Findings presented at Canadian Cardiovascular Congress seen as successful pilot project to improve standards of care and national reporting for cardiology interventions
MONTREAL, Oct. 24, 2016 /CNW/ - The results of the first-ever pan-Canadian effort to document cardiovascular care across the country were presented today by the Canadian Cardiovascular Society Quality Project study team. The team is confident their findings will pave the way for more and better compilation and exchanges of data in all areas of cardiovascular care, and that this initiative will improve outcomes for patients across Canada.
The results presented today at the Canadian Cardiovascular Congress will be the first in a series of "National Quality Reports" on different cardiovascular procedures and the treatment of conditions such as heart failure and atrial fibrillation.
This first report is on the use of transcatheter aortic valve implantation (TAVI), an important minimally invasive procedure performed predominantly on elderly patients, for whom the prior options were high-risk surgery or to be treated medically. This complex and expensive procedure allows the placement of an artificial aortic valve through a much less invasive procedure than open heart surgery, offering a life-extending option to patients who could not withstand such major surgery.
The National Quality Report: TAVI released today shows that Canadian patients are benefiting greatly from the procedure. The rate at which TAVI is being performed and the outcomes are comparable to what is seen in parts of Europe and the US. However, the report also reveals some important differences across provinces and regions that could help identify areas where improvements can occur.
Roadmap for improved cardiovascular care
The processes developed for this initial report will serve as a roadmap for compiling other national reports from existing provincial and hospital databases. The reports will help establish national benchmarks of excellence, identify best practices and encourage their adoption across the country.
"We have 10 different provincial health systems and ways of doing things in Canada and we hope our report paves the way for being able to collect and compile data on TAVI and other procedures over time that will allow those different systems to learn the best of what the others are doing," said Dr. Anita Asgar, Chair of the CCS TAVI Quality Working Group who presented the report to the CCC annual meeting in Montreal. She is the Director of Transcatheter Valve Therapy Research at the Montreal Heart Institute. Collaborating in leading the report development was the Chair of the overall CCS Quality Project, Dr. Paul Dorian, director of the Division of Cardiology at the University of Toronto.
There have been substantial barriers in the past that have prevented the collection of data about the delivery of different medical procedures across Canada. This is believed to be the first which has succeeded in compiling data from every hospital in Canada that performs a specific procedure, in this case TAVI. There were 25 such hospitals during the year surveyed, 2013-14, though programs in Newfoundland and Saskatchewan have since launched. Evaluation of procedures in that year allowed the compilation of data on the outcomes over the following year, 2014-15. The national working group selected nine quality indicators to evaluate, covering structural indicators (wait times), process (use of scoring by a heart team to evaluate risk and collection of quality of life indicators) and outcomes (mortality and in-hospital stroke).
The study found that 1,122 TAVI procedures were performed in Canada from April 1, 2013, to March 31, 2014, with a range from one hospital performing just nine to one performing 170. Overall, the rate of TAVI procedures was 34 per million of the total Canadian population, a rate comparable to Europe. However, provincial and regional rates varied considerably, from 16 to 61 per million; the study team hopes these data will lead to closer examination of access to TAVI with a view to promoting more standardization and determining the cause of appropriate differences.
The study team spent considerable time developing the quality indicators it wanted to evaluate, and then determining whether existing hospital and provincial databases had the necessary information. Various and important differences in data collection were encountered. "Our work highlights the need for both standardization of data collection and ensuring the data that is sought is actually recorded," said Dr. Asgar. "For example, we wanted to look at the impact of TAVI on the quality of life of patients but we're not measuring it. To ensure we are getting optimal value from these expensive procedures, we need to put value on and dedicate resources to collecting the data that will give us such answers."
The good news for Canadian patients is that the report finds overall positive outcomes for TAVI, comparable to those in Europe, including rates of mortality at 30 days (4.2%) and one year after the procedure (13.8%) and rates of in-hospital stroke (2.1%). The average age of patients was 81.9 years with 44.3% being female. Differences in regional results concerning wait times and collection of quality of life indicators illustrate areas where best practices might be better shared.
Value of further investments demonstrated
The Canadian Cardiovascular Society believes this pilot report on TAVI demonstrates the value in supporting efforts that work to better determine the value Canadians are receiving for their healthcare investments.
The CCS is calling on the federal government to prioritize a national quality mandate and commit $5 million a year for five years towards a national quality reporting and improvement program for cardiovascular care. It is also seeking a funding mechanism to sustain national quality measurement for cardiovascular care, given that by 2020 18% of Canadians will be over age 65 and the economic burden of cardiovascular disease is expected to reach $28.3 billion annually.
"The exemplary work of the CCS TAVI Quality Working Group in developing this first Quality Report shows the enormous value that can be generated for patients, health institutions and our health system by further efforts to compile data to guide quality improvements in care for all Canadians," said Dr. Heather Ross, President of the Canadian Cardiovascular Society and Director of the Ted Rogers Centre of Excellence in Heart Function in Toronto. "We can only make things better by learning first what can and should be improved and by following the example of those with best practices. Our Quality Reports program will help us do that."
TAVI, or transcatheter aortic valve implantation, is a transformational technology to treat aortic stenosis (AS), a degenerative heart valve disease and the most commonly acquired valvular abnormality in the elderly, with a prevalence of almost 10%. Left untreated, the one-year mortality rate approaches 50%. Traditionally, AS has been treated by surgical aortic valve replacement (SAVR), but many patients are not eligible due to advanced age and other illnesses. TAVI is a much less invasive procedure. With TAVI, a fully collapsible valve is delivered through a small skin puncture to a blood vessel and then transported to and implanted within the existing, diseased valve. TAVI is now the primary option in severe AS patients who are inoperable or those at high surgical risk with SAVR.
About the Canadian Cardiovascular Congress
The Canadian Cardiovascular Congress (CCC) is the largest gathering of cardiovascular and allied health professionals in Canada, providing a broad spectrum of cardiovascular health professionals with current scientific information, accredited education opportunities and an ideal forum to connect with other cardiovascular health and care colleagues. This annual conference unites Canada's cardiovascular community, from physicians to researchers, to network, learn and showcase the latest in research and innovations. www.cardiocongress.org
About the Canadian Cardiovascular Society
The Canadian Cardiovascular Society is Canada's national voice for cardiovascular clinicians and scientists, promoting cardiovascular health and care excellence through knowledge translation, including dissemination of research and application of best practices, professional development, and leadership in health policy and advocacy. The CCS Vision is "Leading cardiovascular health and care excellence." www.ccs.ca
SOURCE Canadian Cardiovascular Congress
For further information: For media interviews, please contact: Diane Hargrave, [email protected], 416-467-9954, ext. 104; After Oct 25, 2016 please contact: Erin McGeachie, Canadian Cardiovascular Society, 877/613-569-3407 ext. 419, [email protected]