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Article ; Online: Prior bleeding, future bleeding and stroke risk with oral anticoagulation in atrial fibrillation: What new lessons can ARISTOTLE teach us?

Goodman, Shaun G

2016 Volume 175, Page(s) 168–171

Language	English
Publishing date	2016
Publishing country	United States
Document type	Editorial ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2016.02.003
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Article: Real-World Risk of Recurrent Cardiovascular Events in Atherosclerotic Cardiovascular Disease Patients with LDL-C Above Guideline-Recommended Threshold: A Retrospective Observational Study.

Mackinnon, Erin S / Leiter, Lawrence A / Wani, Rajvi J / Burke, Natasha / Shaw, Eileen / Witges, Kelcie / Goodman, Shaun G

Cardiology and therapy

2024 Volume 13, Issue 1, Page(s) 205–220

Abstract: Introduction: The 2021 Canadian Cardiovascular Society (CCS) guidelines recommend intensive low-density lipoprotein cholesterol (LDL-C) reduction for patients with atherosclerotic cardiovascular disease (ASCVD). For patients above LDL-C threshold on ... ...

Abstract	Introduction: The 2021 Canadian Cardiovascular Society (CCS) guidelines recommend intensive low-density lipoprotein cholesterol (LDL-C) reduction for patients with atherosclerotic cardiovascular disease (ASCVD). For patients above LDL-C threshold on maximally tolerated statins, adding ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) is recommended. This population-based, real-world study examined cardiovascular (CV) events in patients with ASCVD who are on statins and above current guideline threshold LDL-C levels. Methods: Using administrative health data in Alberta, Canada, we identified patients with myocardial infarction (MI), ischemic stroke (IS), or peripheral artery disease with LDL-C > 1.8 mmol/L on statins between April 1, 2010 and March 31, 2016. Exploratory subgroups included very high-risk patients with ASCVD shown to derive the most benefit from PCSK9i intensification as identified by the CCS guidelines, including those with acute coronary syndrome (ACS) or recent MI. Frequencies and rates of individual and composite CV events (primary outcome: MI, IS, hospitalization for unstable angina, coronary revascularization, cardiovascular death; secondary outcome: MI, IS, CV death) were calculated over follow-up. Results: The study included 32,984 patients with a mean (standard deviation) follow-up of 40.8 (21.0) months. Overall, 17.7% and 15.6% experienced a primary and secondary outcome, respectively, with rates of 5.58 and 4.83 per 100 patient-years, respectively. CV death and MI were the most common events. Subgroups with recurrent MI and comorbid diabetes exhibited higher CV event rates (23.6% and 22.2% had a primary outcome, respectively). Rates of CV events were notably high in patients with ACS or recent MI (49.4% and 54.0% had a primary outcome, respectively). Conclusion: This real-world study confirms that statin-treated high-risk patients with ASCVD and above-threshold LDL-C levels have substantial incidence of recurrent CV events. These findings reinforce the opportunity for lipid-lowering therapy intensification in high-risk patients to levels below guideline-recommended threshold in order to reduce CV risk.
Language	English
Publishing date	2024-01-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2700626-8
ISSN	2193-6544 ; 2193-8261
ISSN (online)	2193-6544
ISSN	2193-8261
DOI	10.1007/s40119-024-00349-6
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Article ; Online: Access Denied? The Unintended Consequences of Pending Drug Pricing Rules.

Kaplan, Alan / Stewart, David J / Batist, Gerald / Spadafora, Silvana / Sehdev, Sandeep / Goodman, Shaun G

Current oncology (Toronto, Ont.)

2022 Volume 29, Issue 4, Page(s) 2504–2508

Abstract: The government of Canada now plans to bring into force new federal drug pricing regulations on 1 July 2022. We do not take issue with the goal of medication affordability, which is vital in healthcare the world over. Our concern is that the new ... ...

Abstract	The government of Canada now plans to bring into force new federal drug pricing regulations on 1 July 2022. We do not take issue with the goal of medication affordability, which is vital in healthcare the world over. Our concern is that the new guidelines are being implemented without due consideration for three major unintended consequences: regulatory changes will lower the number of clinical trials for new medications in Canada, fewer clinical trials will mean lower research and development investments, and changes will reduce patients' access to new medications. Access to effective medications is a cornerstone of healthcare for Canadian patients. As physicians, our duty to patient care demands that we tell the government to protect the right of Canadians to timely access to life-changing medicines.
MeSH term(s)	Canada ; Costs and Cost Analysis ; Drug Costs ; Humans
Language	English
Publishing date	2022-04-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol29040204
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Article ; Online: Current Gaps in the Provision of Safe and Effective Anticoagulation in Atrial Fibrillation and the Potential for Factor XI-Directed Therapeutics.

