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Lauck SB, Saarijärvi M, De Sousa I, Straiton N, Borregaard B, Lewis KB. Accelerating knowledge translation to improve cardiovascular outcomes and health services: opportunities for bridging science and clinical practice. Eur J Cardiovasc Nurs 2023; 22:e125-e132. [PMID: 37578067 DOI: 10.1093/eurjcn/zvad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023]
Abstract
Knowledge translation (KT) is the exchange between knowledge producers and users to understand, synthesize, share, and apply evidence to accelerate the benefits of research to improve health and health systems. Knowledge translation practice (activities/strategies to move evidence into practice) and KT science (study of the methodology and approaches to promote the uptake of research) benefit from the use of conceptual thinking, the meaningful inclusion of patients, and the application of intersectionality. In spite of multiple barriers, there are opportunities to develop strong partnerships and evidence to drive an impactful research agenda and increase the uptake of cardiovascular research.
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Affiliation(s)
- Sandra B Lauck
- School of Nursing, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Markus Saarijärvi
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Ismália De Sousa
- School of Nursing, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Nicola Straiton
- Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Nursing Research Institute, St Vincent's Health Network, Sydney, Australia
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Krystina B Lewis
- Faculty of Health Sciences, University of Ottawa, University of Ottawa Heart Institute, Ottawa, Canada
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2
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Mahmoud Z, Sanusi M, Nartey C, Adedinsewo D. Using Technology to Deliver Cardiovascular Care in African Countries. Curr Cardiol Rep 2023; 25:1823-1830. [PMID: 37966691 DOI: 10.1007/s11886-023-01988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW This review aims to explore the applications of digital technology in cardiovascular care across African countries. It highlights the opportunities and challenges associated with leveraging technology to enhance patient self-monitoring, remote patient-clinician interactions, telemedicine, clinician and patient education, and research facilitation. The purpose is to highlight how technology can transform cardiovascular care in Africa. RECENT FINDINGS Recent findings indicate that the increasing penetration of mobile phones and internet connectivity in Africa offers a unique opportunity to improve cardiovascular care. Smartphone-based applications and text messaging services have been employed to promote self-monitoring and lifestyle management, although challenges related to smartphone ownership and digital literacy persist. Remote monitoring of patients by clinicians using home-based devices and wearables shows promise but requires greater accessibility and validation studies in African populations. Telemedicine diagnosis and management of cardiovascular conditions demonstrates significant potential but faces adoption challenges. Investing in targeted clinician and patient education on novel digital technology and devices as well as promoting technology-assisted research for participant recruitment and data collection can facilitate cardiovascular care advancements in Africa. Technology has the potential to revolutionize cardiovascular care in Africa by improving access, efficiency, and patient outcomes. However, barriers related to limited resources, supportive infrastructure, digital literacy, and access to devices must be addressed. Strategic actions, including investment in digital infrastructure, training programs, community collaboration, and policy advocacy, are crucial to ensuring equitable integration of digital health solutions.
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Affiliation(s)
- Zainab Mahmoud
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO, 63110-1093, USA.
| | | | - Cecilia Nartey
- Division of Cardiology, Department of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO, 63110-1093, USA
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3
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Højstrup S, Thomsen JH, Prescott E. Disparities in cardiovascular disease and treatment in the Nordic countries. Lancet Reg Health Eur 2023; 33:100699. [PMID: 37953994 PMCID: PMC10636266 DOI: 10.1016/j.lanepe.2023.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 11/14/2023]
Abstract
The Nordic countries, including Denmark, Finland, Iceland, Norway, and Sweden have seen a steep decline in cardiovascular mortality in recent decades. They are among the most egalitarian countries by several measures, and all have universal, publicly funded welfare systems providing healthcare for all citizens. However, despite these seemingly ideal conditions, disparities in access to cardiovascular care and outcomes persist. To address this challenge, The Lancet Region Health-Europe convened experts from a broad range of countries to summarize the current state of knowledge on cardiovascular disease disparities across Europe. This Series Paper presents the main challenges in Nordic countries based on evidence from high-quality nationwide registries. Focusing on major cardiovascular health determinants, areas in need of improvement were identified. There is a need for addressing structural causes underlying these disparities, such as poverty and discrimination, but also to improve access to healthcare in deprived neighborhoods and to address underlying social determinants of health that may mitigate disparities in cardiovascular outcomes. Overall, while the Nordic countries have made great strides in promoting egalitarianism and providing universal healthcare, there is still much work to be done to ensure equitable access to care and improved cardiovascular outcomes for all members of society.
