An Update on the Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation and Atrial Flutter

Roopinder K. Sandhu; Stephen B. Wilton; Jennifer Cruz; Clare L. Aztema; Kendra MacFarlane; Robert McKelvie; Laurie Lambert; Kathy Rush; Rodney Zimmerman; Garth Oakes; Mark Deyell; D. George Wyse; Jafna L. Cox; Allan Skanes

doi:10.1016/j.cjco.2019.05.007

An Update on the Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation and Atrial Flutter

Roopinder K. Sandhu, Stephen B. Wilton, Jennifer Cruz, Clare L. Aztema, Kendra MacFarlane, Robert McKelvie, Laurie Lambert, Kathy Rush, Rodney Zimmerman, Garth Oakes, Mark Deyell, D. George Wyse, Jafna L. Cox, Allan Skanes

Medicine

Medicine

Research output: Contribution to journal › Article › peer-review

10 Citations (Scopus)

Abstract

Background: In 2010, the Canadian Cardiovascular Society Atrial Fibrillation/Atrial Flutter (AF/AFL) quality indicator (QI) working group was established to develop QIs and assess feasibility of measurement. After extensive review, 3 priority QIs were selected. However, none were measurable at a national level. Methods: The working group reconvened in 2017 to review the relevance of previously proposed QIs, identify opportunities to develop new QIs, and propose an initial strategy for measuring and reporting. Results: Two additional priority QIs were added to the previous 3: proportion of patients with nonvalvular (NV) AF/AFL sorted by stroke risk stratum and annual rate of hospitalization for a new heart failure diagnosis. An environmental scan was undertaken to determine the potential of existing databases to provide national and provincial estimates. On the basis of validated administrative codes, the Canadian Institute for Health Information discharge abstract database can be used for inpatients. In collaboration with the Canadian Primary Care Sentinel Surveillance Network, 2 of the 5 QIs can be assessed in outpatients (patients with NVAF/AFL sorted by stroke risk stratum and high risk for stroke NVAF/AFL receiving oral anticoagulation). Stroke prevention therapy can be further measured in selected provinces with linked databases including prescriptions. Conclusions: This first step could provide a better initial understanding of the quality of AF/AFL care in Canada, but important gaps in the meaningful measurement of QIs remain. The AF/AFL QI working group has limited capacity to make progress without national level leadership and the resources to support data aggregation, data analysis, and pan-Canadian reporting.

Original language	English
Pages (from-to)	198-205
Number of pages	8
Journal	CJC Open
Volume	1
Issue number	4
DOIs	https://doi.org/10.1016/j.cjco.2019.05.007
Publication status	Published - Jul 2019

Bibliographical note

Funding Information:
R.K.S.: research grants from Servier Alberta Innovation in Health Fund. S.B.W.: consulting fees/honoraria from Arca Biopharma; research grants from Medtronic , Boston Scientific, and Abbott Canada . M.D.: research grants from Abbott Canada, BMS Pfizer, and Johnson & Johnson; consulting fees/honoraria from Abbott Canada, BMS Pfizer, Boehringer Ingelheim, Johnson & Johnson, and Servier. D.G.W.: research grants from Population Health Research Institute , Montreal Heart Institute , Canadian Institute of Health Research Institutes , Boehringer Ingelheim , Portola , and Bayer HealthCare ; consulting fees/honoraria from the National Institutes of Health (United States). J.L.C.: consulting fees/honoraria from Bayer, BMS Pfizer, and Servier. A.S.: research grant from Johnson & Johnson , Medtronic ; consulting fees/honoraria from Bayer , BMS Pfizer , Boehringer Ingelheim , and Johnson & Johnson . The remaining authors have no conflicts of interest to disclose.

