Publications by authors named "Finlay Mcalister"
Background: The long-term incidence of heart failure (HF) in ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA) patients is uncertain. We examined the 1-year incidence of HF and its association with mortality among patients surviving their first acute coronary syndrome (ACS) hospitalization.
Methods And Results: A retrospective cohort study of patients, aged ≥20 years, with no prior HF, hospitalized for the first time with ACS between April 1, 2002, and December 31, 2008, in Alberta, Canada, and followed up for 1 year.
Objective: To compare ethnic and sex difference in the incidence of newly diagnosed hypertension, and subsequent risk of cardiovascular disease outcomes among South Asian, Chinese and white patients.
Methods: We identified patients with newly diagnosed hypertension aged ≥20 years. Patients were followed for 1-9 years for all-cause mortality and cardiovascular disease with myocardial infarction, heart failure and stroke.
Background: Vertebral fractures detected "incidentally" by chest radiograph usually do not trigger osteoporosis treatment in older patients. In a 3-arm controlled trial we reported that both physician-directed and enhanced (physician plus patient activation) interventions increased treatment rates more than 10-fold (15%-20% absolute increases) compared with usual care; the cost-effectiveness of these interventions is unknown.
Methods: Incremental cost-effectiveness of these 2 interventions compared with usual care was assessed using a Markov decision-analytic model, populated with 1-year outcomes data and direct intervention costs from the trial.
Background: Pay-for-performance (P4P) is increasingly touted as a means to improve health care quality.
Purpose: To evaluate the effect of P4P remuneration targeting individual health care providers.
Data Sources: MEDLINE, EMBASE, Cochrane Library, OpenSIGLE, Canadian Evaluation Society Unpublished Literature Bank, New York Academy of Medicine Library Grey Literature Collection, and reference lists were searched up until June 2012.
Background: The Alberta Cardiac Access (ACA) initiative was implemented in the spring of 2008 to increase access to specialized heart failure (HF) clinics after hospital discharge.
Methods And Results: We identified all adults hospitalized with a most responsible diagnosis of HF between April 1999 and December 2009. We randomly selected 1 episode of care per patient and evaluated outcomes using interrupted time series: the a priori specified primary outcome was all-cause readmission or death in the first 30 days postdischarge.
Background: Cochrane reviews are viewed as the gold standard in meta-analyses given their efforts to identify and limit systematic error which could cause spurious conclusions. The potential for random error to cause spurious conclusions in meta-analyses is less well appreciated.
Methods: We examined all reviews approved and published by the Cochrane Heart Group in the 2012 Cochrane Library that included at least one meta-analysis with 5 or more randomized trials.
Background: It is unclear whether diabetes mellitus or use of particular glucose-lowering agents is associated with increased risk of mortality after noncardiac surgery in patients with known cardiac disease.
Methods: We carried out a retrospective cohort study using 4 linked administrative databases in the province of Alberta, Canada from 1999-2006.
Results: Of the 32,834 patients with known cardiac disease in our cohort, 9305 (28%) had diabetes.
Background: The accuracy of current models to predict the risk of unplanned readmission or death after a heart failure (HF) hospitalization is uncertain.
Methods: We linked four administrative databases in Alberta to identify all adults discharged alive after a HF hospitalization between April 1999 and 2009. We randomly selected one episode of care per patient and evaluated the accuracy of five administrative data-based models (4 already published, 1 new) for predicting risk of death or unplanned readmission within 30 days of discharge.
Background: Although hyponatremia has been linked to increased morbidity and mortality in a variety of medical conditions, its association with perioperative outcomes remains uncertain.
Methods: To determine whether preoperative hyponatremia is a predictor of 30-day perioperative morbidity and mortality, we conducted a cohort study using the American College of Surgeons National Surgical Quality Improvement Program database to identify 964 263 adults undergoing major surgery from more than 200 hospitals (from January 1, 2005, to December 31, 2010) and observed them for 30-day perioperative outcomes. We used multivariable logistic regression to estimate relative risks for death, major coronary events, wound infections, and pneumonia occurring within 30 days of surgery and quantile regression to estimate differences in average length of hospital stay.
Background: Most vertebral compression fractures are not recognized or treated. We conducted a controlled trial in older patients with vertebral fractures incidentally reported on chest radiographs, comparing usual care with osteoporosis interventions directed at physicians (opinion-leader-endorsed evidence summaries and reminders) or physicians+patients (adding activation with leaflets and telephone counseling).
Methods: Patients aged >60 years who were discharged home from emergency departments and who had vertebral fractures reported but were not treated for osteoporosis were allocated to usual care (control) or physician intervention using alternate-week time series.
Blood pressure surveillance, monitoring, and evaluation of programs to prevent and control hypertension are critical because increased blood pressure is a leading risk for premature death and disability. Since 2003, the Hypertension Outcomes Research Task Force has existed in Canada, with members who assist in the development and revision of surveys and conduct analyses that help guide hypertension programs. Although the Task Force has tracked a 5-fold increase in the control of hypertension (from 13% in 1985-1992 to 65% in 2007-2009), surveillance data also indicate that many "care gaps" remain.
View Article and Find Full Text PDFBackground: Drugs reimbursed through a single-party payer such as health maintenance organizations or provincial governments are generally captured in administrative data if they have full-benefit status on that payer's formulary. However, drugs subject to restrictive drug coverage policies are often not fully captured if patients receive these drugs through mechanisms other than the single-payer formulary.
Objective: The goal of this study was to estimate the association between restrictive drug coverage and drug exposure misclassification across the Canadian provinces of Manitoba and Saskatchewan, which provide universal coverage for formulary-approved drugs to all citizens regardless of age or socioeconomic status.
