As a learning organization committed to enhancing the health of current and future generations through research, the CVC relentlessly pursues the generation, translation, and dissemination of new knowledge addressing unmet clinical needs. This section highlights important publications produced by the CVC faculty and our body of research in recent months.
Implications of ischaemic area at risk and mode of reperfusion in ST-elevation myocardial infarction
This study investigated the influence of myocardial territory at risk on the choice of reperfusion strategy. It was based on a unique and comprehensive patient population from the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial randomised to early fibrinolysis versus primary PCI (PPCI). The association between summed baseline ST-segment elevation (STE) or ST-segment deviation (STD) and adverse clinical events has been previously demonstrated by our group. For the first time in this study we have shown similar 30-day and 1-year clinical outcomes with either a pharmacoinvasive strategy or PPCI, irrespective of the extent of baseline STE and/or STD. Thus clinicians should be guided by the overarching need to administer timely reperfusion best suited to individual circumstances in patients presenting early with STEMI.
Early Follow-Up After a Heart Failure Exacerbation: The Importance of Continuity
Although early follow-up for heart failure is recommended, the time window in which physicians should do the follow-up is unclear. Because previous studies have focused on a short follow-up within 7 days, we explored whether longer follow-up within 14 days and physician continuity would influence outcomes within 30 days of a heart failure exacerbation. Of 39,249 adults (mean age, 76 years) with an acute heart failure exacerbation in Alberta resulting in an emergency department visit or a hospitalization, 34% had no outpatient visits in the next 14 days, 56% received follow-up from a familiar physician, and 10% saw an unfamiliar physician. Compared with no outpatient follow-up within 14 days, the risk of death or hospitalization within 30 days was lower in patients who saw a familiar physician (adjusted hazard ratio, 0.94; 95% confidence interval, 0.89–0.99); the risk of death or hospitalization or emergency department visit within 30 days was less common with either familiar physician follow-up (adjusted hazard ratio, 0.86; 95% confidence interval, 0.82–0.89) or unfamiliar physician follow-up (adjusted hazard ratio, 0.93; 95% confidence interval, 0.87–0.996). Hence outpatient follow-up within 14 days is associated with better outcomes and outcomes are best if such follow-up is done by a physician familiar with the patient.
Do stable non-ST-segment elevation acute coronary syndromes require admission to coronary care units?
Current clinical practice guidelines recommend admitting patients with stable non–ST-segment elevation acute coronary syndrome (NSTE ACS) to telemetry units, yet up to two-thirds of patients are admitted to higher-acuity critical care units (CCUs). Using an Alberta population-based data of 7,869 patients hospitalized with NSTE ACS the outcomes among patients initially admitted to a CCU (n = 5,141) were compared with those admitted to cardiology telemetry wards (n = 2,728). Interestingly, no differences in mortality or 30-day all-cause postdischarge readmissions were observed between patients with NSTE ACS initially admitted to a ward or a CCU. These findings suggest that stable NSTE ACS may be managed appropriately on telemetry wards and presents an interesting opportunity to reduce hospital costs and critical care capacity strain.