Funding Information:
The authors thank all the members of the CCS AF/AFL QI working group for their contributions to quality improvement activities. We also thank the CIHI for their expertise regarding national inpatient data and the CCS staff who have organized meetings, compiled minutes, and maintained timelines in support of these activities. The resources required to review and refine the CCS AF/AFL QIs, in addition to the environmental scan completed and documented in this manuscript, were made possible through funding provided by Bristol-Myers Squibb, Pfizer, Novartis, and Edwards Lifesciences. The manuscript was written independently of any of the funding sources. R.K.S.: research grants from Servier Alberta Innovation in Health Fund. S.B.W.: consulting fees/honoraria from Arca Biopharma; research grants from Medtronic, Boston Scientific, and Abbott Canada. M.D.: research grants from Abbott Canada, BMS Pfizer, and Johnson & Johnson; consulting fees/honoraria from Abbott Canada, BMS Pfizer, Boehringer Ingelheim, Johnson & Johnson, and Servier. D.G.W.: research grants from Population Health Research Institute, Montreal Heart Institute, Canadian Institute of Health Research Institutes, Boehringer Ingelheim, Portola, and Bayer HealthCare; consulting fees/honoraria from the National Institutes of Health (United States). J.L.C.: consulting fees/honoraria from Bayer, BMS Pfizer, and Servier. A.S.: research grant from Johnson & Johnson, Medtronic; consulting fees/honoraria from Bayer, BMS Pfizer, Boehringer Ingelheim, and Johnson & Johnson. The remaining authors have no conflicts of interest to disclose. These are disclosures and not the funding sources. Please remove the country from these company names. However, for the disclosures by Bristol-Myers Squibb, Pfizer, Novartis, and Edwards Lifesciences are all from Canada.

Publisher Copyright:
© 2019 Canadian Cardiovascular Society

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine

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10.1016/j.cjco.2019.05.007

Cite this

Sandhu, R. K., Wilton, S. B., Cruz, J., Aztema, C. L., MacFarlane, K., McKelvie, R., Lambert, L., Rush, K., Zimmerman, R., Oakes, G., Deyell, M., Wyse, D. G., Cox, J. L., & Skanes, A. (2019). An Update on the Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation and Atrial Flutter. CJC Open, 1(4), 198-205. https://doi.org/10.1016/j.cjco.2019.05.007

Sandhu, RK, Wilton, SB, Cruz, J, Aztema, CL, MacFarlane, K, McKelvie, R, Lambert, L, Rush, K, Zimmerman, R, Oakes, G, Deyell, M, Wyse, DG, Cox, JL & Skanes, A 2019, 'An Update on the Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation and Atrial Flutter', CJC Open, vol. 1, no. 4, pp. 198-205. https://doi.org/10.1016/j.cjco.2019.05.007

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title = "An Update on the Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation and Atrial Flutter",

abstract = "Background: In 2010, the Canadian Cardiovascular Society Atrial Fibrillation/Atrial Flutter (AF/AFL) quality indicator (QI) working group was established to develop QIs and assess feasibility of measurement. After extensive review, 3 priority QIs were selected. However, none were measurable at a national level. Methods: The working group reconvened in 2017 to review the relevance of previously proposed QIs, identify opportunities to develop new QIs, and propose an initial strategy for measuring and reporting. Results: Two additional priority QIs were added to the previous 3: proportion of patients with nonvalvular (NV) AF/AFL sorted by stroke risk stratum and annual rate of hospitalization for a new heart failure diagnosis. An environmental scan was undertaken to determine the potential of existing databases to provide national and provincial estimates. On the basis of validated administrative codes, the Canadian Institute for Health Information discharge abstract database can be used for inpatients. In collaboration with the Canadian Primary Care Sentinel Surveillance Network, 2 of the 5 QIs can be assessed in outpatients (patients with NVAF/AFL sorted by stroke risk stratum and high risk for stroke NVAF/AFL receiving oral anticoagulation). Stroke prevention therapy can be further measured in selected provinces with linked databases including prescriptions. Conclusions: This first step could provide a better initial understanding of the quality of AF/AFL care in Canada, but important gaps in the meaningful measurement of QIs remain. The AF/AFL QI working group has limited capacity to make progress without national level leadership and the resources to support data aggregation, data analysis, and pan-Canadian reporting.",

