Sex Differences in Cardiovascular Health Status and Long-Term Outcomes in a Primary Prevention Cohort.

Background: Poor cardiovascular health quantified by 8 health behaviors and factors is associated with incident cardiovascular disease (CVD). However, it is not clear if this association differs between women and men.

Objectives: The aim of the study was to determine whether the association between cardiovascular health status and incident CVD events differs by sex.

Association of Albuminuria With 1-Year Risk of Heart Failure and Other Adverse Outcomes in Atrial Fibrillation.

Background: Albuminuria is associated with increased stroke risk in atrial fibrillation (AF), but its relationship with heart failure (HF) and other adverse outcomes in AF is less well understood.

Methods: Using linked administrative databases, we conducted a retrospective cohort study of individuals aged ≥66 years who were newly diagnosed with AF between April 2009 and March 2019 in Ontario, Canada. Albuminuria was assessed using (1) urine albumin-to-creatinine ratio (UACR, mg/g) and (2) dipstick proteinuria (negative, trace, 1+, 2+, ≥3+).

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.

Variations of the Extent of Obstructive Coronary Artery Disease Among Canadian Immigrants.

Background: An increasing proportion of immigrants are residing in developed countries, but little is known about the extent of their obstructive coronary artery disease (CAD). Our objective was to evaluate the association between immigrant status and CAD among immigrants.

Methods And Results: Initial coronary angiography performed for stable CAD from 2012 to 2021 in Ontario, Canada was examined.

Impact of Zero Coronary Artery Calcium Scoring on Downstream Cardiac Testing and Cardiac Outcomes Compared With No Testing.

Background: The impact of coronary artery calcium (CAC) scoring on downstream resource utilisation and outcomes remains unclear, especially in those with zero CAC.

Methods: Consecutive CAC scores from two academic hospitals in Toronto, Ontario, were linked to population-based databases. Subjects with zero CAC without previous cardiovascular disease were propensity score matched with a non-CAC-tested control group for age, sex, cardiovascular risk factors, and comorbidities.

Noninvasive Cardiac Testing and Cardiovascular Outcomes for Low-Risk Chest Pain in the Emergency Department: A Systematic Review and Meta-Analysis.

Background: 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.

Methods: 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.

Transfusion in Anemic Patients With Acute Coronary Syndromes: A Population-Based Cohort Study.

Background: There is controversy surrounding the effectiveness of red blood cell (RBC) transfusion for treating anemia in patients hospitalized for acute coronary syndromes (ACS), particularly as hemoglobin (Hb) levels approach and drop below the range of moderate anemia.

Methods: This population-based cohort study followed all adults hospitalized for ACS who experienced an in-hospital nadir Hb between 6.0 and 8.

Wait-times benchmarks for risk-based prioritization in transcatheter aortic valve implantation: a simulation study.

Background: Demand for transcatheter aortic valve implantation (TAVI) has increased in the last decade, resulting in prolonged wait-times and undesirable health outcomes in many health systems. Risk-based prioritization and wait-times benchmarks can improve equitable access to patients.

Methods And Results: We used simulation models to follow-up a synthetic population of 50 000 individuals from referral to completion of TAVI.

Impact of Neighborhood Social Deprivation on Delays to Access for Transcatheter Aortic Valve Replacement: Wait-Times and Clinical Consequences.

Background: Transcatheter aortic valve replacement (TAVR) has become the standard of care for severe aortic stenosis treatment. Exponential growth in demand has led to prolonged wait times and adverse patient outcomes. Social marginalization may contribute to adverse outcomes.

Implications of five different risk models in primary prevention guidelines.

Background: A lack of consensus exists across guidelines as to which risk model should be used for the primary prevention of cardiovascular disease (CVD). Our objective was to determine potential improvements in the number needed to treat (NNT) and number of events prevented (NEP) using different risk models in patients eligible for risk stratification.

Methods And Results: A retrospective observational cohort was assembled from primary care patients in Ontario, Canada, between 1 January 2010 and 31 December 2014 and followed for up to 5 years.

Transcatheter Aortic Valve Implantation Wait-Time Management: Derivation and Validation of the Canadian TAVI Triage Tool (CAN3T).

Background: Transcatheter aortic valve implantation (TAVI) has seen indication expansion and thus exponential growth in demand over the past decade. In many jurisdictions, the growing demand has outpaced capacity, increasing wait times and preprocedural adverse events. In this study, we derived prediction models that estimate the risk of adverse events on the waitlist and developed a triage tool to identify patients who should be prioritized for TAVI.

Development and Validation of the CANHEART Population-Based Laboratory Prediction Models for Atherosclerotic Cardiovascular Disease.

Background: Prediction of atherosclerotic cardiovascular disease (ASCVD) in primary prevention assessments exclusively with laboratory results may facilitate automated risk reporting and improve uptake of preventive therapies.

Objective: To develop and validate sex-specific prediction models for ASCVD using age and routine laboratory tests and compare their performance with that of the pooled cohort equations (PCEs).

Design: Derivation and validation of the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) Lab Models.

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.

The Importance of Race and Ethnicity Data in Cardiovascular Health Research.

The COVID-19 pandemic has underscored the importance of addressing race and ethnic disparities in healthcare worldwide. In Canada, however, the lack of consistent capture of race and ethnicity data has hindered a comprehensive understanding of these potential disparities. This article explores the importance of and current progress in collecting race and ethnic data in Canada and provides examples of its importance in cardiovascular health outcomes.

Validation of the European SCORE2 models in a Canadian primary care cohort.

Aims: Systematic Coronary Risk Evaluation Model 2 (SCORE2) was recently developed to predict atherosclerotic cardiovascular disease (ASCVD) in Europe. Whether these models could be used outside of Europe is not known. The objective of this study was to test the validity of SCORE2 in a large Canadian cohort.

Trajectories of P2Y12 inhibitor adherence in patients with acute coronary syndromes.

Purpose: P2Y12 inhibitors (P2Y12i) reduce cardiac events after acute coronary syndromes (ACS). However, suboptimal P2Y12i adherence persists. We aimed to examine P2Y12i non-adherence using group-based trajectory methods and to identify adherence predictors.

Impact of Neighborhood Social Deprivation on Health Care Costs Associated With TAVR.

Background: Cumulative costs of transcatheter aortic valve replacement (TAVR) differ in the referral, procedural and postprocedural phases depending on patient comorbidities, type of procedure, and procedural complications. Our goal was to determine the association between neighborhood measures of social deprivation and TAVR costs in each of the 3 phases.

Methods: Demographics, patient comorbidities, procedural details, in-hospital complications, and costs for adults undergoing TAVR between 2017 and 2020 in Ontario, Canada were obtained from administrative databases and linked to social deprivation data using the Ontario Marginalization Index.

Variation and clinical consequences of wait-times for atrial fibrillation ablation: population level study in Ontario, Canada.

Aims: Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Emerging evidence supporting the efficacy of catheter ablation in managing AF has led to increased demand for this therapy, potentially outpacing the capacity to perform this procedure. Mismatch between demand and capacity for AF ablation results in wait-times which have not been comprehensively evaluated at a population level.

Association of Race and Ethnicity With Obstructive Coronary Artery Disease.

Background: Appropriate selection of patients with stable coronary artery disease (CAD) for coronary angiography is dependent on the pretest probability of obstructive CAD; however, little is known about the potential differences in CAD by race and ethnic groups.

Objectives: The purpose of this study was to evaluate the association of race and ethnicity with coronary obstruction in stable CAD.

Methods: We evaluated first coronary angiography for CAD evaluation between 2012 and 2019 in Ontario, Canada.