CCORT A brief overview

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CCORTA brief overview
Canadian Heart Health Strategy Working Group

• Jack V. Tu, MD PhD FRCPC
• July 2007

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Overview of CCORT

• Formed in 2001with funding from
• Canadian Institutes of Health Research
• Heart and Stroke Foundation (HSF)
• Comprised of more than 30 CV outcomes researchers
• Investigators from 5 provinces

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CCORT CV Atlas Objectives

• Create the first national report card on
  cardiac care in Canada
• Study how geography (where you live?) affects the
  burden of cardiac disease and quality of cardiac
  care delivered across Canada
• Stimulate policy changes and quality improvement
  activities across Canada

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CCORT CV Atlas Editors Jack V. Tu (ON)--Louise
Pilote (QC)--William Ghali (AB)--Susan Brien (ON)
David Alter Peter Austin Christine
Beck Jean-Marie Berthelot Ron Carere Chi-Ming
Chow Jafna Cox Paul Daly Linda Donovan Mark
Eisenberg Peter Faris
Woganee Filate Diane Galbraith Min Gao Yanyan
Gong Shaun Goodman Curry Grant Ruth Hall Ansar
Hassan Greg Hirsch Karin Humphries Lissa
Jaakkimainen Cynthia Jackevicius
Shelina Jamal Helen Johansen Igor Karp Courtney
Kennedy Merrill Knudtson Andreas Laupacis Doug
Lee Mark Leung Doug Manuel Patrick Merrett Alice
Newman Colleen Norris
Kathy Nguyen Hude Quan Sara Ramer Hugues
Richard Fiona Shrive Ian Steill Larry
Svenson Peter Tanuseputro Chris Thompson Karen
Tu Christian Vaillancourt
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CCORT CV Atlas Papers (n24 2)

• Introduction to CV Atlas
• Overview of Methods
• Burden of CVD
• Regional variation in self-reported prevalence
• Regional variation in CV mortality rates
• Risk factors for CVD
• Hospitalization rates LOS for CV conditions
• Physician services for CVD
• Outcomes of AMI
• Cardiac procedures post AMI
• Acute treatment of AMI
• Secondary prevention of AMI

• Regional Outcomes of HF
• Acute Chronic treatment of CHF
• Population rates of hospitalization for A Fib
• Cardiac Arrest Care
• Cardiovascular drug utilization
• Diagnostic cardiac cath revascularization for
  CHD
• Outcomes after cardiac cath
• Outcomes after CABG
• Inhospital outcomes after PCI

• Use of Valve Surgery
• Outcomes after AV MV replacement surgery
• Non-clinical determinants of access outcomes
  after AMI

• 2 papers re QI
• QI for AMI
• QI for CHF

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The 24 CV Atlas papers the 2 quality indicator
papers Have been compiled into a
Compendium. Published on July 4, 2006 and
available free of charge from www.ccort.ca\atlas.
asp
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Age-Standardized Canadian Cardiovascular Disease
Mortality Rates, Males/Females, 1950-1999
Year
Data Source Statistics Canada
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Life Expectancy Lost Due to Mortality, by Major
Disease Category, Canada, 1999.
Data Source Statistics Canada
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Age-standardized Cardiovascular Disease (CVD)
Mortality Rates per 100,000 Adults, by Health
Region, 1995 1997
Age-standardized CVD Mortality Rates
Rate per 100, 000 population
of HR in each category
Vancouver
Canadian Rate246 per 100,000 patients
P.E.I
Maritimes
Montreal
Southeast Ontario
Central/Southwest Ontario
Source Canadian Cardiovascular Outcomes Research
Team and Statistics Canada, 1991
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Age standardized Cardiovascular Disease (CVD)
Mortality Rates per 100,000 adults in Canada,
1995-1997
Data source Statistics Canada
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Why are there hot spots for cardiovascular
disease in Canada?

• Lifestyle differences (e.g. smoking, obesity,
  exercise)
• Socioeconomic determinants (e.g. poverty levels,
  education)
• Quality of cardiac care (e.g., door-to-needle
  time)
• Health care spending (e.g., drugs, bypass/PCI
  treatments)
• Other

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Canadian Community Health Survey

• Conducted by Statistics Canada
• Cross-sectional estimates of health determinants,
  health status and health system use across
  Canada, at the health region level
• One respondent per household
• Self-reported information (no physical
  measurements)
• Sample 131, 535 household respondents (12 yrs
  and older) 84.7 response rate
• Data collection started September 2000, from
  first collection cycle (Cycle 1.1)

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Prevalence of Smoking in Canadians, aged 12
years and over, by Province, 2000/01
plt0.05 significant difference between
provincial rate and Canadian rate
Data Source Statistics Canada
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Prevalence of obese Canadians aged 12 years and
over, by Province, 2000/01
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Prevalence of sedentary Canadians aged 12 years
and over, by Province, 2000/01
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Prevalence of Canadians aged 12 years and over
who are diabetic, by Province, 2000/01
4.5
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Prevalence of hypertensive Canadians aged 12
years and over, by Province, 2000/01
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Prevalence of low income Canadians aged 12 years
and over, by Province, 2000/01
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Number of Cardiovascular Disease (CVD) Risk
Factors, per Health Region, with a Prevalence
rate greater than the National Average, 2000/01
of CVD risk factors above Canadian average
HR in each category
Risk Factors
Vancouver
4
30
P.E.I
Maritimes
Montreal
Southeast Ontario
Central/Southwest Ontario
Source Canadian Cardiovascular Outcomes Research
Team,Statistics Canada Canadian Community Health
Survey 2000/01.
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Relative importance of health region
characteristics in explaining regional variation
in cardiovascular mortality
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Limitations

• Other factors may influence cardiovascular death
  rates but regional data are not available.
• E.g., Genetics, diet, pollution, weather

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CVD Disease Burden Risk Factors --Conclusions

• Wide regional variation observed in
  cardiovascular disease mortality rates across
  Canada.
• Smoking and obesity rates appear to be very
  important determinants of regional variation in
  death rates.
• Reducing smoking rates and obesity rates could
  have a major impact in reducing regional
  differences in cardiovascular death rates.

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Goals of Microsimulation

• Project trends of risk factor prevalence
• Project number of cases eligible for primary
  interventions
• Project number of AMI events
• Simulate interventions
• All of these by age, sex, calendar year,
  province, health regions, etc
• May 17, 2005
• Christel Le Petit, Statistics Canada

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Disease Model
Risk factors
Disease progression
AMI risk function
Age Sex Smoking Cholesterol Hypertension Diabetes
BMI
2nd AMI Congestive heart failure Unstable
Angina Death
Incidence of index AMI
May 17, 2005 Christel Le Petit, Statistics Canada
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Our experience with Simulation

• Pros
• Supports what if analyses
• Supports future planning
• Utilize data you have to address gaps (use data
  from Ont to assess national performance)
• Test interventions using simulation model

• Cons
• Dependent on quality of assumptions
• Unable to predict impact of new changes
  technology, drugs,
• Difficult to validate
• Dependent on quality of underlying data

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For More Info see www.ccort.ca