author = "Sandhu, {Roopinder K.} and Wilton, {Stephen B.} and Jennifer Cruz and Aztema, {Clare L.} and Kendra MacFarlane and Robert McKelvie and Laurie Lambert and Kathy Rush and Rodney Zimmerman and Garth Oakes and Mark Deyell and Wyse, {D. George} and Cox, {Jafna L.} and Allan Skanes",

note = "Funding Information: R.K.S.: research grants from Servier Alberta Innovation in Health Fund. S.B.W.: consulting fees/honoraria from Arca Biopharma; research grants from Medtronic , Boston Scientific, and Abbott Canada . M.D.: research grants from Abbott Canada, BMS Pfizer, and Johnson & Johnson; consulting fees/honoraria from Abbott Canada, BMS Pfizer, Boehringer Ingelheim, Johnson & Johnson, and Servier. D.G.W.: research grants from Population Health Research Institute , Montreal Heart Institute , Canadian Institute of Health Research Institutes , Boehringer Ingelheim , Portola , and Bayer HealthCare ; consulting fees/honoraria from the National Institutes of Health (United States). J.L.C.: consulting fees/honoraria from Bayer, BMS Pfizer, and Servier. A.S.: research grant from Johnson & Johnson , Medtronic ; consulting fees/honoraria from Bayer , BMS Pfizer , Boehringer Ingelheim , and Johnson & Johnson . The remaining authors have no conflicts of interest to disclose. Funding Information: The authors thank all the members of the CCS AF/AFL QI working group for their contributions to quality improvement activities. We also thank the CIHI for their expertise regarding national inpatient data and the CCS staff who have organized meetings, compiled minutes, and maintained timelines in support of these activities. The resources required to review and refine the CCS AF/AFL QIs, in addition to the environmental scan completed and documented in this manuscript, were made possible through funding provided by Bristol-Myers Squibb, Pfizer, Novartis, and Edwards Lifesciences. The manuscript was written independently of any of the funding sources. R.K.S.: research grants from Servier Alberta Innovation in Health Fund. S.B.W.: consulting fees/honoraria from Arca Biopharma; research grants from Medtronic, Boston Scientific, and Abbott Canada. M.D.: research grants from Abbott Canada, BMS Pfizer, and Johnson & Johnson; consulting fees/honoraria from Abbott Canada, BMS Pfizer, Boehringer Ingelheim, Johnson & Johnson, and Servier. D.G.W.: research grants from Population Health Research Institute, Montreal Heart Institute, Canadian Institute of Health Research Institutes, Boehringer Ingelheim, Portola, and Bayer HealthCare; consulting fees/honoraria from the National Institutes of Health (United States). J.L.C.: consulting fees/honoraria from Bayer, BMS Pfizer, and Servier. A.S.: research grant from Johnson & Johnson, Medtronic; consulting fees/honoraria from Bayer, BMS Pfizer, Boehringer Ingelheim, and Johnson & Johnson. The remaining authors have no conflicts of interest to disclose. These are disclosures and not the funding sources. Please remove the country from these company names. However, for the disclosures by Bristol-Myers Squibb, Pfizer, Novartis, and Edwards Lifesciences are all from Canada. Publisher Copyright: {\textcopyright} 2019 Canadian Cardiovascular Society",

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T1 - An Update on the Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation and Atrial Flutter

AU - Sandhu, Roopinder K.

AU - Wilton, Stephen B.

AU - Cruz, Jennifer

AU - Aztema, Clare L.

AU - MacFarlane, Kendra

AU - McKelvie, Robert

AU - Lambert, Laurie

AU - Rush, Kathy

AU - Zimmerman, Rodney

AU - Oakes, Garth

AU - Deyell, Mark

AU - Wyse, D. George

AU - Cox, Jafna L.

