Publications by authors named "Finlay McAlister"
Aims: Patients with cardiomyopathies are a heterogeneous group of patients who experience high morbidity and mortality. Early cardiac assessment and intervention with access to genetic counselling in a multidisciplinary Cardiomyopathy Clinic may improve outcomes and prevent progression to advanced heart failure.
Methods And Results: Our prospective cohort study was conducted at a multidisciplinary Cardiomyopathy Clinic with 421 patients enrolled (42.
Background: SODIUM-HF was a large clinical trial testing dietary sodium restriction compared to usual care in patients with heart failure that showed no reduction in clinical events. It has been suggested that diuretic doses in response to dietary sodium modification may have influenced the trial results.
Objective: We assessed the effects of baseline diuretic dose and diuretic dose changes on clinical outcomes in the SODIUM-HF trial.
Background: Whether certain medical conditions are associated with blood pressure (BP) treatment and control is unclear.
Methods: Using the Canadian Health Measures Survey (2007-2019), BP was assessed according to the presence of selected comorbidities, including prior heart attack or stroke, dyslipidemia, chronic kidney disease, diabetes mellitus, obstructive sleep apnea, and overweight or obesity.
Results: A total of 5,841,453 people, representing 23.
Aims: Patients visiting the emergency department (ED) or hospitalized for heart failure (HF) are at increased risk for subsequent adverse outcomes, however effective risk stratification remains challenging. We utilized a machine-learning (ML)-based approach to identify HF patients at risk of adverse outcomes after an ED visit or hospitalization using a large regional administrative healthcare data system.
Methods And Results: Patients visiting the ED or hospitalized with HF between 2002-2016 in Alberta, Canada were included.
Assessing agreement between population-level administrative pharmaceutical databases and patient-reported medication dispensation in cardiac rehabilitation patients.
J Epidemiol Popul Health
October 2024
Background: Pharmacoepidemiology has emerged as a crucial field in evaluating the use and effects of medications in large populations to ensure their safe and effective use. This study aimed to assess the agreement of cardiac medication use between a provincial medication database, the Pharmaceutical Information Network (PIN), and reconciled medication data from confirmation through patient interviews for patients referred to cardiac rehabilitation.
Methods: The study included data from patients referred to the TotalCardiology Rehabilitation CR program, and medication data was available in both TotalCardiology Rehabilitation charts and PIN.
Importance: Major gaps in the delivery of appropriate oral anticoagulation therapy (OAC) exist, leaving a large proportion of persons with atrial fibrillation (AF) unnecessarily at risk for stroke and its sequalae.
Objective: To investigate whether pharmacist-led OAC prescription can increase the delivery of stroke risk reduction therapy in individuals with AF.
Design, Setting, And Participants: This prospective, open-label, patient-level randomized clinical trial of early vs delayed pharmacist intervention from January 1, 2019, to December 31, 2022, was performed in 27 community pharmacies in Alberta, Canada.
Article Synopsis
- - This analysis of the SODIUM-HF study examined how dietary sodium intake affects cardiovascular health in heart failure patients over two years, focusing on hospitalizations and death rates.
- - Among 792 participants, most consumed between 1501-3000 mg/day of sodium, and no significant connection was found between sodium intake levels or changes and health outcomes at 12 or 24 months.
- - However, those who reduced their sodium intake to below 1500 mg/day at 6 months showed a trend towards lower risks of cardiovascular issues, indicating a potential benefit that needs further research.
Background: Prior studies of COVID-19 cardiovascular sequelae include diagnoses made within 4 weeks, but the World Health Organization definition for "postacute phase" is >3 months.
Objectives: The purpose of this study was to determine which cardiovascular diagnoses in the postacute phase of COVID-19 are associated with SARS-CoV-2 infection.
Methods: Retrospective cohort study of all adults in Alberta who had a positive SARS-CoV-2 reverse transcription polymerase chain reaction test between March 1, 2020 and June 30, 2021, matched (by age, sex, Charlson Comorbidity score, and test date) with controls who had a negative reverse transcription polymerase chain reaction test.
