Do Provincial Formulary Restrictions Explain Differential Uptake of Sodium-Glucose Co-Transporter-2 Inhibitors in Adults with Diabetes and Cardiovascular Disease in Canada? A Retrospective Cohort Study of Pharmacy Claims.

Background: Ontario listed SGLT-2 inhibitors (SGLT2i) as regular public drug benefits for adults age ≥ 65, while other Canadian provinces providing benefits for SGLT2i implemented special authorization restrictions. We hypothesized that special authorization led to lower SGLT2i use among older adults with diabetes and cardiovascular disease (CVD) in other provinces (Alberta, Manitoba, New Brunswick, and Saskatchewan), compared to Ontario.

Methods: Retrospective cohort study of adults with diabetes and CVD, age ≥ 65 years, discharged from hospital April 1, 2016 to March 31, 2019, in five Canadian provinces.

Economic Burden of Heart Failure Hospitalizations in Canada: A Population-based Study.

Background: Heart failure (HF) is associated with significant mortality and morbidity and accounts for substantial health care resources. We examined hospitalization costs of patients with HF in Canada (excluding patients from Quebec and the Territories) between 2010/2011 and 2018/2019 and estimated future costs to 2039/2040.

Methods: We identified hospitalization records with a primary diagnosis of HF between 2010/2011 and 2018/2019.

The COVID-19 Pandemic Did Not Negatively Impact Adherence to Cardiovascular Medications Among 548,601 Chronically Treated Patients in Alberta.

Background: Studies have suggested that the COVID-19 pandemic negatively impacted patient adherence with chronic medications. We explored whether adherence patterns changed in patients chronically treated with cardiovascular drugs after onset of the COVID-19 pandemic.

Methods: In this retrospective cohort study we examined drug dispensation data for all adult Albertans who were chronic users of at least 1 cardiovascular drug class between 2017 and 2023.

Long-term outcomes of catheter ablation compared with medical therapy in atrial fibrillation.

Background: The long-term effects of catheter ablation (CA) compared with medical therapy on cardiovascular outcomes for atrial fibrillation (AF) remain undetermined.

Objective: Using a population-based cohort, we sought to determine what the association between CA and medical therapy was on these outcomes.

Methods: By use of Alberta administrative data, patients with AF as the primary diagnosis during hospitalization, emergency department visit, or physician visit were included between October 1, 2008, and March 31, 2018.

Impact of Remoteness of Residence and Socioeconomic Status on Outcomes Among Children With Heart Disease in Alberta.

Background: There is a paucity of data regarding the impact of remoteness of residence (RoR) and socioeconomic status (SES) on access to care and outcomes for children with congenital heart disease (CHD) or acquired heart disease (AHD) in a jurisdiction of universal health and centralized cardiac care.

Objectives: The primary objective was to examine whether RoR, SES, and their interaction impact access to health care and outcomes for children with heart disease in Alberta, Canada.

Methods: This was a population-based study of children with CHD or AHD born between January 1, 2005, and December 31, 2017, in Alberta, Canada.

Canadian Cost-Effectiveness of Coronary Artery Calcium Screening Based on the Multi-Ethnic Study of Atherosclerosis.

Background: Cost-effectiveness of testing for coronary artery calcium (CAC) relative to other treatment strategies is not established in Canada.

Objectives: The purpose of this study was to evaluate the cost-effectiveness of using CAC score-guided statin treatment compared with universal statin therapy among intermediate-risk, primary prevention patients eligible for statins.

Methods: A state transition, microsimulation model used data from Canadian sources and the Multi-Ethnic Study of Atherosclerosis to simulate clinical and economic consequences of cardiovascular disease from a Canadian publicly funded health care system perspective.

Uptake of SGLT2i and Outcomes in Patients with Diabetes and Heart Failure: A Population-Based Cohort and a Specialized Clinic Cohort.

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are effective in adults with diabetes mellitus (DM) and heart failure (HF) based on randomized clinical trials. We compared SGLT2 inhibitor uptake and outcomes in two cohorts: a population-based cohort of all adults with DM and HF in Alberta, Canada and a specialized heart function clinic (HFC) cohort.

Methods: The population-based cohort was derived from linked provincial healthcare datasets.

Outcomes of management strategies in patients with prior coronary artery bypass grafting presenting with an acute coronary syndrome.

