Background Prehospital delay remains a major contributor to poor outcomes in myocardial infarction (MI), and treatment-seeking decision time (TSDT) constitutes a substantial portion of this interval. Previous research has focused primarily on prolonged treatment seeking, whereas less is known about prompt help-seeking. This study initially aimed to explore gendered dimensions of prompt help-seeking in MI; however, the analytic focus was refined to men’s experiences because all patients referred to and enrolled by the research team during the recruitment period were men. Methods A qualitative study using interpretive description and thematic analysis was conducted at an acute cardiology unit in Vancouver, Canada. Eligible participants were adults with MI who sought treatment within 90 minutes of symptom onset, were hemodynamically stable, planned for discharge, and could complete an interview in English. Although eligibility was not restricted by gender, all participants meeting the prompt criterion were men. Nine men consented; one was excluded because of limited English proficiency, resulting in a final sample of eight men. Results Three themes described the men’s prompt help-seeking experiences: (1) evaluating symptoms, (2) putting the pieces together, and (3) societal norms surrounding masculinity. Men described symptom intensity, persistence, and unfamiliarity as cues to urgent action, while prior knowledge, personal experience, bystander input, and masculinity-related norms shaped decision-making. Conclusions This study provides an initial understanding of prompt help-seeking among men with MI. Symptom appraisal, cognitive processing, and masculinity-related social norms may shape how some men decide to seek care quickly.
Background Sodium-glucose cotransporter 2 inhibitors improve cardiovascular and heart failure outcomes. Prior studies using SPECT and PET showed SGLT2i did not alter myocardial flow reserve. We aimed to confirm these findings using cardiac MRI (cMRI) technology, building on the results of the EMPA-HEART CardioLink-6 trial. This post-hoc analysis used cMRI to determine whether empagliflozin improves resting left ventricular (LV) perfusion among patients with type 2 diabetes mellitus (T2DM) and established coronary artery disease (CAD). Secondary objectives were to assess for the effect of empagliflozin on LV wall stress. Methods Eighty adult patients with established coronary artery disease and type 2 diabetes were randomized to 6 months of empagliflozin 10 mg/day versus placebo. Using cardiac MRI, myocardial first pass perfusion global indices including: maximum slope, perfusion index, time to maximum slope and maximum signal intensity were measured by an independent reader. Results Six months of empagliflozin did not significantly alter maximum slope (p=0.27), perfusion index (p=0.210), time to maximum slope (p=0.96) or maximum signal intensity (p=0.17). There was no heterogeneity of effect in relation to baseline perfusion measurements. There was a significant reduction in end systolic wall stress in the empagliflozin group versus placebo (p=0.0098). Conclusion Six months of empagliflozin therapy in persons with T2DM and pre-existing CAD did not alter resting global LV myocardial perfusion but decreased wall stress, as assessed by CMR, confirming similar findings from prior studies using other imaging modalities.
Background Cardiovascular disease remains the leading cause of mortality among women worldwide and accounts for approximately one-third of all deaths globally. Elevated low-density lipoprotein cholesterol (LDL-C) is a well-established, causal, and modifiable risk factor in the development of atherosclerotic cardiovascular disease (ASCVD). Methods This review was conducted in accordance with PRISMA 2020 and registered in PROSPERO (CRD420261288376). Randomized controlled trials and observational studies reporting female-specific LDL-C outcomes following treatment with PCSK9 monoclonal antibodies (evolocumab and alirocumab) were included. The primary outcome was percentage change in LDL-C from baseline. Risk of bias was assessed using the Newcastle–Ottawa Scale for observational studies. Results Three observational cohort studies (n = 353 female participants total) were included in the quantitative synthesis. Variance data could not be derived for the remaining observational studies. The pooled mean percentage reduction in LDL-C at 12–30 weeks was −48.4% (95% CI −62.7% to −34.1%; P = 0.005), with high heterogeneity (I2 = 73%). Narrative synthesis of randomized trial subgroup analyses demonstrated LDL-C reductions ranging from approximately −45% to −60%. Conclusions This review synthesized available female-specific LDL-C evidence for PCSK9 monoclonal antibodies. Available evidence suggests substantial LDL-C reductions among female patients; however, these findings are based on a limited quantitative evidence base consisting of three observational cohort studies and should be interpreted cautiously. Interpretation is limited to LDL-C outcomes, which represent a surrogate marker rather than a direct clinical outcome, as cardiovascular outcomes and ASCVD event reduction were not evaluated in this review.