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Affiliation(s)
- Signe Højstrup
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jakob Hartvig Thomsen
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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4
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den Hartog SJ, Roozenbeek B, van der Bij S, Amini M, van Leeuwen N, Boersma E, Dirven CMF, Dippel DWJ, Lingsma HF. Standardized mortality ratios for regionalized acute cardiovascular care. BMC Health Serv Res 2023; 23:951. [PMID: 37670336 PMCID: PMC10481617 DOI: 10.1186/s12913-023-09883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Standardized Mortality Ratios (SMRs) are case-mix adjusted mortality rates per hospital and are used to evaluate quality of care. However, acute care is increasingly organized on a regional level, with more severe patients admitted to specialized hospitals. We hypothesize that the current case-mix adjustment insufficiently captures differences in case-mix between non-specialized and specialized hospitals. We aim to improve the SMR by adding proxies of disease severity to the model and by calculating a regional SMR (RSMR) for acute cerebrovascular disease (CVD) and myocardial infarction (MI). METHODS We used data from the Dutch National Basic Registration of Hospital Care. We selected all admissions from 2016 to 2018. SMRs and RSMRs were calculated by dividing the observed in-hospital mortality by the expected in-hospital mortality. The expected in-hospital mortality was calculated using logistic regression with adjustment for age, sex, socioeconomic status, severity of main diagnosis, urgency of admission, Charlson comorbidity index, place of residence before admission, month/year of admission, and in-hospital mortality as outcome. RESULTS The IQR of hospital SMRs of CVD was 0.85-1.10, median 0.94, with higher SMRs for specialized hospitals (median 1.12, IQR 1.00-1.28, 71%-SMR > 1) than for non-specialized hospitals (median 0.92, IQR 0.82-1.07, 32%-SMR > 1). The IQR of RSMRs was 0.92-1.09, median 1.00. The IQR of hospital SMRs of MI was 0.76-1.14, median 0.98, with higher SMRs for specialized hospitals (median 1.00, IQR 0.89-1.25, 50%-SMR > 1 versus median 0.94, IQR 0.74-1.11, 44%-SMR > 1). The IQR of RSMRs was 0.90-1.08, median 1.00. Adjustment for proxies of disease severity mostly led to lower SMRs of specialized hospitals. CONCLUSION SMRs of acute regionally organized diseases do not only measure differences in quality of care between hospitals, but merely measure differences in case-mix between hospitals. Although the addition of proxies of disease severity improves the model to calculate SMRs, real disease severity scores would be preferred. However, such scores are not available in administrative data. As a consequence, the usefulness of the current SMR as quality indicator is very limited. RSMRs are potentially more useful, since they fit regional organization and might be a more valid representation of quality of care.
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Affiliation(s)
- Sanne J den Hartog
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
- Dutch Hospital Data, Utrecht, The Netherlands.
- Erasmus MC, Department of Neurology, Department of Radiology and Nuclear Medicine, Department of Public Health, University Medical Center, Room Ee2240, 3000 CA, Rotterdam, P.O. Box 2040, the Netherlands.
| | - Bob Roozenbeek
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Marzyeh Amini
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Langlais ÉL, Thériault-Lauzier P, Marquis-Gravel G, Kulbay M, So DY, Tanguay JF, Ly HQ, Gallo R, Lesage F, Avram R. Novel Artificial Intelligence Applications in Cardiology: Current Landscape, Limitations, and the Road to Real-World Applications. J Cardiovasc Transl Res 2022:10.1007/s12265-022-10260-x. [PMID: 35460017 DOI: 10.1007/s12265-022-10260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
Cardiovascular diseases are the leading cause of death globally and contribute significantly to the cost of healthcare. Artificial intelligence (AI) is poised to reshape cardiology. Using supervised and unsupervised learning, the two main branches of AI, several applications have been developed in recent years to improve risk prediction, allow large-scale analysis of medical data, and phenotype patients for personalized medicine. In this review, we examine the key advances in AI in cardiology and its limitations regarding bias in the data, standardization in reporting, data access, and model trust and accountability in cases of error. Finally, we discuss implementation methods to unleash AI's potential in making healthcare more accurate and efficient. Several steps need to be followed and challenges overcome in order to successfully integrate AI in clinical practice and ensure its longevity.