AU - Skanes, Allan

N1 - Funding Information: R.K.S.: research grants from Servier Alberta Innovation in Health Fund. S.B.W.: consulting fees/honoraria from Arca Biopharma; research grants from Medtronic , Boston Scientific, and Abbott Canada . M.D.: research grants from Abbott Canada, BMS Pfizer, and Johnson & Johnson; consulting fees/honoraria from Abbott Canada, BMS Pfizer, Boehringer Ingelheim, Johnson & Johnson, and Servier. D.G.W.: research grants from Population Health Research Institute , Montreal Heart Institute , Canadian Institute of Health Research Institutes , Boehringer Ingelheim , Portola , and Bayer HealthCare ; consulting fees/honoraria from the National Institutes of Health (United States). J.L.C.: consulting fees/honoraria from Bayer, BMS Pfizer, and Servier. A.S.: research grant from Johnson & Johnson , Medtronic ; consulting fees/honoraria from Bayer , BMS Pfizer , Boehringer Ingelheim , and Johnson & Johnson . The remaining authors have no conflicts of interest to disclose. Funding Information: The authors thank all the members of the CCS AF/AFL QI working group for their contributions to quality improvement activities. We also thank the CIHI for their expertise regarding national inpatient data and the CCS staff who have organized meetings, compiled minutes, and maintained timelines in support of these activities. The resources required to review and refine the CCS AF/AFL QIs, in addition to the environmental scan completed and documented in this manuscript, were made possible through funding provided by Bristol-Myers Squibb, Pfizer, Novartis, and Edwards Lifesciences. The manuscript was written independently of any of the funding sources. R.K.S.: research grants from Servier Alberta Innovation in Health Fund. S.B.W.: consulting fees/honoraria from Arca Biopharma; research grants from Medtronic, Boston Scientific, and Abbott Canada. M.D.: research grants from Abbott Canada, BMS Pfizer, and Johnson & Johnson; consulting fees/honoraria from Abbott Canada, BMS Pfizer, Boehringer Ingelheim, Johnson & Johnson, and Servier. D.G.W.: research grants from Population Health Research Institute, Montreal Heart Institute, Canadian Institute of Health Research Institutes, Boehringer Ingelheim, Portola, and Bayer HealthCare; consulting fees/honoraria from the National Institutes of Health (United States). J.L.C.: consulting fees/honoraria from Bayer, BMS Pfizer, and Servier. A.S.: research grant from Johnson & Johnson, Medtronic; consulting fees/honoraria from Bayer, BMS Pfizer, Boehringer Ingelheim, and Johnson & Johnson. The remaining authors have no conflicts of interest to disclose. These are disclosures and not the funding sources. Please remove the country from these company names. However, for the disclosures by Bristol-Myers Squibb, Pfizer, Novartis, and Edwards Lifesciences are all from Canada. Publisher Copyright: © 2019 Canadian Cardiovascular Society

PY - 2019/7

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N2 - Background: In 2010, the Canadian Cardiovascular Society Atrial Fibrillation/Atrial Flutter (AF/AFL) quality indicator (QI) working group was established to develop QIs and assess feasibility of measurement. After extensive review, 3 priority QIs were selected. However, none were measurable at a national level. Methods: The working group reconvened in 2017 to review the relevance of previously proposed QIs, identify opportunities to develop new QIs, and propose an initial strategy for measuring and reporting. Results: Two additional priority QIs were added to the previous 3: proportion of patients with nonvalvular (NV) AF/AFL sorted by stroke risk stratum and annual rate of hospitalization for a new heart failure diagnosis. An environmental scan was undertaken to determine the potential of existing databases to provide national and provincial estimates. On the basis of validated administrative codes, the Canadian Institute for Health Information discharge abstract database can be used for inpatients. In collaboration with the Canadian Primary Care Sentinel Surveillance Network, 2 of the 5 QIs can be assessed in outpatients (patients with NVAF/AFL sorted by stroke risk stratum and high risk for stroke NVAF/AFL receiving oral anticoagulation). Stroke prevention therapy can be further measured in selected provinces with linked databases including prescriptions. Conclusions: This first step could provide a better initial understanding of the quality of AF/AFL care in Canada, but important gaps in the meaningful measurement of QIs remain. The AF/AFL QI working group has limited capacity to make progress without national level leadership and the resources to support data aggregation, data analysis, and pan-Canadian reporting.

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An Update on the Development and Feasibility Assessment of Canadian Quality Indicators for Atrial Fibrillation and Atrial Flutter

Abstract

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