Study Objective: To quantify the potential cost savings of a community pharmacy-based hypertension management program based on the results of the Study of Cardiovascular Risk Intervention by Pharmacists-Hypertension (SCRIP-HTN) study in terms of avoided cardiovascular events-myocardial infarction, stroke, and heart failure hospitalization, and to compare these cost savings with the cost of the pharmacist intervention program.
Design: An economic model was developed to estimate the potential cost avoidance in direct health care resources from reduced cardiovascular events over a 1-year period.
Measurements And Main Results: The SCRIP-HTN study found that patients with diabetes mellitus and hypertension who were receiving the pharmacist intervention had a greater mean reduction in systolic blood pressure of 5.
Over the last 10 years, several large, well-designed clinical trials have firmly established the role of cardiac resynchronization therapy (CRT) as a recommended treatment strategy for moderate-to-severe heart failure (HF). A review of the relevant results from the MUSTIC, MIRACLE, CONAK-CD, and MIRACLE ICD trials reveals that in patients with New York Heart Association (NYHA) class III-IV HF, CRT produces consistent improvements in quality of life, functional status, and exercise capacity while also providing strong evidence for reverse remodeling and diminished functional mitral regurgitation, resulting in reductions in both HF hospitalizations and all-cause morbidity and mortality. In patients with earlier NYHA class I-II HF, the benefit of CRT has been more controversial.
View Article and Find Full Text PDFBackground: Low testosterone is an independent predictor of reduced exercise capacity and poor clinical outcomes in patients with heart failure (HF). We sought to determine whether testosterone therapy improves exercise capacity in patients with stable chronic HF.
Methods And Results: We searched Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials (1980-2010).
Background: Prior studies in heart failure (HF) have used the Modification of Diet in Renal Disease (MDRD) equation to calculate estimated glomerular filtration rate (eGFR). The Chronic Kidney Disease-Epidemiology Collaboration Group (CKD-EPI) equation provides a more-accurate eGFR than the MDRD when compared against the radionuclide gold standard. The prevalence and prognostic import of renal dysfunction in HF if the CKD-EPI equation is used rather than the MDRD is uncertain.
View Article and Find Full Text PDFBackground: Approximately 17% of Canadians with high blood pressure were unaware of their condition, and of Canadians aware of having the condition, approximately 1 in 5 have uncontrolled high blood pressure despite high rates of pharmacotherapy. The objectives of the current study are to estimate the prevalence of resistant hypertension and examine factors associated with (1) lack of awareness and (2) uncontrolled hypertension despite pharmacotherapy.
Methods: Using the 2007-2009 Canadian Health Measures Survey (N = 3473, aged 20-79 years) and logistic regression, we quantified relationships between characteristics and (1) presence of hypertension, (2) lack of awareness (among those with hypertension), and (3) uncontrolled high blood pressure (among those treated for hypertension).
Background And Objectives: Despite reporting estimated GFR (eGFR), use of evidence-based interventions in CKD remains suboptimal. This study sought to determine the effect of an enhanced eGFR laboratory prompt containing specific management recommendations, compared with standard eGFR reporting in CKD.
Design, Setting, Participants, & Measurements: A cluster randomized trial of a standard or enhanced eGFR laboratory prompt was performed in 93 primary care practices in Alberta, Canada.
Background: Prior national surveys suggested that treatment and control of hypertension were poor in individuals with diabetes. Using measured blood pressures, we estimated prevalence, awareness, treatment, and control of hypertension between 2007 and 2009 among Canadians with diabetes and sought to determine whether a treatment gap still exists for individuals with diabetes.
Methods: Using data from cycle 1 of the Canadian Health Measures Survey, estimates of hypertension prevalence, awareness, treatment, and control were described and compared between individuals with and without self-reported diabetes.
Objective: Drug exposure misclassification may occur in administrative databases when individuals obtain nonreimbursed drugs by paying "out-of-pocket" or via alternative drug coverage plans. We examined the apparent association between oral antidiabetic therapy and mortality by simulating the effects of restrictive drug coverage policies.
Methods: Population-based cohort study of 12,272 new patients using oral antidiabetic agents were identified using the administrative databases of Saskatchewan Health, 1991 to 1996.
Atrioventricular nodal ablation in atrial fibrillation: a meta-analysis and systematic review.
Circ Arrhythm Electrophysiol
February 2012
Background: In the treatment of patients with refractory atrial fibrillation (AF), the safety and efficacy of atrioventricular nodal ablation (AVNA) versus pharmacotherapy alone remains unclear. Additionally, the impact of AVNA in patients with reduced systolic function is of growing interest.
Methods And Results: A total of 5 randomized or prospective trials were included for efficacy review (314 patients), 11 studies for effectiveness review (810 patients), and 47 studies for safety review (5632 patients).
Background: Although studies have demonstrated excess risk of ischemic events if aspirin is withheld preoperatively, it is unclear whether preoperative thienopyridine use influences postoperative outcomes.
Methods: We conducted a systematic review of 37 studies (31 cardiac and 6 noncardiac surgery, 3 randomized, 34 observational) comparing postoperative outcomes in patients who were versus were not exposed to thienopyridine in the 5 days before surgery.
Results: Exposure to thienopyridine in the 5 days preceding surgery (compared with no exposure) was not associated with any reduction in postoperative myocardial infarction (23 studies, 12,872 patients, 3.
Objective: To examine whether warfarin use and outcomes differ across CHADS(2) and CHA(2)DS(2)-VASc risk strata for non-valvular atrial fibrillation (NVAF).
Design: Population-based cohort study using linked administrative databases in Alberta, Canada.
Setting: Inpatient and outpatient.