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Affiliation(s)
- Élodie Labrecque Langlais
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
- Biomedical Engineering, École Polytechnique de Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Pascal Thériault-Lauzier
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Guillaume Marquis-Gravel
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
- Department of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Merve Kulbay
- Department of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Derek Y So
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Jean-François Tanguay
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Hung Q Ly
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Richard Gallo
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
- Department of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Frédéric Lesage
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
- Biomedical Engineering, École Polytechnique de Montréal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - Robert Avram
- Division of Cardiology, Department of Medicine, Montreal Heart Institute, University of Montreal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
- Department of Medicine, University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada.
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Fredericks S, Van Bulck L, Ski C, Skibelund AK, Sanders J. From new kid on the block to leading journal: a review and reflection on the first 20 years of the European Journal of Cardiovascular Nursing. Eur J Cardiovasc Nurs 2022; 21:4-8. [PMID: 34977936 DOI: 10.1093/eurjcn/zvab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND This year marks the 20th birthday of the European Journal of Cardiovascular Nursing (EJCN). The official journal of the Association of Cardiovascular Nursing and Allied Professionals, is now recognized as one of the leading nursing and allied professional journals. AIMS This article reflects on the developments and impact of the journal over its 20-year lifespan. METHODS AND RESULTS We present a descriptive account of the journal from inception (2002) until present day (2021), using data provided by the EJCN editorial office and extracted from published and available information. In the last 20 years, the EJCN has published 20 volumes, 106 issues, and 1320 papers from 79 countries. The volume and quality of papers has been consistently increasing, culminating in a 2020 impact factor of 3.908, the highest in its history, ranking second for nursing science. Papers are predominantly patient focused with a range of research methods that cover an extensive range of cardiovascular conditions. Authors who contributed to the first issue continued their contribution; 293 articles in total. CONCLUSION The EJCN has evolved into a leading journal of cardiovascular care. As the journal enters its next era, with a new Editor-in-Chief, it is appropriate to have reflected on the phenomenal contribution of the outgoing Editor-in-Chief, and the editorial team, over the last 20 years.
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Affiliation(s)
- Suzanne Fredericks
- ACNAP Science Committee member and Daphne Cockwell School of Nursing, Ryerson University, 288 Church Street; Toronto, ONT; M5B 1Z5, Canada
| | - Liesbet Van Bulck
- ACNAP Young Community National Ambassador and KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Chantal Ski
- ACNAP Science Committee member, Integrated Care Academy, University of Suffolk, Ipswich IP4 1QJ, UK
| | | | - Julie Sanders
- ACNAP Science Committee Chair and St Bartholomew's Hospital, Barts Health NHS Trust. London EC1A 7BE, UK.,Clinical Professor Cardiovascular Nursing William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
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7
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Diamond JE, McIlvaine S, Korjian S, Cruden P, Dechen T, Piatkowski G, Kazi DS, Gavin M. Patterns of Recovery in Cardiovascular Care after the COVID-19 Pandemic Surge. Am J Med Sci 2021; 363:305-310. [PMID: 34597690 PMCID: PMC8481002 DOI: 10.1016/j.amjms.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/05/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022]
Abstract
Background Cardiovascular disease remains the number one cause of death globally. Patients with cardiovascular disease are at risk of poor outcomes from deferral of healthcare during the coronavirus disease 2019 (COVID-19) pandemic. Little is known about recovery of cardiovascular hospitalizations or procedural volume following the COVID-19 surges. We sought to examine the cardiovascular diagnoses requiring healthcare utilization surrounding the first and second COVID-19 waves and characterize trends in return to pre-pandemic levels at a tertiary care center in Massachusetts. Materials and Methods Using electronic health records and administrative claims data, we performed a retrospective analysis of patients undergoing cardiovascular procedures and admitted to inpatient cardiology services throughout the first two COVID surges. ICD-10 codes were used to categorize admissions. Results Patients who presented for care during the initial COVID-19 surge were younger, had higher comorbidity burden, and longer length-of-stay compared with pre- and post-surge. Marked declines in admissions in the first wave (to 29% of pre-surge levels) followed eventually by complete recovery were noted across all cardiac diagnoses, with smaller declines seen in the second wave. Cardiac procedural volume declined significantly during the initial surge but quickly rebounded post-surge, eventually eclipsing pre-COVID volume. Conclusions There was a gradual but initially incomplete recovery to pre-surge levels of hospitalizations and procedures during the reopening phase, which eventually rebounded to meet or exceed pre-COVID-19 levels. To the extent that this reflects deferred or foregone essential care, it may adversely affect long-term cardiovascular outcomes. These results should inform planning for cardiovascular care delivery during future pandemic surges.