Background Aortic stenosis (AS) and hemodialysis are closely associated with fluid overload, a major determinant of poor prognosis in dialysis patients. Transcatheter aortic valve implantation (TAVI) may improve fluid overload by ameliorating cardiac hemodynamics. This study evaluated the effects of TAVI on dialysis-related parameters, primarily fluid overload, in patients with AS undergoing hemodialysis. Methods This retrospective study analyzed 34 consecutive hemodialysis patients who underwent TAVI between September 2023 and August 2025. Dialysis session data from one month before and after TAVI were assessed. Measured Weight was defined as the mean pre-dialysis body weight, and Ideal Weight as the post-TAVI dry weight. The Excessive Weight Index (EWI) was calculated as [(Measured Weight − Ideal Weight) / Ideal Weight] × 100 (%). Subgroup analyses were performed according to improvement in left ventricular ejection fraction (LVEF). Results After TAVI, LVEF significantly improved (49.8 ± 16.7% to 52.0 ± 16.1%, p = 0.007), and EWI significantly decreased (6.5% to 4.2%, p < 0.001). The reduction in EWI was more evident in patients with improved LVEF (p = 0.002). CTR also significantly decreased after TAVI (p < 0.001). Changes in EWI were correlated with baseline LVEF (p = 0.019). Conclusions TAVI was associated with improved fluid status in patients with AS undergoing hemodialysis. EWI may serve as a practical surrogate marker for assessing changes in fluid overload.
Background Heart failure with reduced ejection fraction (HFrEF) carries high morbidity and mortality. Guideline-directed medical therapy (GDMT) improves outcomes, yet implementation in routine practice remains inadequate.Community cardiology practices in Canada show suboptimal adherence to GDMT for HFrEF, highlighting a gap between evidence and care. Methods We conducted a prospective, two-phase, before-and-after observational quality-improvement study (the Heart Failure iDentification and Optimization in the Community [HFiDOC] program) in Canadian community cardiology practices (Phase 1, Ontario, 2021–2022; Phase 2, pan-Canadian, 2022–2024). Patient identification used EMR cell queries and natural language processing (NLP; DARWEN™ and Apollo™). In Phase 1, cardiologists received aggregate practice-level reports of GDMT use (traditional audit-and-feedback); in Phase 2, NLP-derived, patient-specific recommendations prioritized individuals for GDMT initiation or intensification delivered via secure dashboards or electronic fax. The primary outcome was the change in GDMT prescription rates. Results A total of 1,796 HFrEF patients followed by 57 community cardiologists were identified. At baseline, fewer than half received an MRA or SGLT2i, and only 22.7% were treated with all four GDMT classes. After a median 259 days, the proportion on quadruple therapy increased from 15.4% to 74.9% (p<0.0001); only 3.1% remained on no GDMT. Women were consistently less likely than men to receive ARNI, beta-blockers, and MRAs. Conclusions EMR-based identification of under-treated HFrEF patients, combined with personalized, tiered recommendations, substantially improved GDMT use in Canadian community cardiology practices, but persistent sex-based disparities require targeted strategies.
