Improving Cardiovascular Outcomes in Nova Scotia (ICONS): A Successful Public-Private Partnership in Primary Healthcare

Montague, Terrence J.; Cox, Jafna L.; Krämer, Sarah; Nemis-White, Joanna; Cochrane, Bonnie; Wheatley, Marlene; Joshi, Y N; Carrier, Robert; Grégoire, Jean‐Pierre; Johnstone, David

doi:10.12927/hcq..16498

Cited by 10 publications

(11 citation statements)

References 9 publications

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“…Several researchers (26)(27)(28) have explored approaches to improving the treatment gap in cardiovascular care and prevention. Audit with feedback on performance may play an important role in achieving this goal among post-CABG surgery patients and should be explored further.…”

Section: Discussionmentioning

confidence: 99%

Use of cardiovascular medical therapy among patients undergoing coronary artery bypass graft surgery: Results from the ROSETTA-CABG Registry

Okrainec¹,

Pilote²,

Platt³

et al. 2006

Canadian Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Use of cardiovascular medical therapy among patients undergoing coronary artery bypass graft surgery: Results from the ROSETTA-CABG Registry

Okrainec¹,

Pilote²,

Platt³

et al. 2006

Canadian Journal of Cardiology

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“…From October 15, 1997 until present, this registry has captured information on all hospitalizations across Nova Scotia for selected cardiovascular diseases including acute MI (14,15). In addition to possessing detailed data relating to patient demographic characteristics and comorbid illnesses, the ICONS database contains information regarding discharge drug prescriptions, in-hospital and out of hospital procedure use (cardiac catheterization, PCI, CABG and heart valve surgery) and outcome data such as all-cause mortality and readmission to the hospital for various cardiac problems including nonfatal MI, unstable angina or congestive heart failure (CHF).…”

Section: Data Sourcesmentioning

confidence: 99%

The effect of place of residence on access to invasive cardiac services following acute myocardial infarction

Hassan

Pearce

Mathers³

et al. 2009

Canadian Journal of Cardiology

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“…A study from Nova Scotia was presented at the Canadian Cardiovascular Congress in 2003, in which data from the ICONS (improving cardiovascular outcomes in Nova Scotia) registry showed no difference in the outcome between the different statins used [45]. The MACE rate was 4.6% in patients on atorvastatin co-medication (n=338 patients) after 30 days, compared to 4.1% (n=318) in patients on simvastatin and 3.5% (n=319) on pravastatin.…”

Section: Drug-drug Interaction: Clinical Evidencementioning

confidence: 99%

Thienopyridines and Statins: Assessing a Potential Drug-Drug Interaction

Neubauer¹,

Mügge

2006

CPD

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Clopidogrel and statins are frequently administered in patients with ischemic heart disease or other atherothrombotic manifestations and are effective in the prevention of cardiovascular disease. The thienopyridine clopidogrel is a pro-drug metabolised in the liver via the cytochrome P450 (CYP) 3A4 system to the active compound which inhibits the P2Y(12) ADP platelet receptor. The assumption exists that the effect of clopidogrel in inhibiting platelet aggregation is attenuated by co-administration of lipophilic statins such as atorvastatin or simvastatin which are metabolised by the CYP3A4 system to inactive substrates. Assessing a possible drug-drug interaction ex-vivo, inconclusive studies have been published: In an aggregometer study, a strong and dose-dependent interference between atorvastatin and the inhibitory effect of clopidogrel on platelet function was observed. Another study, measuring the effect of clopidogrel by flow cytometry, found a significant attenuation of the clopidogrel effect by lipophilic statins, predominantly in the loading phase. In contrast a recent study, which used 600 mg clopidogrel for loading, found no significant interference between various statins and clopidogrel on ADP-induced platelet aggregation and in addition another study revealed no attenuation of the clopidogrel effect despite statin co-medication after 5 weeks. Additionally, retrospective analysis of clinical studies (CREDO-study) or registries (MITRA-PLUS) revealed no significant influence of different statins on the clinical outcome in patients treated with clopidogrel. However, these clinical studies showed a trend towards a diminishing effect of clopidogrel on those treated with cytochrome CYP3A4 metabolised statins. Even more important seems to be the considerable variability in the response of the antiplatelet effect of clopidogrel. A certain percentage of patients apparently do not respond adequately to clopidogrel treatment. This effect of clopidogrel resistance seems to be more important as the potential interference between CYP3A4 metabolized statins and clopidogrel. Finally, up until now sufficient evidence has not been gained to prefer hydrophil statins on patients receiving clopidogrel co-medication or when to discontinue the use of statins in clopidogrel treatment. Prospective studies are necessary in order to evaluate the magnitude of clopidogrel resistance and the impact of clopidogrel co-medication as well as to redefine antithrombotic therapy for this subgroup.

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Improving Cardiovascular Outcomes in Nova Scotia (ICONS): A Successful Public-Private Partnership in Primary Healthcare

Abstract: his paper outlines, from the partners' views, the background, rationale, key challenges and successes of the ICONS project. ICONS represents a case study of a successful, real-world community health initiative driven by measurement of practices and outcomes.

Cited by 10 publications

References 9 publications

Use of cardiovascular medical therapy among patients undergoing coronary artery bypass graft surgery: Results from the ROSETTA-CABG Registry

Use of cardiovascular medical therapy among patients undergoing coronary artery bypass graft surgery: Results from the ROSETTA-CABG Registry

The effect of place of residence on access to invasive cardiac services following acute myocardial infarction

Thienopyridines and Statins: Assessing a Potential Drug-Drug Interaction

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