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Affiliation(s)
- Jamie E Diamond
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Susan McIlvaine
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Serge Korjian
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Patrick Cruden
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Tenzin Dechen
- Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Gail Piatkowski
- Department of Decision Support, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Dhruv S Kazi
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Michael Gavin
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Bots SH, Siegersma KR, Onland-Moret NC, Asselbergs FW, Somsen GA, Tulevski II, den Ruijter HM, Hofstra L. Routine clinical care data from thirteen cardiac outpatient clinics: design of the Cardiology Centers of the Netherlands (CCN) database. BMC Cardiovasc Disord 2021; 21:287. [PMID: 34112101 PMCID: PMC8191101 DOI: 10.1186/s12872-021-02020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 04/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the increasing availability of clinical data due to the digitalisation of healthcare systems, data often remain inaccessible due to the diversity of data collection systems. In the Netherlands, Cardiology Centers of the Netherlands (CCN) introduced "one-stop shop" diagnostic clinics for patients suspected of cardiac disease by their general practitioner. All CCN clinics use the same data collection system and standardised protocol, creating a large regular care database. This database can be used to describe referral practices, evaluate risk factors for cardiovascular disease (CVD) in important patient subgroups, and develop prediction models for use in daily care. CONSTRUCTION AND CONTENT The current database contains data on all patients who underwent a cardiac workup in one of the 13 CCN clinics between 2007 and February 2018 (n = 109,151, 51.9% women). Data were pseudonymised and contain information on anthropometrics, cardiac symptoms, risk factors, comorbidities, cardiovascular and family history, standard blood laboratory measurements, transthoracic echocardiography, electrocardiography in rest and during exercise, and medication use. Clinical follow-up is based on medical need and consisted of either a repeat visit at CCN (43.8%) or referral for an external procedure in a hospital (16.5%). Passive follow-up via linkage to national mortality registers is available for 95% of the database. UTILITY AND DISCUSSION The CCN database provides a strong base for research into historically underrepresented patient groups due to the large number of patients and the lack of in- and exclusion criteria. It also enables the development of artificial intelligence-based decision support tools. Its contemporary nature allows for comparison of daily care with the current guidelines and protocols. Missing data is an inherent limitation, as the cardiologist could deviate from standardised protocols when clinically indicated. CONCLUSION The CCN database offers the opportunity to conduct research in a unique population referred from the general practitioner to the cardiologist for diagnostic workup. This, in combination with its large size, the representation of historically underrepresented patient groups and contemporary nature makes it a valuable tool for expanding our knowledge of cardiovascular diseases. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Sophie H Bots
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Klaske R Siegersma
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Amsterdam University Medical Centres, location VUmc, Amsterdam, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - G Aernout Somsen
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Igor I Tulevski
- Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Leonard Hofstra
- Department of Cardiology, Amsterdam University Medical Centres, location VUmc, Amsterdam, The Netherlands.,Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
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9
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Walunas TL, Ye J, Bannon J, Wang A, Kho AN, Smith JD, Soulakis N. Does coaching matter? Examining the impact of specific practice facilitation strategies on implementation of quality improvement interventions in the Healthy Hearts in the Heartland study. Implement Sci 2021; 16:33. [PMID: 33789696 PMCID: PMC8011080 DOI: 10.1186/s13012-021-01100-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Practice facilitation is a multicomponent implementation strategy used to improve the capacity for practices to address care quality and implementation gaps. We sought to assess whether practice facilitators use of coaching strategies aimed at improving self-sufficiency were associated with improved implementation of quality improvement (QI) interventions in the Healthy Hearts in the Heartland Study. METHODS We mapped 27 practice facilitation activities to a framework that classifies practice facilitation strategies by the degree to which the practice develops its own process expertise (Doing Tasks, Project Management, Consulting, Teaching, and Coaching) and then used regression tree analysis to group practices by facilitation strategies experienced. Kruskal-Wallis tests were used to assess whether practice groups identified by regression tree analysis were associated with successful implementation of QI interventions and practice and study context variables. RESULTS There was no association between number of strategies performed by practice facilitators and number of QI interventions implemented. Regression tree analysis identified 4 distinct practice groups based on the number of Project Management and Coaching strategies performed. The median number of interventions increased across the groups. Practices receiving > 4 project management and > 6 coaching activities implemented a median of 17 of 35 interventions. Groups did not differ significantly by practice size, association with a healthcare network, or practice type. Statistically significant differences in practice location, number and duration of facilitator visits, and early study termination emerged among the groups, compared to the overall practice population. CONCLUSIONS Practices that engage in more coaching-based strategies with practice facilitators are more likely to implement more QI interventions, and practice receptivity to these strategies was not dependent on basic practice demographics.
