The development and evaluation of the cardiovascular assessment screening program

BACKGROUND: An exploratory mixed methods study, with the philosophical basis of pragmatism and interpretive description, was used to develop, implement, and evaluate an intervention called the Cardiovascular Assessment Screening Program (CASP) to address the underutilization of clinical practice guidelines for cardiovascular screening. The Knowledge-to-Action (KTA) Framework with guideline adaptation was used to guide the study. METHODS: In phase 1, the qualitative study, ten interviews and five focus groups were conducted with healthcare providers (HCPs), managers, and the public to gain different perspectives to inform the development of CASP. In phase 2, the quantitative study, CASP was tested in a randomized controlled trial (RCT) with eight nurse practitioners (NPs) and 167 patients aged 40-74 years without previously diagnosed cardiovascular disease (CVD). The intervention group implemented CASP while the control group provided usual care. Phase 3 integration examined the results from phases 1 and 2. RESULTS: From the focus groups and interviews conducted in the qualitative phase, themes emerged related to the barriers to, facilitators of, and strategies for CVD screening in the local context. The Theoretical Domains Framework (TDF) was applied to the themes to identify relevant behaviour change techniques and modes of delivery, from which specific intervention components for CASP were developed. Findings from Phase 2, the RCT, showed a statistically and clinically significant difference between the NP intervention group compared to the control group in terms of comprehensiveness of screening, RR = 43.9, 95% CI [13.4, 144.2], p < .0001. The NPs in the intervention group were able to identify multiple risk factors; determine their patients’ level of CVD risk; identify NPs’ and patients’ priorities for action; and encourage individualized goal-setting with patients for heart health. In Phase 3, the integration of results from phases 1 and 2 confirmed and refined strategies for knowledge translation. The mixed methods study results are reported in Manuscript 1, while Manuscript 2 focuses primarily on Phase 2, the results from the RCT. Manuscript 3 discusses strategies to address recruitment issues of HCPs such as nurses and NPs, as participants in research studies. CONCLUSION: CASP was effective and can be used by HCPs and patients for CVD screening and management utilizing current guidelines to identify risk factors and promote relevant actions to reduce CVD risk and promote healthy aging

The Canadian Women’s Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 8: Knowledge Gaps and Status of Existing Research Programs in Canada

Despite significant progress in medical research and public health efforts, gaps in knowledge of women’s heart health remain across epidemiology, presentation, management, outcomes, education, research, and publications. Historically, heart disease was viewed primarily as a condition in men and male individuals, leading to limited understanding of the unique risks and symptoms that women experience. These knowledge gaps are particularly problematic because globally heart disease is the leading cause of death for women. Until recently, sex and gender have not been addressed in cardiovascular research, including in preclinical and clinical research. Recruitment was often limited to male participants and individuals identifying as men, and data analysis according to sex or gender was not conducted, leading to a lack of data on how treatments and interventions might affect female patients and individuals who identify as women differently. This lack of data has led to suboptimal treatment and limitations in our understanding of the underlying mechanisms of heart disease in women, and is directly related to limited awareness and knowledge gaps in professional training and public education. Women are often unaware of their risk factors for heart disease or symptoms they might experience, leading to delays in diagnosis and treatments. Additionally, health care providers might not receive adequate training to diagnose and treat heart disease in women, leading to misdiagnosis or undertreatment. Addressing these knowledge gaps requires a multipronged approach, including education and policy change, built on evidence-based research. In this chapter we review the current state of existing cardiovascular research in Canada with a specific focus on women. Résumé: En dépit des avancées importantes de la recherche médicale et des efforts en santé publique, il reste des lacunes dans les connaissances sur la santé cardiaque des femmes sur les plans de l’épidémiologie, du tableau clinique, de la prise en charge, des résultats, de l’éducation, de la recherche et des publications. Du point de vue historique, la cardiopathie a d’abord été perçue comme une maladie qui touchait les hommes et les individus de sexe masculin. De ce fait, la compréhension des risques particuliers et des symptômes qu’éprouvent les femmes est limitée. Ces lacunes dans les connaissances posent particulièrement problème puisqu’à l’échelle mondiale la cardiopathie est la cause principale de décès chez les femmes. Jusqu’à récemment, la recherche en cardiologie, notamment la recherche préclinique et clinique, ne portait pas sur le sexe et le genre. Le recrutement souvent limité aux participants masculins et aux individus dont l’identité de genre correspond au sexe masculin et l’absence d’analyses de données en fonction du sexe ou du genre ont eu pour conséquence un manque de données sur la façon dont les traitements et les interventions nuisent aux patientes féminines et aux individus dont l’identité de genre correspond au sexe féminin, et ce, de façon différente. Cette absence de données a mené à un traitement sous-optimal et à des limites de notre compréhension des mécanismes sous-jacents de la cardiopathie chez les femmes, et est directement reliée à nos connaissances limitées, et à nos lacunes en formation professionnelle et en éducation du public. Le fait que les femmes ne connaissent souvent pas leurs facteurs de risque de maladies du cœur ou les symptômes qu’elles peuvent éprouver entraîne des retards de diagnostic et de traitements. De plus, le fait que les prestataires de soins de santé ne reçoivent pas la formation adéquate pour poser le diagnostic et traiter la cardiopathie chez les femmes les mène à poser un mauvais diagnostic ou à ne pas traiter suffisamment. Pour pallier ces lacunes de connaissances, il faut une approche à plusieurs volets, qui porte notamment sur l’éducation et les changements dans les politiques, et qui repose sur la recherche fondée sur des données probantes. Dans ce chapitre, nous passons en revue l’état actuel de la recherche existante sur les maladies cardiovasculaires au Canada, plus particulièrement chez les femmes