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Article ; Online: Commentary: You have to be able to walk the walk if you want to have a successful proximal aortic procedure.

Hassan, Ansar

The Journal of thoracic and cardiovascular surgery

2020 Volume 163, Issue 3, Page(s) 898–899

MeSH term(s)	Aorta ; Humans ; Walking
Language	English
Publishing date	2020-05-15
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2020.04.142
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Article ; Online: Commentary: Time to standardize physician expertise and coverage in cardiac intensive care units?

Légaré, Jean-Francois / Hassan, Ansar

The Journal of thoracic and cardiovascular surgery

2019 Volume 159, Issue 4, Page(s) 1390–1391

MeSH term(s)	Cardiac Surgical Procedures ; Humans ; Intensive Care Units ; Physicians ; Workforce
Language	English
Publishing date	2019-05-16
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2019.04.079
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Article ; Online: Reply: Have we done the best that we could have done?

Arora, Rakesh C / Hassan, Ansar / Haft, Jonathan W

The Journal of thoracic and cardiovascular surgery

2020 Volume 160, Issue 3, Page(s) e149–e151

MeSH term(s)	COVID-19 Testing ; Cardiac Surgical Procedures ; Clinical Laboratory Techniques ; Coronavirus ; Coronavirus Infections/diagnosis ; Humans
Keywords	covid19
Language	English
Publishing date	2020-08-24
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2020.05.071
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Article ; Online: Commentary: Frailty and cardiac surgery: Is there strength in numbers?

Kehler, Dustin Scott / Hassan, Ansar / Arora, Rakesh C

The Journal of thoracic and cardiovascular surgery

2020 Volume 163, Issue 1, Page(s) 161–162

MeSH term(s)	Aged ; Cardiac Surgical Procedures/adverse effects ; Frail Elderly ; Frailty/diagnosis ; Humans
Language	English
Publishing date	2020-05-16
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2020.05.010
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Article ; Online: Enhanced Telehealth Home-Monitoring Intervention for Vulnerable and Frail Patients after Cardiac Surgery (THE-FACS Pilot Intervention Study).

Sarkar, Shreya / MacLeod, Jeffrey / Hassan, Ansar / Brunt, Keith R / Palmer, Krisan / Légaré, Jean-François

BMC geriatrics

2022 Volume 22, Issue 1, Page(s) 836

Abstract: Background: Frail cardiac surgery patients have an increased risk of worse postoperative outcomes. The purpose of this study was to evaluate the implementation of a novel Telehealth Home monitoring Enhanced-Frailty And Cardiac Surgery (THE-FACS) ... ...

Abstract	Background: Frail cardiac surgery patients have an increased risk of worse postoperative outcomes. The purpose of this study was to evaluate the implementation of a novel Telehealth Home monitoring Enhanced-Frailty And Cardiac Surgery (THE-FACS) intervention and determine its impact on clinical outcomes in frail patients post-cardiac surgery. Methods: Frail/vulnerable patients defined by Edmonton Frailty Scale (EFS > 4) undergoing cardiac surgery were prospectively enrolled (November 2019 -March 2020) at the New Brunswick Heart Centre. Exclusion criteria included age < 55 years, emergent status, minimally invasive surgery, lack of home support, and > 10-days postoperative hospital stay. Following standard training on THE-FACS, participants were sent home with a tablet device to answer questions about their health/recovery and measure blood pressure for 30-consecutive days. Transmitted data were monitored by trained cardiac surgery follow-up nurses. Patients were contacted only if the algorithm based on the patient's self-collected data triggered an alert. Patients who completed the study were compared to historical controls. The primary outcome of interest was to determine the number of patients that could complete THE-FACS; secondary outcomes included participant/caregiver satisfaction and impact on hospital readmission. Results: We identified 86 eligible (EFS > 4), out of 254 patients scheduled for elective cardiac surgery during the study period (vulnerable: 34%). The patients who consented to participate in THE-FACS (64/86, 74%) had a mean age of 69.1 ± 6.4 years, 25% were female, 79.7% underwent isolated Coronary Artery Bypass Graft (CABG) and median EFS was 6 (5-8). 29/64 (45%) were excluded post-enrollment due to prolonged hospitalization (15/64) or requirement for hospital-to-hospital transfer (12/64). Of the remaining 35 patients, 21 completed the 30-day follow-up (completion rate:60%). Reasons for withdrawal (14/35, 40%) were mostly due to technical difficulties with the tablet. Hospital readmission, although non-significant, was reduced in THE-FACS participants compared to controls (0% vs. 14.3%). A satisfaction survey revealed > 90% satisfaction and ~ 67% willingness to re-use a home monitoring device. Conclusions: THE-FACS intervention can be used to successfully monitor vulnerable patients returning home post-cardiac surgery. However, a significant number of frail patients could not benefit from THE-FACS given prolonged hospitalization and technological challenges. Our findings suggest that despite overall excellent satisfaction in participants who completed THE-FACS, there remain major challenges for wide-scale implementation of technology-driven home monitoring programs as only 24% completed the study.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Frailty/diagnosis ; Frail Elderly ; Pilot Projects ; Cardiac Surgical Procedures/adverse effects ; Telemedicine
Language	English
Publishing date	2022-11-05
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-022-03531-4
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Article ; Online: Increased Travel Time to the Tertiary Centre Is Associated With Decreased Long-term Survival Following Ascending Aortic Operations.