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Affiliation(s)
- Theresa L Walunas
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 625 N. Michigan, 15th Floor, Chicago, IL, 60611, USA.
| | - Jiancheng Ye
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 625 N. Michigan, 15th Floor, Chicago, IL, 60611, USA
| | - Jennifer Bannon
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 625 N. Michigan, 15th Floor, Chicago, IL, 60611, USA
| | - Ann Wang
- Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 625 N. Michigan, 15th Floor, Chicago, IL, 60611, USA
| | - Abel N Kho
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Health Information Partnerships, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, 625 N. Michigan, 15th Floor, Chicago, IL, 60611, USA.,Department of Preventive Medicine, Division of Healthcare and Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Science, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nicholas Soulakis
- Department of Preventive Medicine, Division of Healthcare and Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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10
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Kalra A, Bhatt DL, Wei J, Anderson KL, Rykowski S, Kerkar PG, Kumar G, Maddox TM, Oetgen WJ, Virani SS. Electronic health records and outpatient cardiovascular disease care delivery: Insights from the American College of Cardiology's PINNACLE India Quality Improvement Program (PIQIP). Indian Heart J 2018; 70:750-752. [PMID: 30392517 PMCID: PMC6204447 DOI: 10.1016/j.ihj.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 03/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background There has been a push toward implementation of electronic health records (EHRs) in federally-funded hospitals under the current policies initiated by the Indian government, with a lack of evidence supporting their adoption. We analyzed data from the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP) to evaluate the association between EHR use and quality of cardiovascular disease care in India. Methods and Results Between 2011–2016, we collected data on performance measures for patients with coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF) among 17 participating practices in PIQIP. There were 19,035 patients with CAD, 9,373 patients with HF, and 1,127 patients with AF. Documentation of co-morbidity burden in patients with CAD was lower among practices with EHR—hypertension (49.8% vs. 52.1%, p = 0.003), diabetes (34.9% vs. 38.3%, p < 0.001), and hyperlipidemia (0.2 vs. 3.9%, p < 0.001). On the contrary, documentation of medication prescription was higher in CAD patients seen at practices with EHR—aspirin (63.2% vs. 17.8%, p < 0.001), clopidogrel (41.7% vs. 27.4%, p < 0.001), beta-blockers (61.4% vs. 9.8%, p < 0.001), and ACE-i or ARBs (53.9% vs. 16.4%, p < 0.001). Similarly, documentation of receipt of beta-blockers (43.8% vs. 10.7%, p < 0.001), ACE-i or ARBs (40.8% vs. 16.1%, p < 0.001), and beta-blockers + ACE-i or ARBs (36.4% vs. 3.6%, p < 0.001) was also significantly higher in patients with HF seen at practices with EHR. Among patients with AF, documentation of oral anticoagulation use was significantly higher among EHR practices—warfarin (42.5% vs. 26.1%, p < 0.001). Conclusions Documentation of receipt of guideline-directed medical therapy in CAD, HF, and AF was significantly higher in practices with EHRs in India compared with sites without EHRs. Our findings shed a spotlight on the value of EHRs in future health care policy-making in India with regard to widespread adoption of EHRs in primary and advanced specialty care settings across public and private sectors.
