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CCORT reaches 10 Year milestone—2001-2011
CCORT’s research addresses the leading cause of death world-wide—heart disease—in order to improve patient outcomes. Launched in 2001, led by PI Dr. Jack Tu, CCORT consists of over 30 leading cardiovascular outcomes researchers from 6 provinces (BC, AB, ON, QC, NB, NS) across Canada. CCORT’s research, made possible by two team grants from the Canadian Institutes of Health Research, (and supplemental funding from the Heart and Stroke Foundation of Canada) has improved care quality, service delivery and changed the landscape of cardiovascular health services outcomes research. Its innovative methodologies and findings are documented in over 170 peer-reviewed publications, including the first ever Canadian Cardiovascular Atlas. In addition, CCORT trained over 60 ‘next generation’ outcomes researchers from across Canada as part of the CCORT Student Training program. 2001-2006 CIHR IHRT grant; 2006-2011 CIHR Team grant in cardiovascular outcomes research
	CCORT’s 10 year journey is described in the attached article entitled '*Canadian Cardiovascular Outcomes Research Team: Lessons Learned'*. Tu JV. Canadian Journal of General Internal Medicine 2011; 6(1):18-19 PDF

Variation in coronary revascularization practices explored A new study, published in the CMAJ, led by Dr. Jack Tu, for the Cardiac Care Network (CCN) of Ontario’s Variations in Revascularization Practice in Ontario (VRPO) Working Group explores what drives the variation observed in the ratio of percutaneous coronary interventions to coronary artery bypass graft surgeries (PCI:CABG ratio) across Ontario hospitals. The study also involved several other CCORT investigators--see reference below. This retrospective cohort study involved a population-based sample of 8,972 patients who underwent an index cardiac catheterization between April 2006 and March 2007 at any of Ontario’s 17 cardiac centres. The study's objective was to identify clinical and nonclinical factors associated with the considerable degree of variation observed in the ratio across centres. The study revealed a threefold variation in the ratios across the four hospital ratio groups (low [< 2.0], low–medium [2.0–2.7], medium–high [2.8–3.2] and high [> 3.2]). The overall mean PCI:CABG ratio was 2.7. However, ratios ranged from a mean of 1.6 in the lowest ratio group to a mean of 4.6 in the highest ratio group. Most of the variation in ratios was driven by the variation in how patients with non-emergent multivessel disease were managed. The strongest independent predictors of the mode of revascularization were i) the physician performing the diagnostic catheterization; and ii) the treating hospital. These findings, as discussed in the accompanying commentary, indicate that the transparency and consistency of the decision making process for revascularization can be improved. For further details please see the article here. The commentary is available here. Tu JV, Ko DT, Guo H, Richards JA, Walton N, Natarajan MK, Wijeysundera HC, So D, Latter DA, Feindel CM, Kingsbury K, Cohen EA, for the Cardiac Care Network of Ontario’s Variations in Revascularization Practice in Ontario Working Group. Determinants of variations in coronary revascularization Practices. CMAJ. December 12, 2011.

	CCORT Investigators Active at the 2011 Canadian Cardiovascular Congress
A number of CCORT investigators presented their research at the Canadian Cardiovascular Congress held October 22-26, 2011 in Vancouver, British Columbia including the following: Drs. Jack Tu, Jafna Cox and Karin Humphries participated in a workshop entitled Achieving Pan-Canadian Consensus on Cardiovascular Quality Indicators and Data Definitions for Patient Registries: A Recommendation from the Canadian Heart Health Strategy and Action Plan. Dr. Jack Tu, as part of a second workshop, presented on the topic of Ethnicity, CVD and Diabetes. A webcast of the full workshop entitled Cardiovascular disease and diabetes in multiculturally diverse communities: Lessons for CVD prevention, treatment, & management can be viewed here. Dr. Mark Eisenberg presented findings from a trial of bupropion (Wellbutrin/ Zyban), a smoking-cessation drug. In this randomized, double-blind placebo-controlled trial involving smokers hospitalized post AMI, bupropion was found to have no benefit at one year. Dr. Louise Pilote was also involved in this study. Dr. Douglas Lee’s poster presentation described the Emergency Heart Failure Mortality Risk Grade, a new mortality prediction tool developed from his study of patients presenting to the ED with acute heart failure. Dr. Karin Humphries, who holds the UBC Heart and Stroke Foundation Professorship in Women’s Cardiovascular Health, presented findings indicating men under age 55 tend to recover better than women of similar age following an MI. Dr. Humphries’ study received considerable media coverage including the following story in the Vancouver Sun.

Recent CCORT Publications
Effect of marriage on duration of chest pain associated with AMI before seeking care Atzema et al. CMAJ 2011; [Epub July 18 2011]
In this study, led by Dr. Clare Atzema, CCORT investigators conducted a retrospective population-based cohort analysis of patients with AMI admitted to 96 acute care hospitals in Ontario, Canada between April 2004 and March 2005. Among men experiencing AMI with chest pain, being married was associated with significantly earlier presentation for care. This benefit was not observed among married women. The study, published in the CMAJ July 2011, received significant media coverage with headlines of *Married men seek help for heart attacks sooner*. PDF

Rescue PCI for failed fibrinolytic therapy in STEMI Ko et al. Am Heart J 2011; Apr:161(4):764-770
Dr. Dennis Ko led a team of CCORT investigators in this observational analysis of a population-based cohort including 2,953 patients with STEMI hospitalized between 2004 and 2005 in Ontario, Canada. The team found that Rescue PCI was associated with significantly lower risk of long-term adverse outcomes (death or repeat hospitalization for ACS at 4 years) for patients with STEMI who failed lytics (defined as <50% ST-segment resolution on follow up ECG 60-90 minutes post lytics). However, rescue PCI is substantially undersued in clinical practice. Abstract

Restricted use of ARBs could save millions without any adverse effects Geurtin et al. CMAJ 2011;183(3):E180-E186 [Epub Jan 24 2011]
Despite staggering increases in the use of angiotensin-receptor blockers (ARB), their benefit over less expensive angiotensin-converting enzyme inhibitors (ACEI) has not been proven, apart from a reduction in dry cough. ARBs and ACEI are typically prescribed for hypertension, heart failure and related cardiovascular health issues. In this study, CCORT investigators conducted a cost minimization economic analysis, led by Jason Guertin, using a decision-tree model with province-level drug cost data to estimate potential cost savings that might have been gained if access to ARBs had been restricted. The investigators conducted the economic analyses over a one year period from a societal perspective, using data for 2006 from IMS Health Canada’s Canadian CompuScript Audit Database. Monte Carlo simulations with 10,000 iterations were used to test the impact of different model parameters including drug prices, administrative costs and the frequency of dry cough. The study revealed that if access to ARBs had been restricted to those with a demonstrated need, a potential cost savings of more than $77 million may have been achieved in 2006, with no ill effects on cardiovascular health. Only British Columbia has instituted a restrictive access policy for ARBs. As the cost of cardiovascular drugs increased over 200% between 1996-2006, strategies favouring lower cost medications with comparable effectiveness, over higher cost ones, are one option to help reign in rising drug costs. PDF