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The Evidence Speaks

The Evidence Speaks (February 2020)

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The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators. The Series is designed to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Awad E, Christenson J, Grunau B, Tallon J, Humphries K. Sex differences in out-of-hospital cardiac arrest interventions within the province of British Columbia, Canada. Resuscitation. 2020 Mar;148:128-34.

Despite out-of-hospital cardiac arrest (OHCA) occurring similarly in both men and women, it has been reported that the outcomes between sexes vary across different regions. A team of researchers from Vancouver, including CHÉOS Scientists Drs. Brian Grunau and Karin Humphries, conducted a study examining OHCA resuscitation interventions in B.C. to determine precisely why this disparity exists. The research examined 7,398 patients who had OHCA in B.C., focusing on the sex differences in three pre-hospital interventions: provision of bystander CPR, chest compression rate, and decision to initiate travel to hospital before return of spontaneous circulation (ROSC). Overall, the study determined that there is no apparent association between sex and the provision of bystander CPR or chest compression rate. However, it did note that of the individuals who did not attain ROSC pre-hospital, men were 1.2-times more likely to be transported to hospital with ongoing resuscitation than women, who were more likely to be declared deceased at the scene – a small but statistically significant and clinically important difference.

Loewen PS, Bansback N, Hicklin J, Andrade JG, Kapanen AI, Kwan L, Lynd LD, McClean A, MacGillivray J, Salmasi S. Evaluating the Effect of a Patient Decision Aid for Atrial Fibrillation Stroke Prevention Therapy. Ann Pharmacother. 2019 Jul;53(7):665-74.

Atrial fibrillation is associated with up to a five-fold increase in the risk of stroke. To ensure patients are informed and able to participate in shared decision making on stroke prevention treatment with their clinician, patient decision aids (PDAs) are key. PDAs may improve patient knowledge and reduce decisional conflict; however, few are available for clinical use. In this study, CHÉOS Scientists Drs. Nick Bansback and Larry Lynd worked with colleagues from across Vancouver and New Westminster to develop a PDA to inform stroke prevention therapy decision making in atrial fibrillation. Upon use, the novel PDA they created revealed that, for many patients, the prescribed treatment was different to their preferred treatment. Going forward, the PDA could be a valuable tool for helping clinicians and their patients select the best course of treatment, as it was shown to be effective for reducing decisional conflict, increasing patient knowledge, representing patient values, and offering valid therapy options in line with patient preferences.

King-Shier K, Quan H, Mather C, Chong E, LeBlanc P, Khan N. Understanding ethno-cultural differences in cardiac medication adherence behavior: a Canadian study. Patient Prefer Adherence. 2018 Sep;12:1737-47.

While it is recognized that there are ethno-cultural variations in adherence to cardiac medications, the reasons behind them remain unclear. CHÉOS Scientist Dr. Nadia Khan joined forces with colleagues from the University of British Columbia and University of Calgary to employ a descriptive decision model in an effort to understand the contextual factors behind why the differences in adherence may exist. Using the model, the researchers surveyed 286 participants – 117 white, 79 Chinese, and 90 south Asian – to determine the reasons behind their decisions to take or not take their cardiac medications. Each participant group reported that affordability of medications increased their adherence, while remembering to take medication, especially when away from home, put participants at risk of non-adherence. The researchers noted that south Asian participants were less likely to be adherent if they felt that communication with their health care provider was poor. Furthermore, south Asian and Chinese participants were more likely to be non-adherent if they had doubts about western medicine. The outcomes of this study could help inform future medication adherence questionnaires and interventional processes, with the aim of increasing cardiac medicine adherence in those who need it.