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Affiliation(s)
- Ankur Kalra
- Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC (Sri Ram Cardio-thoracic and Neurosciences Centre) Pvt. Ltd., New Delhi, India; Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, United States
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, United States
| | - Jessica Wei
- American College of Cardiology Foundation, Washington, DC, United States
| | - Karen L Anderson
- American College of Cardiology Foundation, Washington, DC, United States
| | - Stefan Rykowski
- American College of Cardiology Foundation, Washington, DC, United States
| | - Prafulla G Kerkar
- King Edward VII Memorial Hospital and Seth G S Medical College, Mumbai, India; Asian Heart Institute and Research Center, Mumbai, India
| | | | - Thomas M Maddox
- Veterans Affairs Eastern Colorado Health Care System, United States; University of Colorado School of Medicine, United States; Colorado Cardiovascular Outcomes Research Consortium, Denver, CO, United States
| | - William J Oetgen
- American College of Cardiology Foundation, Washington, DC, United States
| | - Salim S Virani
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, United States; Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, United States; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
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Krishnaswami A, Maurer MS, Alexander KP. Contextualizing Myocardial Infarction: Comorbidities and Priorities in Older Adults. Am J Med 2017; 130:1144-1147. [PMID: 28687265 DOI: 10.1016/j.amjmed.2017.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 05/27/2017] [Accepted: 05/31/2017] [Indexed: 01/06/2023]
Abstract
Cardiovascular care for older adults has become increasingly complex owing to a rise in the concurrent comorbidity burden that accompanies senescence. Internists, hospitalists, and cardiologists often encounter geriatric patients with multiple chronic conditions needing acute cardiovascular care. Abnormal cardiac biomarker levels in patients with multiple noncardiac conditions are a common reason for older adults to enter the hospital. This type of acute coronary syndrome, defined as a non-ST segment elevation myocardial infarction or, more precisely, type 2 myocardial infarction, often leads to substantial consternation. Although guideline-based single-disease care may be appropriate in younger individuals, a more cautious approach is needed when considering optimal care strategies for older adults. We discuss a case of an older adult presenting with type 2 myocardial infarction, to highlight a modern-day approach that requires a deliberate shift from an evidence-based focus to a more value-based geriatric mindset.
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Affiliation(s)
- Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, Calif; Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif.
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Karen P Alexander
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC
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Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is now the leading cause of morbidity and mortality worldwide. Industrialization and economic growth have led to an unprecedented increment in the burden of CVD and their risk factors in less industrialized regions of the world. While there are abundant data on CVD and their risk factors from longitudinal cohort studies done in the West, good-quality data from South Asia are lacking. RECENT FINDINGS Several multi-institutional, observational, prospective registries, and epidemiologic cohorts in South Asia have been established to systematically evaluate the burden of CVD and their risk factors. The PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP), the Kerala Acute Coronary Syndrome (ACS), and Trivandrum Heart Failure registries have focused on secondary prevention of CVD and performance measurement in both outpatient and inpatient settings, respectively. The Prospective Urban and Rural Epidemiology (PURE), Centre for Cardiometabolic Risk Reduction in South Asia (CARRS), and other epidemiologic and genetic studies have focused on primary prevention of CVD and evaluated variables such as environment, smoking, physical activity, health systems, food and nutrition policy, dietary consumption patterns, socioeconomic factors, and healthy neighborhoods. The international cardiovascular community has been responsive to a burgeoning cardiovascular disease burden in South Asia. Several collaborations have formed between the West (North America in particular) and South Asia to catalyze evidence-based and data-driven changes in the federal health policy in this part of the world to promote cardiovascular health and mitigate cardiovascular risk.
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Affiliation(s)
- Ankur Kalra
- Kalra Hospital SRCNC (Sri Ram Cardio-Thoracic and Neurosciences Centre) Pvt. Ltd., New Delhi, India.,Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,Weill Cornell Medical College, New York, NY, USA.,Safety, Quality, Informatics and Leadership, Harvard Medical School, Boston, MA, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center; Division of Cardiovascular Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kunal Suri
- Kalra Hospital SRCNC (Sri Ram Cardio-Thoracic and Neurosciences Centre) Pvt. Ltd., New Delhi, India
| | - Sundeep Mishra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, 2002 Holcombe Blvd, Houston, TX, 77030, USA. .,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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Abstract
Hospital 30-day readmissions have become a major priority for hospitals. Hospitals face penalties for excessive readmissions for acute myocardial infarction (AMI) and heart failure (HF). Thus, it is important for hospitals to understand the transitions of care that occur for both of these conditions, and what tools are available to guide the processes involved. A multi-disciplinary team including Emergency Medical Service providers, Emergency Medicine providers, cardiologists, hospitalists, pharmacists, nurses, case managers, and outpatient physicians can all be involved in the process of safely transitioning a patient between care settings. Small-scale studies in the geriatric population have shown improved transitions of care and decreased readmissions with these care teams. The emergency department is a key transition point for patients with AMI and HF, yet it is rarely identified and utilized as such in transitions of care interventions. Future research and implementation projects will need to refine and expand the role of the emergency department in the process.
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