Cote, Claudia L / De Waard, Dominique / Tansley, Gavin / Horne, Gabrielle / Hassan, Ansar / Hajizadeh, Mohammad / Herman, Christine R

The Canadian journal of cardiology

2022 Volume 38, Issue 6, Page(s) 801–807

Abstract: Background: The association between travel time from tertiary care centre and outcomes after ascending thoracic aortic surgery is unknown. We determined the effect of travel time from the tertiary care centre on outcomes in ascending aortic repair in ... ...

Abstract	Background: The association between travel time from tertiary care centre and outcomes after ascending thoracic aortic surgery is unknown. We determined the effect of travel time from the tertiary care centre on outcomes in ascending aortic repair in Nova Scotia. Methods: A retrospective analysis of patients undergoing elective and emergent ascending thoracic aortic operations from 2005 to 2015 was carried out. Patient's residential geographic coordinates were used to calculate travel time to the tertiary care centre, and patients who resided < 1 hour vs ≥ 1 hour were compared. Multivariable logistic regression was performed to determine the effect of travel time on in-hospital outcomes. Cox-proportional hazard modelling and Kaplan-Meier survival estimates were created to determine the effect on long-term survival. Results: A total of 476 patients underwent ascending thoracic aortic surgery from 2005 to 2015. Patients who resided < 1 hour from the tertiary care centre vs patients who resided ≥ 1 hour had similar rates of in-hospital mortality (4.4% vs 6.1%, P = 0.42), in-hospital composite complications (66.7% vs 67.7%, P = 0.80), hospital length of stay (median 9 days; interquartile range [7-16] vs 10 [7-17], P = 0.41), and discharge disposition other than home (9.7% vs 11.7%, P = 0.55). Compared with patients who resided < 1 hour from the tertiary centre, patients who resided ≥ 1 hour were at higher risk for long-term mortality (hazard ratio, 2.19; 95% confidence interval, 1.13-4.28; P = 0.02). Conclusions: Patients who reside remotely from the tertiary centre experience equivalent in-hospital outcomes but decreased long-term survival following ascending aortic operations. These findings may guide resource expansion for postoperative follow-up.
MeSH term(s)	Aortic Aneurysm, Thoracic ; Blood Vessel Prosthesis Implantation/adverse effects ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Postoperative Complications/etiology ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Vascular Surgical Procedures/adverse effects
Language	English
Publishing date	2022-02-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2022.02.006
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Article: Reply: Have we done the best that we could have done?

Arora, Rakesh C / Hassan, Ansar / Haft, Jonathan W

J Thorac Cardiovasc Surg

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #712786
Database	COVID19

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Article ; Online: An age-independent hospital record-based frailty score correlates with adverse outcomes after heart surgery and increased health care costs.

Sarkar, Shreya / MacLeod, Jeffrey B / Hassan, Ansar / Dutton, Daniel J / Brunt, Keith R / Légaré, Jean-François

JTCVS open

2021 Volume 8, Page(s) 491–502

Abstract: Background: Globally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a ... ...