Background Frail patients are considered to be at higher risk of bleeding than non-frail patients; however, the association between frailty and bleeding risk in patients with heart failure (HF) remains unclear. Therefore, this study aims to evaluate the prevalence of bleeding events, examine the relationship between frailty severity and bleeding risk, and assess the association between bleeding events and subsequent mortality in patients with HF receiving antiplatelet or anticoagulant therapy. Methods This post hoc analysis used data from the Japanese Registry of Acute Decompensated Heart Failure–Next, a prospective, multicentre, nationwide registry. Frailty was evaluated using the Clinical Frailty Scale (CFS). Bleeding events were defined as major or clinically relevant non-major bleeding, based on the International Society on Thrombosis and Haemostasis Bleeding Scale. Results Among 4016 patients, 3029 (75.4%) were discharged on antiplatelet or anticoagulant medication. After excluding 89 with missing CFS data, 2940 patients were analyzed (mean age: 75 ± 12 years; 64.0% male). Patients were grouped by CFS scores: 1-3 (n = 1033); 4-5 (n = 1364); and 6-9 (n = 543). At 2 years, 149 (5.0%) experienced bleeding. Higher CFS scores were associated with increased bleeding risk (CFS score 4-5: hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.00-2.34; CFS score 6-9: HR: 1.75; 95% CI: 1.04-2.93). In addition, bleeding events were associated with a higher risk of mortality (HR: 2.80; 95% CI: 1.88-4.17, P < 0.001). Conclusions Frailty is associated with bleeding risk in patients with HF receiving antithrombotic therapy. Bleeding events were associated with a higher risk of subsequent death.
Background Given the paradigm shift from surgical aortic valve replacement (SAVR) to transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), we examined the temporal trends in AS hospitalization and treatment across Canada. Methods Data from the Canadian Institute for Health Information Discharge Abstract Database were used for a population-based cross-sectional study of inpatients between April 1, 2012, and March 31, 2024. We estimated national and provincial rates and reported the annual changes in hospitalization for AS, SAVR, and TAVI. Rates were expressed as episodes/procedures per million, and stratified by age group, sex, and urban-vs-rural residence. Results Between 2012 and 2024, hospitalizations for AS increased from 259.8 to 362.4 per million. Rates of SAVR declined from 104.4 to 66.5 per million, whereas rates of TAVI rose from 19.0 to 136.9 per million. The average annual per-million increases in AS hospitalizations were highest in Prince Edward Island (25.0), Nova Scotia (22.9), and Newfoundland and Labrador (21.3), particularly among individuals ≥ 80 years of age. The rates of SAVR declined, as the uptake of TAVI increased, with the shift mostly evident in those 60-79 years of age. Rates of TAVI were higher in men than in women, whereas AS hospitalizations were higher in rural than in urban areas. Conclusions Not unexpectedly there has been a dramatic shift from SAVR to TAVI observed, with an overall improvement in access to care. Nevertheless, sex-related and geographic disparities persist, highlighting the need for a coordinated national effort to ensure equitable access to AS management.
Background Subclinical atrial fibrillation (SCAF) is common in older adults, but its clinical significance in heart failure (HF) patients remains unclear. We evaluated the prevalence of SCAF in patients hospitalized with HF without prior atrial fibrillation (AF) and examined its association with HF-related outcomes. Methods Hospitalized patients with a primary diagnosis of HF exacerbation without prior AF were prospectively recruited across 5 sites in Ontario, Canada. Participants were discharged home with 28-day continuous electrocardiogram monitoring to detect SCAF. The association between SCAF and HF readmission, cardiovascular death, and other HF-related outcomes at 1-year follow-up was determined using logistic regression models. Results Among 242 participants, the mean age was 70.9 ± 13.3 years; 51% were male; the mean body mass index was 31.6 ± 10.8 kg/m2; and the mean left ventricular ejection fraction was 42.3% ± 17.1%. SCAF was detected in 17 patients (7.1%), comprising 31 episodes with a median duration of 6.3 hours (interquartile range: 0.21-32.5). SCAF was associated with cardiovascular death (6 vs 28 events; adjusted odds ratio (aOR) 4.22 [95% confidence interval {CI}, 1.34-12.8]; P = 0.014) and progression to clinical AF (5 vs 14 events; aOR 8.26, [95% CI, 2.33-28.2]; P = 0.001), whereas a significant association was not observed with HF rehospitalization (4 vs 54 events; aOR 1.12 [95% CI, 0.32-3.31]; P = 0.85). Conclusions In patients hospitalized with HF and no prior AF, SCAF was detected in approximately 1 in 14 individuals early after discharge and was associated with higher cardiovascular mortality and progression to clinical AF. No association with HF rehospitalization was observed, although the study may have been underpowered for this outcome. Clinical Trial Registration NCT03541616