Artificial intelligence-enabled electrocardiogram (ECG) algorithms are gaining prominence for the early detection of cardiovascular (CV) conditions, including those not traditionally associated with conventional ECG measures or expert interpretation. This study develops and validates such models for simultaneous prediction of 15 different common CV diagnoses at the population level. We conducted a retrospective study that included 1,605,268 ECGs of 244,077 adult patients presenting to 84 emergency departments or hospitals, who underwent at least one 12-lead ECG from February 2007 to April 2020 in Alberta, Canada, and considered 15 CV diagnoses, as identified by International Classification of Diseases, 10th revision (ICD-10) codes: atrial fibrillation (AF), supraventricular tachycardia (SVT), ventricular tachycardia (VT), cardiac arrest (CA), atrioventricular block (AVB), unstable angina (UA), ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), pulmonary embolism (PE), hypertrophic cardiomyopathy (HCM), aortic stenosis (AS), mitral valve prolapse (MVP), mitral valve stenosis (MS), pulmonary hypertension (PHTN), and heart failure (HF).
View Article and Find Full Text PDFObjective: To characterize the association between ambulatory cardiology or general internal medicine (GIM) assessment prior to surgery and outcomes following scheduled major vascular surgery.
Background: Cardiovascular risk assessment and management prior to high-risk surgery remains an evolving area of care.
Methods: This is population-based retrospective cohort study of all adults who underwent scheduled major vascular surgery in Ontario, Canada, April 1, 2004-March 31, 2019.
Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are effective in adults with diabetes mellitus (DM) and heart failure (HF) based on randomized clinical trials. We compared SGLT2 inhibitor uptake and outcomes in two cohorts: a population-based cohort of all adults with DM and HF in Alberta, Canada and a specialized heart function clinic (HFC) cohort.
Methods: The population-based cohort was derived from linked provincial healthcare datasets.
Article Synopsis
- Understanding the frequency and outcomes of neurological disorders linked to COVID-19 is crucial for assessing risks and recognizing new neurological issues.
- A case-control study analyzed health data from March 2020 to June 2021, comparing 177,892 individuals infected with SARS-CoV-2 and 177,800 uninfected individuals, focusing on mortality rates and neurological complications.
- Results showed that individuals with pre-existing neurological conditions faced significantly higher mortality rates and were at increased risk for new neurological issues both during the acute phase and up to nine months after infection, including encephalopathy, dementia, and brain fog.
Background And Aims: In the COMPASS trial, low-dose rivaroxaban with aspirin improved cardiovascular outcomes in patients with atherosclerotic cardiovascular disease (ASCVD). We aimed to assess the potential clinical implications of this therapy in a generalizable population.
Methods And Results: A retrospective cohort of adults with ASVCD was formed using healthcare administrative databases in Alberta, Canada (population 4.
Background: Studies have shown an association between iron deficiency (ID) and clinical outcomes in patients with heart failure (HF), irrespective of the presence of ID anemia (IDA). The current study used population-level data from a large, single-payer health care system in Canada to investigate the epidemiology of ID and IDA in patients with acute HF and those with chronic HF, and the iron supplementation practices in these settings.
Methods: All adult patients with HF in Alberta between 2012 and 2019 were identified and categorized as acute or chronic HF.
Background: In this pre-planned variation of the Comparing Strategies Targeting Osteoporosis to Prevent Fractures After an Upper Extremity Fracture (C-STOP) trial, we investigated whether adherence-specific coaching by the case manager (CM) further improved the adherence and persistence rates compared to those seen in the C-STOP trial.
Methods: We conducted a prospective observational cohort study of community-dwelling adults 50 years or older who suffered an upper-extremity fracture and were not previously treated with osteoporosis medications, to assess whether a well-trained CM can partner with patients to improve adherence to and persistence with oral bisphosphonate intake. The primary outcome was adherence (taking > 80% of prescribed doses) to oral bisphosphonate intake at 12 months after study enrollment.
