted a population-based study of patients aged ≥65 years hospitalized for their first acute myocardial infarction between April 1, 2010 and March 1, 2019.

Association of neighbourhood-level material deprivation with adverse outcomes and processes of care among patients with heart failure in a single-payer healthcare system: A population-based cohort study.

Aim: We studied the association between neighbourhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure patients in a universal healthcare system.

Methods And Results: In a population-based retrospective study (2007-2019), we examined the association of material deprivation with 1-year all-cause mortality, cause-specific hospitalization, and 90-day processes of care. Using cause-specific hazards regression, we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years.

The Relationship Between Residential Mobility and Mortality Following Acute Myocardial Infarction.

Background: The extent to which residential mobility is associated with declining health among disease-specific populations, such as survivors of acute myocardial infarction (AMI), remains unknown.

Methods: This prospective cohort study consisted of 3377 patients followed from index AMI (December 1, 1999 to March 30, 2003) to death or the last available follow-up date (March 30, 2020) in Ontario, Canada. Each residential postal code move from a patient's sentinel AMI event was tracked.

Association of Neighborhood-Level Material Deprivation With Atrial Fibrillation Care in a Single-Payer Health Care System: A Population-Based Cohort Study.

Background: There are limited data on the association of material deprivation with clinical care and outcomes after atrial fibrillation (AF) diagnosis in jurisdictions with universal health care.

Methods: This was a population-based cohort study of individuals ≥66 years of age with first diagnosis of AF between April 1, 2007, and March 31, 2019, in the Canadian province of Ontario, which provides public funding and prohibits private payment for medically necessary physician and hospital services. Prescription medications are subsidized for residents >65 years of age.

Cardiac Rehabilitation Is Associated With Improved Long-Term Outcomes After Coronary Artery Bypass Grafting.

Background: Although cardiac rehabilitation (CR) has proven to have short- and mid-term benefit in treatment of coronary artery disease, its long-term benefit in patients who have undergone coronary artery bypass grafting (CABG) is less certain. Our objective was to examine the late outcomes of patients who attended CR within the first year after CABG.

Methods: Adult CABG patients referred to Toronto Rehabilitation Institute (CR group: were referred and attended at least 1 session; No-CR group: were referred but did not attend) between January 1996 and September 2008 were identified through linkages with clinical and provincial administrative databases for comorbidities and outcome ascertainment.

Impact of socioeconomic status on end-of-life costs: a systematic review and meta-analysis.

Background: Socioeconomic inequalities in access to, and utilization of medical care have been shown in many jurisdictions. However, the extent to which they exist at end-of-life (EOL) remains unclear.

Methods: Studies in MEDLINE, EMBASE, CINAHL, ProQuest, Web of Science, Web of Knowledge, and OpenGrey databases were searched through December 2019 with hand-searching of in-text citations.

Comparative Effectiveness of the Core Components of Cardiac Rehabilitation on Mortality and Morbidity: A Systematic Review and Network Meta-Analysis.

A systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating the core components of cardiac rehabilitation (CR), nutritional counseling (NC), risk factor modification (RFM), psychosocial management (PM), patient education (PE), and exercise training (ET)) was undertaken. Published RCTs were identified from database inception dates to April 2017, and risk of bias assessed using Cochrane's tool. Endpoints included mortality (all-cause and cardiovascular (CV)) and morbidity (fatal and non-fatal myocardial infarction (MI), coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and hospitalization (all-cause and CV)).

Projected Real-World Effectiveness of Using Aggressive Low-Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada.

Background: The extent to which outcome benefits may be achieved through the implementation of aggressive low-density lipoprotein (LDL) cholesterol targets in real world settings remains unknown, especially among elderly statin users following acute coronary syndromes.

Methods And Results: A population-based cohort study consisting of 19 544 post-acute coronary syndrome statin-users aged ≥66 years between January 1, 2017 and March 31, 2014 was used to project the number of adverse outcome events (acute myocardial infarction or death from any cause) that could be prevented if all post-acute coronary syndrome elderly statin users were treated to 1 of 2 LDL cholesterol target levels (≤50 and ≤70 mg/dL). The number of preventable adverse outcomes was estimated by using model-based expected event probabilities as derived from Cox Proportional hazards models.