Background Neuroendocrine tumours (NETs) are uncommon cancers that secrete vasoactive hormones. Around half of those with metastatic small bowel NETs develop carcinoid syndrome, and historically, up to 50% develop carcinoid heart disease (CHD). We evaluated clinical characteristics, echocardiographic features, and outcomes of patients with NETs and CHD in a contemporary cohort to identify factors associated with CHD development and mortality. Methods We identified patients with NETs who underwent an echocardiogram at a tertiary cancer centre–affiliated laboratory (2013-2023). Patients were classified based on whether they developed CHD. Clinical characteristics, echocardiographic data within 6 months of NET diagnosis, treatments, and outcomes were compared between CHD and non-CHD patients. Results Over a 10-year period, 87 patients with NETs were identified (48% female; median age, 61 years), with 18 (21%) developing CHD. Primary small bowel NETs were more common with CHD (83% vs 55%, P = 0.032). Patients with CHD exclusively had right-sided valve involvement: 100% tricuspid, 61% pulmonary, and 0% mitral/aortic; 17% had a patent foramen ovale. Compared to non-CHD patients, CHD patients demonstrated higher right atrial volume index and right ventricular basal diameter, with more frequent right ventricular dysfunction. Patients with CHD had a lower median survival from the time of NET diagnosis (6.6 vs 13.4 years; P = 0.007). Among CHD patients, primary NET resection was associated with improved survival (P = 0.006). Conclusions Within a contemporary cohort, approximately 1 in 5 patients with NETs develop CHD and exhibit only right-sided valve involvement. CHD was associated with increased mortality whereas primary NET resection was associated with improved survival.
BACKGROUND Persistent and paroxysmal atrial fibrillation (pAFib) are associated with a 3- to 5-fold increased stroke risk. Oral anticoagulation (OAC) mitigates this risk at the expense of increased bleeding events. Acetylcholine-induced AFib (AchAFib) occurs during coronary reactivity testing. It is unclear whether AchAFib carries the same thromboembolic risk as pAFib. We sought to determine the phenotypic profile and prognosis of AchAFib patients. METHODS Patients were included if they underwent coronary reactivity testing with acetylcholine. Patients were excluded if they had persistent AFib, or if maximal dose acetylcholine was not administered for any reason other than AchAFib. Follow-up was obtained during clinic visits and by telephone. RESULTS Among 567 patients, 42 (7.4%) suffered AchAFib. One had preceding pAFib treated with OAC and was excluded from the initial baseline characteristics analysis; the remaining 41 patients had no history of pAFib and did not receive OAC or experience subsequent pAFib or thromboembolic events during 918 +/- 556 days of follow-up. During long-term follow-up, 15 patients developed clinically apparent episodes of pAFib, none of whom experienced AchAFib. Compared to 42 patients with a history of preceding pAFib (n=32) and/or subsequent pAFib (n=15), the 41 patients with isolated AchAFib were significantly younger, and had significantly less left ventricular hypertrophy, smaller left atria, lower pulmonary pressures, and better exercise tolerance. CONCLUSIONS Isolated AchAFib may represent a benign event. Larger studies are required to confirm this conclusion.
Background Heart failure with non-reduced ejection fraction (HFnrEF) is a clinically heterogeneous condition leading to diagnostic challenges. Identifying populations with a higher likelihood of HFnrEF may increase diagnostic efficiency and translate into earlier appropriate care. Methods We conducted a retrospective cohort analysis of adult patients with an LVEF ≥ 40% and negative CA screening (SPECT-pyrophosphate imaging and/or via a dedicated CA clinic) at our center from January 2018 to August 2023. H2FPEF and HFA-PEFF scores were calculated for each patient. Patients were subsequently categorized as high (both H2FPEF ≥ 6 and HFA-PEFF ≥ 5), intermediate (either H2FPEF ≥ 6 or HFA-PEFF ≥ 5), or otherwise indeterminate probability of HFnrEF. Baseline medical management and clinical outcomes at 1 year were recorded. Results Of the 302 patients included (43% women, mean age 74 years, BMI 28.7 ± 6.8 kg/m2, NT-pro-BNP 4,640 ± 7,877 ng/L), 25% were classified as high and 42% as intermediate HFnrEF probability. However, only half had a documented clinical diagnosis of HFnrEF. Among patients with high or intermediate probability, 6% were treated with SGLT2i, 29% with MRA and 43% with ACEI/ARB. Heart failure hospitalizations occurred in 16% and mortality was 14% at 1 year in this group. Conclusion Two-thirds of patients with negative CA screening had intermediate or high probability of HFnrEF based on H2FPEF and HFA-PEFF scores, which was also associated with a higher rate of adverse events. Using these scores in combination to prioritize patient referrals to dedicated HFnrEF clinics may lead to improved treatment and outcomes.