Background: Preclinical and observational studies suggest that the gut microbiome plays a role in the pathogenesis of heart failure (HF); the gut microbiome may be modified by fermentable dietary fibre (FDF). The Need for ibr ddition in ympomatic eart ailure (FEAST-HF) trial evaluated feasibility of recruitment and supplementation with FDF in HF and whether FDF (acacia), compared to control, reduced the level of N-terminal pro-b-type natriuretic peptide (NT-proBNP) and growth stimulation expressed gene 2 (ST2), and produced changes in the gut microbiome.
Methods: Participants were randomly allocated 1:1:1 to either of the intervention arms (5 g/d or 10 g/d acacia) or to the control arm (10 g/d microcrystalline cellulose (MCC; nonfermentable active control).
Introduction: Not all patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection develop symptomatic coronavirus disease 2019 (COVID-19), making it challenging to assess the burden of COVID-19-related hospitalizations and mortality. We aimed to determine the proportion, resource utilization, and outcomes of SARS-CoV-2 positive patients admitted for COVID-19, and assess the impact of using the Center for Disease Control's (CDC) discharge diagnosis-based algorithm and the Massachusetts state department's drug administration-based classification system on identifying admissions for COVID-19.
Methods: In this retrospective cohort study, we enrolled consecutive SARS-CoV-2 positive patients admitted to one of five hospitals in British Columbia between December 19, 2021 and May 31,2022.
Article Synopsis
- Pulmonary hypertension is prevalent in heart failure patients, and right ventricular systolic pressure (RVSP) is key in gauging its severity, though the impact of repeated RVSP measurements had not been thoroughly examined.
- In a study involving 4319 heart failure patients, it was found that higher RVSP levels (mildly to severely elevated) were linked to an increased risk of hospitalization and mortality over a median follow-up of 19.4 months.
- The findings suggest that both high RVSP values and improving RVSP categories can signify a higher risk in patients, indicating a need for closer monitoring and potential changes in treatment plans, but more research is warranted to understand the reasons behind this.
Outpatient care patterns have changed markedly during the COVID-19 pandemic. In this population-based retrospective cohort study, we compared the frequency of outpatient care (whether in-person or virtual) and continuity of care for all community-dwelling adults in Alberta between March 1, 2019 and February 29, 2020 (pre-pandemic) versus March 1, 2020 to February 28, 2021 (pandemic). We calculated provider continuity using Breslau's Usual Provider Continuity (UPC) for patients with at least 2 outpatient encounters.
View Article and Find Full Text PDFBackground: Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently co-exist. The frequency of kidney monitoring and range of kidney function in patients with AF in clinical practice are uncertain.
Methods: All adult Albertans with AF between 2008 and 2017 were identified using ICD-9 and -10 codes 427.
Objective: The objective of this study was to determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in major general surgery patients.
Background: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in major general surgical patients have not been described.
Importance: The association of inpatient COVID-19 caseloads with outcomes in patients hospitalized with non-COVID-19 conditions is unclear.
Objective: To determine whether 30-day mortality and length of stay (LOS) for patients hospitalized with non-COVID-19 medical conditions differed (1) before and during the pandemic and (2) across COVID-19 caseloads.
Design, Setting, And Participants: This retrospective cohort study compared patient hospitalizations between April 1, 2018, and September 30, 2019 (prepandemic), vs between April 1, 2020, and September 30, 2021 (during the pandemic), in 235 acute care hospitals in Alberta and Ontario, Canada.
Objectives: We sought to validate, or refute, the common belief that bedtime diuretics are poorly tolerated due to nocturia.
Design: Prespecified prospective cohort analysis embedded within the randomised BedMed trial, in which hypertensive participants are randomised to morning versus bedtime antihypertensive administration.
Setting: 352 community family practices across 4 Canadian provinces between March 2017 and September 2020.