Association of high-density lipoprotein cholesterol with non-fatal cardiac and non-cardiac events: a CANHEART substudy.

Background: Emerging evidence has questioned the role of high-density lipoprotein cholesterol (HDL-C) as an independent and modifiable risk factor for cardiovascular disease. We sought to understand the relationship between HDL-C levels and subsequent non-fatal clinical events.

Methods: Individuals without prior cardiovascular disease or cancer were identified.

Music for anxiety reduction in patients undergoing cardiac catheterization: A systematic review and meta-analysis of randomized controlled trials.

Background: Medical diagnostic procedures, such as cardiac catheterization, can cause significant patient anxiety. Patient anxiety can have negative implications for compliance with healthcare visits, medical tests, and treatments. Music interventions may have a role in reducing anxiety related to cardiac catheterization procedures.

The energy expenditure benefits of reallocating sedentary time with physical activity: a systematic review and meta-analysis.

Background: We compared direct and daily cumulative energy expenditure (EE) differences associated with reallocating sedentary time to physical activity in adults for meaningful EE changes.

Methods: Peer-reviewed studies in PubMed, Medline, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews were searched from inception to March 2017. Randomized and non-randomized interventions with sedentary time and EE outcomes in adults were included.

Patient and practitioner perspectives on reducing sedentary behavior at an exercise-based cardiac rehabilitation program.

Purpose: To understand the awareness of sedentary behavior, as well as the perceived facilitators and barriers to reducing sedentary behaviors from the perspectives of patients undertaking an exercise-based cardiac rehabilitation program, and from staff involved in supporting patient self-management.

Materials And Methods: A qualitative study was conducted at a large cardiac rehabilitation program in a metropolitan city in Canada. Guided by an ecological framework, semi-structured interviews were conducted individually with 15 patients, and in two focus groups with six staff.

Stress testing after percutaneous coronary interventions: a population-based study.

Background: Routine stress testing is commonly used after percutaneous coronary intervention (PCI) to detect in-stent restenosis or suboptimal procedure results; however, recent studies suggest that such testing is rarely indicated. Our main objectives were to assess temporal trends in utilization of stress testing and to determine factors associated with its use.

Methods: We conducted an observational study involving all patients who had undergone PCI in Ontario, Canada, from Apr.

Regional variations in ambulatory care and incidence of cardiovascular events.

Background: Variations in the prevalence of traditional cardiac risk factors only partially account for geographic variations in the incidence of cardiovascular disease. We examined the extent to which preventive ambulatory health care services contribute to geographic variations in cardiovascular event rates.

Methods: We conducted a cohort study involving 5.

Relationship Between Cardiac Rehabilitation Participation and Health Service Expenditures Within a Universal Health Care System.

Objectives: To examine the relationship between cardiac rehabilitation participation and health service expenditures in Ontario, Canada.

Patients And Methods: A total of 6284 patients referred to cardiac rehabilitation between April 1, 2003, and December 31, 2010, were linked to 6284 matched cardiac rehabilitation eligible nonreferred controls and followed over a 3-year period across multiple linked administrative databases to identify health service utilization expenditures and mortality. All patients had previous cardiac hospitalizations within the preceding year.

Association Between Cardiovascular Risk Factors and Aortic Stenosis: The CANHEART Aortic Stenosis Study.

Background: Few longitudinal studies have delineated the association between traditional cardiovascular risk factors and development of aortic stenosis (AS).

Objectives: The authors examined the association between traditional cardiovascular risk factors and incident severe AS in a large, unselected elderly population.

Methods: This observational cohort study used multiple linked health care population-based databases of individuals older than 65 years on April 1, 2002, without prior valvular disease, coronary artery disease, heart failure, cardiac arrhythmia, cerebrovascular disease, congenital heart disease, or admissions with cardiac symptoms.