Background Contemporary national data on temporary mechanical circulatory support (tMCS) practice patterns within Canada’s publicly funded healthcare system are limited. Methods In 2025, a cross-sectional survey was distributed to catheterization laboratory and cardiac intensive care unit directors at all 50 Canadian hospitals with cardiac catheterization capabilities. Data were collected on tMCS access, utilization, funding, protocols, and perceived barriers. Results Forty-seven institutions (94%) responded. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was available at 33 sites (70%), percutaneous microaxial flow pumps (pMFP) at 25 sites (53%), 23 (49%) had both, and 12 (26%) had no advanced tMCS; 88% of sites with pMFP were academic, while 94% of sites with VA-ECMO were academic. Sites use pMFP for cardiogenic shock (CS) (92%), high-risk percutaneous coronary intervention (96%), and left ventricular unloading during VA-ECMO (56%). VA-ECMO is used for CS (97%), post-cardiotomy shock (90%) and extracorporeal cardiopulmonary resuscitation (55%). Funding is predominantly hospital based (91%), with variable provincial support. Major barriers to tMCS access include lack of funding (92%) and limited interprofessional support (92%). Among tMCS capable sites, protocols are common for eligibility (83%) and daily management (71%), but less frequent for insertion (43%) and weaning or explant (43%). Conclusions Access to tMCS in Canada is heterogeneous and concentrated in academic centers, with funding and limited interprofessional support representing the principal barriers to broader adoption. Strengthening funding frameworks, expanding regional systems of care and expertise, and implementing protocolized management may improve equitable access to high quality tMCS care across Canada.
Background Mitral transcatheter edge-to-edge repair (M-TEER) is an established therapy for patients with severe mitral regurgitation (MR), with randomized trials demonstrating improved outcomes in selected ambulatory populations. However, patients hospitalized with decompensated heart failure (HF) have been largely excluded from these studies, and outcomes of inpatient M-TEER remain incompletely characterized. Methods We conducted a retrospective cohort study of 149 consecutive patients who underwent M-TEER during hospitalization for decompensated HF at a tertiary care centre between 2014 and 2024. The primary endpoint was 1-year all-cause mortality. The secondary endpoint was a composite of 1-year mortality or hospitalization. Multivariable logistic regression was used to identify predictors of outcomes. Results Patients were at high risk, with a substantial comorbidity burden and advanced HF. MR < moderate was achieved in 83.9%. In-hospital mortality was 10.8%, increasing to 30.2% at 1 year. The composite endpoint occurred in 52.3%. Prior valve surgery and prior stroke independently predicted 1-year mortality, and prior stroke and lower left ventricular ejection fraction predicted the composite endpoint. Conclusions In hospitalized patients with decompensated HF, inpatient M-TEER is feasible and achieves high rates of MR reduction. However, 1-year mortality and hospitalization remain substantial and are driven primarily by comorbidities and ventricular dysfunction. Careful patient selection is critical to optimize clinical benefit.