Goodman, Shaun G / Roy, Denis / Pollack, Charles V / Leblanc, Kori / Kwaku, Kevin F / Barnes, Geoffrey D / Bonaca, Marc P / True Hills, Mellanie / Campello, Elena / Fanikos, John / Connors, Jean M / Weitz, Jeffrey I

Critical pathways in cardiology

2024

Abstract: The global prevalence of atrial fibrillation is rapidly increasing, in large part due to the aging of the population. Atrial fibrillation is known to increase the risk of thromboembolic stroke by five times, but it has been evident for decades that well- ... ...

Abstract	The global prevalence of atrial fibrillation is rapidly increasing, in large part due to the aging of the population. Atrial fibrillation is known to increase the risk of thromboembolic stroke by five times, but it has been evident for decades that well-managed anticoagulation therapy can greatly attenuate this risk. Despite advances in pharmacology (such as the shift from vitamin K antagonists to direct oral anticoagulants) that have increased the safety and convenience of chronic oral anticoagulation in atrial fibrillation, a preponderance of recent observational data indicates that protection from stroke is poorly achieved on a population basis. This outcomes deficit is multifactorial in origin, stemming from a combination of underprescribing of anticoagulants (often as a result of bleeding concerns by prescribers), limitations of the drugs themselves (drug-drug interactions, bioaccumulation in renal insufficiency, short half-lives that result in lapses in therapeutic effect, etc.), and suboptimal patient adherence that results from lack of understanding/education, polypharmacy, fear of bleeding, forgetfulness, and socioeconomic barriers, among other obstacles. Often this adherence is not reported to treating clinicians, further subverting efforts to optimize care. A multidisciplinary, interprofessional panel of clinicians met during the 2023 International Society of Thrombosis and Haemostasis Congress to discuss these gaps in therapy, how they can be more readily recognized, and the potential for Factor XI-directed anticoagulants to improve the safety and efficacy of stroke prevention. A full appreciation of this potential requires a re-evaluation of traditional teaching about the "coagulation cascade" and decoupling the processes that result in (physiologic) hemostasis and (pathologic) thrombosis. The panel discussion is summarized and presented here.
Language	English
Publishing date	2024-02-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2079676-6
ISSN	1535-2811 ; 1535-282X
ISSN (online)	1535-2811
ISSN	1535-282X
DOI	10.1097/HPC.0000000000000351
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Article ; Online: Does enoxaparin have enough FINESSE to replace unfractionated heparin in primary percutaneous coronary intervention?

Goodman, Shaun G

JACC. Cardiovascular interventions

2010 Volume 3, Issue 2, Page(s) 213–214

MeSH term(s)	Angioplasty, Balloon, Coronary ; Anticoagulants/therapeutic use ; Coronary Artery Disease/drug therapy ; Coronary Artery Disease/therapy ; Coronary Restenosis/drug therapy ; Coronary Restenosis/therapy ; Enoxaparin/therapeutic use ; Fibrinolytic Agents/therapeutic use ; Heparin/therapeutic use ; Humans ; Myocardial Reperfusion
Chemical Substances	Anticoagulants ; Enoxaparin ; Fibrinolytic Agents ; Heparin (9005-49-6)
Language	English
Publishing date	2010-02
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	2452157-7
ISSN	1876-7605 ; 1936-8798
ISSN (online)	1876-7605
ISSN	1936-8798
DOI	10.1016/j.jcin.2009.10.028
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Article ; Online: Trends in Uptake and Adherence to Oral Anticoagulation for Patients With Incident Atrial Fibrillation at High Stroke Risk Across Health Care Settings.

Yogasundaram, Haran / Dover, Douglas C / Hawkins, Nathaniel M / McAlister, Finlay A / Goodman, Shaun G / Ezekowitz, Justin / Kaul, Padma / Sandhu, Roopinder K

Journal of the American Heart Association

2022 Volume 11, Issue 15, Page(s) e024868

Abstract: Background Oral anticoagulation (OAC) therapy prevents morbidity and mortality in nonvalvular atrial fibrillation; whether location of diagnosis influences OAC uptake or adherence is unknown. Methods and Results Retrospective cohort study (2008-2019), ... ...

