Atrial Fibrillation

The Atrial Fibrillation (AF) track, led by Dr. Allan Skanes, aims to reduce inappropriate AF hospitalizations and emergency department (ED) visits by 20%, while improving access, quality and effectiveness of care for AF patients.

Currently, the track is focusing on these solutions:

  • Create an AF research program to identify AF patients’ concerns leading to ED visits. This will lead to the development of an individualized patient education and management program, in order to provide alternatives to emergency room visits for appropriate patients, through evidence based alternative care plan options. This will be integrated into the VIRTUES platform. This will have a direct impact on reducing AF-related ED visits and hospitalizations, while improving the quality and continuity of care for AF patients.
  • Embrace existing and developing digital technologies that can provide near real-time data capture, transmission, and feedback to a patient-driven solution that will also put in the hands of health providers the information and advanced analytics necessary for advice on appropriate treatment options. This will provide timely, efficient, state-of-the-art AF care to people across geographic barriers.
  • Devise treatment to address diverse etiologies, including:
    • Reduction of risk factors (hypertensive, diabetes, obesity, sleep apnea, inactivity, alcohol consumption and smoking) predisposing people to have AF
    • Early detection and treatment to abolish AF with catheter ablation, thus retarding progression
    • For patients later in the disease progression, some clinical parameters such as AF type, imaging parameters such as left atrial size, atrial fibrosis, and genetic factors may predict the success of AF ablation. Such patient factors should guide effective and efficient treatment strategy.

Syncope

The syncope research track, led by Dr. Robert Sheldon, aims to streamline care for patients with recurrent syncope to achieve a 30% reduction in health care costs attributable to syncope over 10 years while achieving measurable improvements in overall mortality, morbidity, and quality of life.

Currently, the track is focusing on these solutions:

  • Better, alternative care to emergency departments
    • Qualitative and quantitative assessments of the attitudes of people and patients who faint, regarding why and how they choose to access health care
    • Development and testing of simple tools for paramedics to assess and release low-risk syncope patients
    • Development of an electronic tool that can be accessed by patients, family members, and health care professionals for education and advice
    • Cluster randomized trial of tool to prevent transport of low-risk patients to emergency departments, and into alternate care pathway

In this research program, we aim to reduce visits to the emergency department by 35% by providing paramedics with appropriate tools and training to effectively screen low-risk syncope patients and thus avoid useless transport to the ED.

  • Better, alternative care to hospital admissions
    • Development of a pilot ambulatory syncope unit for medium risk patients
    • Pilot study of early ED discharge of medium-risk patients using Ottawa Syncope Rule
    • Cluster RCT of Ottawa Syncope Rule will be performed to test the cost effectiveness of this
      solution

In this research, we aim to reduce admissions through the emergency ward to hospital by 30% for medium-risk patients.

  • Smarter care during hospital admissions
    • Use a combination of CME and electronic medical record prompts to reduce the unnecessary use of specific investigations such as CT and MRI of the head in the assessment of hospitalized syncope patients
    • Develop prompts and perform phase 1 uptake studies in 3 health care systems
    • Perform a cluster RCT to test the effectiveness and cost-effectiveness of prompts in reducing unnecessary investigations in those patients admitted to the hospital for syncope

Sudden Cardiac Death

The Sudden Cardiac Death (SCD) track, led by Dr. L. Brent Mitchell, aims to decrease SCD by 10% over 10 years.

Currently, the track is focusing on these solutions:

  • Derive a mechanism to inform and remind targeted patients and their care providers that LVEF should be determined for SCD risk assessment. The research strategy will develop and test a patient-driven solution so that patients discharged from hospital after acute care of MI will be identified. An electronic application will be installed onto the patient’s choice of mobile computing device (smart phone, tablet, computer), which will provide each patient’s personalized education, medical data, and a reminder that LVEF should be determined after 3 to 6 months. The same information will be sent to the patient’s healthcare providers (family health team, internist, cardiologist). Follow-up reminders will be sent periodically, until the information is recorded so that a recommendation of action will be delivered to the patient and to the healthcare provider.
    • The research program will:
      • develop the required hardware and software
      • assess its acceptability to patients, caregivers
      and health care providers
      • assess its effectiveness in a randomized
      controlled trial
      • assess the cost-effectiveness of the
      intervention.
      Implementation of the program will include
      assessment of the impact of LVEF
      determination on the use of guideline-directed
      medications and ICD implants.
  • The REFINE-ICD program is designed to identify among the intermediate-risk population those featuring other abnormalities (in cardiac re-polarization and in abnormal autonomic tone) that are further markers of SCD risk that could make them prime candidates for an ICD implant for the purpose of prevention of subsequent sudden death. Presently, most of these patients are not identified and do not undergo such treatment.
    • The research program will determine if the mortality risk of these patients is reduced by the ICD. If so, the discriminative tools will be employed widely in the medical community and will be implemented routinely by deploying the Network knowledge mobilization strategies, notably involving professional societies (CHRS) and provincial health authorities. This will have significant impact on SCD rates in Canada and, eventually, internationally.

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