Postoperative atrial fibrillation (POAF) remains the most common complication following cardiac surgery and contributes substantially to patient morbidity and healthcare utilization. Although amiodarone is among the most effective pharmacologic agents for the prevention and treatment of POAF, its routine use is limited by systemic toxicity and drug interactions. Localized delivery strategies may achieve therapeutic myocardial concentrations while minimizing systemic exposure, but they have never been tested in appropriately powered trials. Experimental studies have indicated that epicardial and intrapericardial administration of amiodarone can reduce atrial vulnerability to tachyarrhythmias while maintaining low circulating drug levels. Preliminary clinical investigations have suggested a potential reduction in POAF incidence with topical amiodarone; however, studies have yielded inconsistent results, leaving uncertainty regarding clinical efficacy. The BiodEgradable soaked Amiodarone paTch use for the prevention of Atrial Fibrillation after cardiac surgery (BEAT-AF) trial is a single-center, double-blind, randomized, placebo-controlled trial designed to evaluate the efficacy and safety of topical amiodarone administration for the prevention of POAF following cardiac surgery. A minimum of 500 patients undergoing elective cardiac surgery through median sternotomy will be randomized in a 1:1 ratio to receive either amiodarone-soaked (150 mg/3 mL) or saline-soaked oxidized regenerated cellulose patches applied intra-operatively to the dome of the left atrium and the ostia of the right pulmonary veins immediately prior to sternal closure. The primary outcome is the occurrence of POAF within five days postoperatively. This trial will inform use of topical amiodarone as a strategy for POAF prevention in cardiac surgery patients. NCT06722196.
Background Valvular heart disease (VHD) is estimated to affect nearly one million Canadians, yet awareness and screening rates remain poorly characterized in primary care settings. Cardiac auscultation is the cornerstone of early detection, but its consistent application in primary care (PC) encounters is unclear. The objective was to assess VHD awareness, symptom recognition, concern levels, and frequency of stethoscope checks during primary care visits among Canadians aged ≥50. Methods Cross-sectional, quota-based online survey administered by Environics Research from January 20, 2025, to February 1, 2025, to 1,000 Canadian residents aged ≥50. Quotas based on 2021 Canadian Census distributions. Results Among 1,000 respondents (53% women), 49% reported awareness of VHD, while 7% expressed concern. Despite 75% reporting a PC visit within 12 months, only 48% recalled having a stethoscope check. Substantial gender disparities existed in screening frequency: 32% of women versus 45% of men received a stethoscope check at every PC visit (P<0.05). Rural residents demonstrated lower PCP access (69% vs. 77%; P<0.05), reduced VHD awareness, and decreased likelihood of seeking care for cardiac symptoms. Among those examined, 9% had abnormalities detected, with higher detection rates in women (12%) versus men (6%) (P<0.05). Sixty nine percent indicated likelihood of obtaining stethoscope check at pharmacies if available. Conclusions Limited symptom familiarity, gap between PC visits and reported stethoscope check, coupled with gender-based screening disparities, may contribute to delayed diagnosis, increasing treatment complexity and surgical risk. Community-based screening initiatives may serve as complementary safety nets to increase detection rates, and help address system-level screening gaps.
Background Recent guidelines recommend coronary computed tomography angiography (CCTA) instead of invasive coronary angiography (ICA) for pre-operative coronary evaluation in valve surgery patients with low-moderate risk of coronary artery disease (CAD). However, evidence supporting the use of CCTA as a first-line pre-operative coronary assessment strategy in this population remains uncertain. We performed a systematic review and meta-analysis comparing diagnostic performance and clinical outcomes of CCTA versus ICA. Methods We searched five databases through October 2025 for studies comparing pre-operative CCTA with ICA in valve surgery patients reporting diagnostic accuracy and/or clinical outcomes. Pooled estimates were calculated. Co-primary outcomes were per-patient diagnostic accuracy and late major adverse cardiovascular events (MACE). Results Sixteen observational studies were included (n=5781). Pooled sensitivity and specificity of CCTA relative to ICA were 86% (95% CI: 0.78-0.91) and 87% (95% CI: 0.81-0.91), respectively (AUC=0.93). There was no difference in concomitant CABG (RD: -0.10, 95% CI: -0.36-0.17, P=0.32) and unplanned CABG rates (RD: -0.00, 95% CI: -0.01-0.01, P=0.76) between CCTA and ICA. In-hospital/30-day outcomes were similar, including mortality (OR: 1.07, 95% CI: 0.42-2.70, P=0.79), MI (OR: 0.90, 95% CI: 0.11-7.21, P=0.63), stroke (OR: 1.41, 95% CI: 0.01-286.87, P=0.56), AKI (OR: 1.07, 95% CI: 0.90-1.26, P=0.25), and revascularization (RD: -0.00, 95% CI: -0.00-0.00, P=0.26). Late MACE did not differ (IRR: 1.16, 95% CI: 0.15-8.96, P=0.52, median follow-up: 31.7 months). Conclusions CCTA may serve as a reasonable rule-out strategy for CAD in appropriately selected elective valve surgery patients. While no significant differences in clinical outcomes were observed compared with ICA, larger contemporary prospective studies are required.