Abstract	Background Oral anticoagulation (OAC) therapy prevents morbidity and mortality in nonvalvular atrial fibrillation; whether location of diagnosis influences OAC uptake or adherence is unknown. Methods and Results Retrospective cohort study (2008-2019), identifying adults with incident nonvalvular atrial fibrillation across health care settings (emergency department, hospital, outpatient) at high risk of stroke. OAC uptake and adherence via proportion of days covered for direct OACs and time in therapeutic range for warfarin were measured. Proportion of days covered was categorized as low (0-39%), intermediate (40-79%), and high (80-100%). Warfarin control was defined as time in therapeutic range ≥65%. All-cause mortality was examined at a 3-year landmark. Among 75 389 patients with nonvalvular atrial fibrillation (47.0% women, mean 77.4 years), 19.7% were diagnosed in the emergency department, 59.1% in the hospital, and 21.2% in the outpatient setting. Ninety-day OAC uptake was 51.6% in the emergency department, 50.9% in the hospital, and 67.9% in the outpatient setting (
MeSH term(s)	Administration, Oral ; Adult ; Anticoagulants/therapeutic use ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/epidemiology ; Delivery of Health Care ; Female ; Humans ; Male ; Retrospective Studies ; Stroke/epidemiology ; Stroke/etiology ; Stroke/prevention & control ; Warfarin/therapeutic use
Chemical Substances	Anticoagulants ; Warfarin (5Q7ZVV76EI)
Language	English
Publishing date	2022-07-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.121.024868
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Article ; Online: Long-Term Outcomes for Patients With Acute Coronary Syndrome and Nonvalvular Atrial Fibrillation.

Gouda, Pishoy / Dover, Douglas C / Savu, Anamaria / Bainey, Kevin / Goodman, Shaun G / Welsh, Robert / Kaul, Padma / Sandhu, Roopinder Kaur

The American journal of cardiology

2022 Volume 167, Page(s) 54–61

Abstract: Short-term outcomes are worse for patients with acute coronary syndrome (ACS) with a history of nonvalvular atrial fibrillation (NVAF). However, long-term prognosis remains unclear. We linked administrative health databases to identify patients ... ...

Abstract	Short-term outcomes are worse for patients with acute coronary syndrome (ACS) with a history of nonvalvular atrial fibrillation (NVAF). However, long-term prognosis remains unclear. We linked administrative health databases to identify patients hospitalized with ACS (ST-elevation myocardial infarction [STEMI], non-STEMI [NSTEMI], and unstable angina) between 2008 and 2019 in Alberta, Canada. Patients were stratified according to history of NVAF before hospitalization. The primary outcome was a composite of all-cause mortality, hospitalization for myocardial infarction, or stroke at 3 years. Cox models were constructed to estimate the association between ACS, NVAF, and outcomes. Of 54,309 ACS hospitalizations, 6,351 patients (11.7%) had a history of NVAF. Compared with patients without NVAF, patients with previous NVAF were older (75.6 ± 11.6 vs 64.9 ± 13.4 years), women (35.1% vs 30.0%), had higher comorbid burden (Charlson co-morbidity index 3.0 vs 1.0), and more often presented with NSTEMI (57.5% vs 49.0%). The primary outcome occurred in 37.0% of patients with previous NVAF and 17.4% without (p <0.001). In the multivariable analysis, there was a 1.14-fold (95% confidence interval [CI] 1.09 to 1.20) higher risk of the primary outcome in patients with previous NVAF. There was a significant association with STEMI (adjusted harazard ratio [aHR] 1.24, 95% CI 1.12 to 1.36) and NSTEMI (aHR 1.12, 95% CI 1.06 to 1.19) but not with unstable angina (aHR 1.04, 95% CI 0.90 to 1.22). In conclusion, in this population-based study, we identified that a history of NVAF at ACS presentation is associated with worse long-term prognosis, particularly for STEMI and NSTEMI.
MeSH term(s)	Acute Coronary Syndrome/complications ; Acute Coronary Syndrome/epidemiology ; Alberta ; Angina, Unstable/epidemiology ; Atrial Fibrillation/complications ; Atrial Fibrillation/epidemiology ; Female ; Humans ; Non-ST Elevated Myocardial Infarction/epidemiology ; ST Elevation Myocardial Infarction/epidemiology
Language	English
Publishing date	2022-01-07
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80014-4
ISSN	1879-1913 ; 0002-9149
ISSN (online)	1879-1913
ISSN	0002-9149
DOI	10.1016/j.amjcard.2021.11.043
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Article ; Online: Associated factors and clinical outcomes in mechanical circulatory support use in patients undergoing high risk on-pump cardiac surgery: Insights from the LEVO-CTS trial.

Verma, Sanam / Rathwell, Sarah / Fremes, Stephen / Zheng, Yinggan / Mehta, Rajendra / Lopes, Renato D / Alexander, John H / Goodman, Shaun G / Diepen, Sean van

American heart journal

2022 Volume 248, Page(s) 35–41

Abstract: Background: We describe variables and outcomes associated with peri-operative mechanical circulatory support (MCS) utilization among patients enrolled in the Levosimendan in patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery ... ...