Background: Patients with prior coronary artery bypass grafting (CABG) presenting with an acute coronary syndrome (ACS) have poor outcomes and the optimal treatment strategy for this population is unknown.

Methods: Using linked administrative databases, we examined patients with an ACS between 2008 and 2019, identifying patients with prior CABG. Patients were categorized by ACS presentation type and treatment strategy.

Association Between Hemoglobin A1c and Development of Cardiovascular Disease in Canadian Men and Women Without Diabetes at Baseline: A Population-Based Study of 608 474 Adults.

Background: We examined the association between hemoglobin A1c (HbA1c) and the development of cardiovascular disease (CVD) in men and women, without diabetes or CVD at baseline.

Methods And Results: This retrospective cohort study included adults aged 40 to <80 years in Alberta, Canada. Men and women were divided into categories based on a random HbA1c during a 3-year enrollment period.

Relationships Between Measures of the Physical Activity-Related Built Environment and Excess Weight in Preschoolers: A Retrospective, Population-Level Cohort Study.

The built environment can impact health outcomes. Our purpose was to examine relationships between built environment variables related to physical activity and excess weight in preschoolers. In this retrospective, population-level study of 4- to 6-year-olds, anthropometric measurements were taken between 2009 and 2017 in Calgary and Edmonton, Alberta, Canada.

Iron Deficiency, Anemia, and Iron Supplementation in Patients With Heart Failure: A Population-Level Study.

Background: Studies have shown an association between iron deficiency (ID) and clinical outcomes in patients with heart failure (HF), irrespective of the presence of ID anemia (IDA). The current study used population-level data from a large, single-payer health care system in Canada to investigate the epidemiology of ID and IDA in patients with acute HF and those with chronic HF, and the iron supplementation practices in these settings.

Methods: All adult patients with HF in Alberta between 2012 and 2019 were identified and categorized as acute or chronic HF.

Sex Differences in High-Cost Users of Healthcare for Atrial Fibrillation.

Background: Healthcare resource use for atrial fibrillation (AF) is high, but it may not be equivalent across all patients. We examined whether sex differences exist for AF high-cost users (HCUs), who account for the top 10% of total acute care costs.

Methods: All patients aged ≥ 20 years who presented to the emergency department (ED) or were hospitalized with AF were identified in Alberta, Canada, between 2011 and 2015.

Lower Socioeconomic Status is Associated with an Increased Incidence and Spectrum of Major Congenital Heart Disease and Associated Extracardiac Pathology.

Several studies have suggested an inverse relationship between lower socioeconomic status (SES) and the incidence of congenital heart disease (CHD) among live births. We sought to examine this relationship further in a Canada-wide population study, exploring CHD subtypes, trends, and associated noncardiac abnormalities. Infants born in Canada (less Quebec) from 2008 to 2018 with CHD requiring intervention in the first year were identified using ICD-10 codes through the Canadian Institute for Health Information Discharge Abstract Database.

The Challenges of Identifying Patients With Peripheral Artery Disease Utilizing Administrative Databases.

Peripheral artery disease (PAD) carries a high burden of morbidity when identified in patients with coronary artery disease (CAD). However, identification of patients with concomitant CAD and PAD remains challenging. Using linked administrative databases of 207,026 individuals with CAD between 2002 and 2019 (median follow-up, 4.

Associations between social determinants of health and weight status in preschool children: a population-based study.

Introduction: Social determinants of health (SDH) may influence children's weight status. Our objective was to examine relationships between SDH and preschoolers' weight status.

Methods: This retrospective cohort study included 169 465 children (aged 4-6 years) with anthropometric measurements taken at immunization visits from 2009 to 2017 in Edmonton and Calgary, Canada.

Disparities in adherence to diabetes screening guidelines among males and females in a universal care setting: A population-based study of 1,380,697 adults.

Background: National guidelines recommend that all adults over the age of 40 years undergo screening for diabetes at least once every 3-years. We examined the adherence to these guidelines among males and females after accounting for age, urban/rural residence, and material deprivation. We also examined the incidence of prediabetes and diabetes in adherent and non-adherent individuals.

Use of Guideline-Directed Medical Therapy in Patients Aged ≥ 65 Years After the Diagnosis of Heart Failure: A Canadian Population-Based Study.

Background: Guideline-directed medical therapy (GDMT) improves clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). Despite its proven efficacy, GDMT is underutilized in clinical practice. The current study examines GDMT utilization after incident hospitalization for HF to promote medication initiation, and titration to target dosing within a reasonable time period.