Cardiovascular disease remains a leading cause of morbidity and mortality in Canada. With an aging population, the burden of cardiovascular disease is expected to increase. While national reporting exists for certain cardiac procedures, there are significant gaps and variability in the reporting of time to specialists' consultations, diagnostic testing, electrophysiology procedures, and valvular heart disease interventions. Lack of systematic surveillance strategies, formalized wait-time policies, and healthcare capacity constraints contribute to prolonged wait times in cardiovascular care in Canada. These delays contribute to downstream adverse outcomes of premature deaths, preventable hospitalizations, disease progression, and rising healthcare costs. We present key lessons from national and international healthcare initiatives in addressing wait times in cardiac care. Addressing these gaps will require policy actions such as implementation of systematic surveillance programs and performance benchmarks, digital health initiatives, and reorganization of healthcare resources.
Cardiac implantable electronic devices (CIEDs)are implanted in over 3 million people globally each year, resulting in substantial burden to the health care system in caring for these patients, particularly as the population ages. The follow up for these devices is critical to mitigate device related issues, detect and treat arrhythmias and provide some measure of security to the patient. Traditional follow up has been in clinics that may or may not have electrophysiology on site. Remote monitoring has been available for several years and is done using a transmitter that communicates with device clinics from the patient’s home, yet is used inconsistently. More importantly, there is a lack of reliable communication between the clinic and the patient after a transmission is sent, despite patients desiring knowledge regarding their device function to achieve health security. The Cardiovascular Network of Canada has tasked itself with the design and testing of a comprehensive platform entitled Virtual Integrated Reliable Transformative User-driven E-health System(VIRTUES) to address the gaps in care delivery for patients with CIEDs. We describe the program, including parallel multicenter randomized clinical trials, designed to test VIRTUES along with remote monitoring as compared to standard of care to ascertain whether this system is non-inferior in terms of safety and efficacy and that the VIRTUES care is superior to usual care in reducing cost to the patients and to the healthcare system. The clinical implications could improve how device care is delivered, reducing workloads on clinics with this patient-centered model.
Background New-onset atrial fibrillation (AF) occurring after surgery is called postoperative atrial fibrillation (POAF). Whether its clinical impact differs according to the type of thoracic surgery is unclear, so we investigated the differences of POAF after thoracic aortic (AS), esophageal (ES), and lung (LS) surgery. Methods In this observational cohort study, we analyzed 2424 consecutive patients from 2010-2023 that underwent these surgeries. Late-occurring AF was defined as an electrocardiogram-documented AF event (lasting ≥30s or the entire 12-lead standard electrocardiogram) after 30 days postoperatively. We examined the association between POAF and late-occurring AF. Results POAF occurred in 339 patients (13.9%) and its prevalence was 49.9% (n=205) after AS, 16.8% (n=80) after ES, and 3.6% (n=54) after LS (p<0.001). Late-occurring AF occurred in 105 patients with POAF (31.0%) and 69 patients without POAF (3.3%). In patients with POAF (n=339), the incidences of late-occurring AF were 16.0% (AS), 3.2% (ES) and 13.9% (LS) per year. Cox regression analysis and Kaplan–Meier curve revealed that AF recurrence was significantly less common after ES than after AS or LS (p<0.001). Especially after ES, the incidence of late-occurring AF was not significantly different between patients with a single-day episode of POAF and those without POAF (p=0.96). Conclusion Late-occurring AF was more commonly observed in patients with POAF. However, the AF recurrence rate differed by type of thoracic surgery and the number of days with POAF. Therapeutic strategy for POAF might require reconsideration.