Abstract	Background: We describe variables and outcomes associated with peri-operative mechanical circulatory support (MCS) utilization among patients enrolled in the Levosimendan in patients with Left Ventricular Systolic Dysfunction Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass (LEVO-CTS) trial. Methods: In the LEVO-CTS trial, MCS utilization (defined as intra-aortic balloon pump, extracorporeal membrane oxygenation, or surgical ventricular assist device) within 5 days of surgery was examined. The association between MCS use and outcomes including 90-day mortality, 30-day renal-replacement therapy, and hospital and critical stay length of stay were determined. Results: Among the 849 patients from 70 centers randomized to levosimendan or placebo, 85 (10.0%) patients were treated with MCS (71 intra-aortic balloon pump, 7 extracorporeal membrane oxygenation, 7 ventricular assist device); with 89.4% started on post-operative day 0. Inter-institutional use ranged from 0% to 100%. Variables independently associated with MCS utilization included combined coronary artery bypass grafting and valve surgery (adjusted odds ratio [OR] 2.73, 95% confidence interval [CI] 1.70-4.37, P < .001), history of lung disease (OR 1.70, 95% CI 1.06-2.70, P = .029), and history of heart failure (OR 2.44, 95% CI 1.10-5.45, P = .027). Adjusted 90-day mortality (22.4% vs 4.1%, hazard ratio 6.11, 95% CI 3.95-9.44, P < .001) was higher, and median critical care length of stay (8.0 vs 4.0 days, P < .001) was longer in patients managed with MCS. Conclusions: In a randomized controlled trial of high-risk cardiac surgical patients in North America, we observed patient, and surgical variables associated with MCS utilization. MCS use was associated with a higher risk of post-operative mortality.
MeSH term(s)	Cardiac Surgical Procedures/adverse effects ; Extracorporeal Membrane Oxygenation ; Heart-Assist Devices ; Humans ; Intra-Aortic Balloon Pumping ; Risk Factors ; Simendan/adverse effects
Chemical Substances	Simendan (349552KRHK)
Language	English
Publishing date	2022-03-07
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	80026-0
ISSN	1097-6744 ; 0002-8703
ISSN (online)	1097-6744
ISSN	0002-8703
DOI	10.1016/j.ahj.2022.02.013
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Article ; Online: A practical approach to prescribing antiplatelet therapy in patients with acute coronary syndromes.

Alkhalil, Mohammad / Kuzemczak, Michał / Bell, Alan / Stern, Sol / Welsford, Michelle / Cantor, Warren J / Goodman, Shaun G

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

2022 Volume 194, Issue 6, Page(s) E205–E215

MeSH term(s)	Acute Coronary Syndrome/drug therapy ; Aspirin/therapeutic use ; Canada ; Drug Therapy, Combination ; Europe ; Female ; Hemorrhage/epidemiology ; Humans ; Male ; Percutaneous Coronary Intervention/methods ; Platelet Aggregation Inhibitors/therapeutic use ; Practice Guidelines as Topic ; Prasugrel Hydrochloride/therapeutic use ; Purinergic P2Y Receptor Antagonists/therapeutic use ; Risk Factors ; Ticagrelor/therapeutic use
Chemical Substances	Platelet Aggregation Inhibitors ; Purinergic P2Y Receptor Antagonists ; Prasugrel Hydrochloride (G89JQ59I13) ; Ticagrelor (GLH0314RVC) ; Aspirin (R16CO5Y76E)
Language	English
Publishing date	2022-02-14
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	215506-0
ISSN	1488-2329 ; 0008-4409 ; 0820-3946
ISSN (online)	1488-2329
ISSN	0008-4409 ; 0820-3946
DOI	10.1503/cmaj.202863
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Article ; Online: [No title information]

Alkhalil, Mohammad / Kuzemczak, Michał / Bell, Alan / Stern, Sol / Welsford, Michelle / Cantor, Warren J / Goodman, Shaun G

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

2022 Volume 194, Issue 17, Page(s) E620–E631

Title translation	Approche pratique à la prescription des antiplaquettaires chez les patients atteints de syndromes coronariens.
MeSH term(s)	Humans ; Platelet Aggregation Inhibitors ; Prescriptions ; Syndrome
Chemical Substances	Platelet Aggregation Inhibitors
Language	French
Publishing date	2022-04-22
Publishing country	Canada
Document type	Journal Article ; Review
ZDB-ID	215506-0
ISSN	1488-2329 ; 0008-4409 ; 0820-3946
ISSN (online)	1488-2329
ISSN	0008-4409 ; 0820-3946
DOI	10.1503/cmaj.202863-f
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