Impact of Socioeconomic Status and Residence Distance on Infant Heart Disease Outcomes in Canada.

Background Socioeconomic status (SES) impacts clinical outcomes associated with severe congenital heart disease (sCHD). We examined the impact of SES and remoteness of residence (RoR) on congenital heart disease (CHD) outcomes in Canada, a jurisdiction with universal health insurance. Methods and Results All infants born in Canada (excluding Quebec) from 2008 to 2018 and hospitalized with CHD requiring intervention in the first year were identified.

Nationwide Study of Sex Differences in Incident Heart Failure in Newly Diagnosed Nonvalvular Atrial Fibrillation.

Background: Heart failure (HF) is a leading complication of nonvalvular atrial fibrillation (NVAF), and the presence of both conditions worsens prognosis. Sex-specific associations between NVAF and outcomes focus on stroke; less is known about HF. We evaluated sex differences in incident HF in NVAF.

Trends in Uptake and Adherence to Oral Anticoagulation for Patients With Incident Atrial Fibrillation at High Stroke Risk Across Health Care Settings.

Background Oral anticoagulation (OAC) therapy prevents morbidity and mortality in nonvalvular atrial fibrillation; whether location of diagnosis influences OAC uptake or adherence is unknown. Methods and Results Retrospective cohort study (2008-2019), identifying adults with incident nonvalvular atrial fibrillation across health care settings (emergency department, hospital, outpatient) at high risk of stroke. OAC uptake and adherence via proportion of days covered for direct OACs and time in therapeutic range for warfarin were measured.

Epidemiology of Worsening Heart Failure in a Population-based Cohort from Alberta, Canada: Evaluating Eligibility for Treatment With Vericiguat.

Background: Patients with heart failure (HF) and a reduced ejection fraction (HFrEF) who experience worsening HF (WHF) events are at increased risk of adverse outcomes and experience significant morbidity and mortality. We herein describe the epidemiology of these patients and identify those potentially eligible for vericiguat therapy in this population-based study.

Methods And Results: This retrospective cohort study included hospitalized or emergency department patients with a primary diagnosis of HF and a left ventricular ejection fraction (LVEF) of less than 45% diagnosed between April 1, 2009, and March 31, 2019 in Alberta, Canada, with follow-up to March 31, 2020.

Sex Differences in the Management of Oral Anticoagulation and Outcomes for Emergency Department Presentation of Incident Atrial Fibrillation.

Study Objective: To examine sex differences in oral anticoagulation management and outcomes among patients with incident nonvalvular atrial fibrillation presenting to the emergency department (ED).

Methods: We identified patients older than 20 years presenting to the ED with incident nonvalvular atrial fibrillation between April 1, 2012, and March 30, 2019, using linked administrative databases in Alberta, Canada. We assessed the use of and adherence to oral anticoagulants at 1 year using the proportion of days covered for direct oral anticoagulants and time in therapeutic range for warfarin.

Prevalence of Cardiovascular Disease in a Population-Based Cohort of High-Cost Healthcare Services Users.

Background: Data are limited data on the prevalence of cardiovascular disease (CVD) and multimorbidity in contemporary cohorts of high-cost users (HCUs) in Canada.We examined the following: (i) the prevalence of CVD, with a comparison of total healthcare costs among HCUs with vs without CVD; (ii) the contribution of other comorbidities to costs among HCUs with CVD; and (iii) the trajectory of healthcare costs in the years before and after becoming an HCU.

Methods: The study included adult Alberta patients in the Canadian Institutes of Health Research/Canadian Institute for Health Information Dynamic Cohort of Complex, High System Users from 2011-2012 through 2014-2015.

The Introduction of Direct Oral Anticoagulants Has Not Resolved Treatment Gaps for Frail Patients With Nonvalvular Atrial Fibrillation.

Background: The extent to which the introduction of direct oral anticoagulants (DOACs) influenced treatment patterns in frail and nonfrail patients with nonvalvular atrial fibrillation (NVAF) is unclear.

Methods: This was a retrospective cohort study of all Albertans 20 years or older who were discharged from an emergency department or hospital with a new diagnosis of NVAF between April 1, 2009, and March 31, 2019. The Hospital Frailty Risk Score was used to define frailty and the CHADS-VASc and CHADS-65 scores were used to identify if anticoagulation was indicated.