Abstract	Background: Globally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a retrospective registry-based frailty score (FS), (2) determine its effect on outcomes and age, and (3) health care costs. Methods: Retrospective data were obtained from the New Brunswick Heart Centre registry for all cardiac surgery patients between 2012 and 2017. A 20-point FS was created using available binary risk variables. The primary outcomes of interest most relevant to vulnerable patients were prolonged hospitalization, failure to be discharged home, and hospitalization bed cost. Composite outcome of prolonged hospitalization (>8 days) and/or non-home discharge were analyzed using multivariate analysis. Results: A total of 3463 patients (mean age, 66 ± 10 years) were included in the final analysis. Tercile-based FSs were: low (0-4; n = 856), medium (5-7; n = 1709), high (≥8; n = 898). In unadjusted data, frail patients were older with more comorbidities. High FS patients had greater risks of prolonged hospitalization (median 7 vs 5 days; Conclusions: A registry-based FS can be used to identify vulnerable or frail patients undergoing cardiac surgery and was associated with poor outcomes independent of age. This highlights that although frailty defined by increased vulnerability is often associated with older age, it is not a surrogate for aging, thereby having important implications in reducing health system costs and efforts to provide streamlined care to the most vulnerable.
Language	English
Publishing date	2021-10-24
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-2736
ISSN (online)	2666-2736
DOI	10.1016/j.xjon.2021.10.018
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Characterizing Physician-Staffing Models in the Care of Postoperative Cardiac Surgical Patients in Canada.

Arora, Rakesh C / Lee, Erika / Kent, David E / Asif, Mina / Lamarche, Yoan / Hassan, Ansar / Legare, Jean Francois / Hiebert, Brett

CJC open

2021 Volume 3, Issue 11, Page(s) 1365–1371

Abstract: Background: Current intensive care unit physician-staffing (IPS) models for postoperative cardiac surgery have not been previously investigated in Canada. The purpose of this study was to determine current IPS models at 2 time points and describe the ... ...

Abstract	Background: Current intensive care unit physician-staffing (IPS) models for postoperative cardiac surgery have not been previously investigated in Canada. The purpose of this study was to determine current IPS models at 2 time points and describe the evolution of Canadian cardiac surgery IPS models. Methods: A survey of 32 Canadian cardiovascular intensive care units (CVICUs) was undertaken in 2012 and 2017 to determine IPS models of care during "daytime" and "after-hours" in each unit. Data were collected regarding surgical volume, base specialties, and style of IPS management ("open"; "semi-open"; "closed"). In addition, we collected the overnight experience level of the bedside healthcare provider for in-house intensive care units. Results: Survey responses were received from 27 of 32 CVICUs (87%). As of 2017, the style of 1 (4%) was open, 7 (26%) were semi-open, and 19 (70%) were closed in their unit IPS strategy. Base specialties of CVICU physicians varied. A medical doctor provided after-hours coverage in 81% of CVICUs. Senior residents (37%) or critical care certified attending staff (25%) typically provided after-hours coverage for in-house CVICUs. Linked Canadian Institute for Health Information data did not indicate a difference among CVICU models in mortality or rehospitalization for coronary artery bypass graft or valve procedures. Conclusions: Considerable heterogeneity is demonstrated in CVICU staffing patterns. No consensus was identified regarding the appropriate level of training for "after-hours" coverage. In-house overnight physician staffing in CVICUs varies widely. Finally, semi-open and closed style models did not demonstrate differences compared to Canadian Institute for Health Information data. Variability among CVICUs does exist; however, benefits of one model over another have not been identified.
Language	English
Publishing date	2021-07-14
Publishing country	United States
Document type	Journal Article
ISSN	2589-790X
ISSN (online)	2589-790X
DOI	10.1016/j.cjco.2021.07.001
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Article ; Online: Fast tracking in cardiac surgery: is it safe?

MacLeod, Jeffrey B / D'Souza, Kenneth / Aguiar, Christie / Brown, Craig D / Pozeg, Zlatko / White, Christopher / Arora, Rakesh C / Légaré, Jean-François / Hassan, Ansar

Journal of cardiothoracic surgery

2022 Volume 17, Issue 1, Page(s) 69

Abstract: Background: While fast track clinical pathways have been demonstrated to reduce resource utilization in patients undergoing cardiac surgery, it remains unclear as to whether they adversely affect post-operative outcomes. The purpose of this study was to ...

Abstract	Background: While fast track clinical pathways have been demonstrated to reduce resource utilization in patients undergoing cardiac surgery, it remains unclear as to whether they adversely affect post-operative outcomes. The purpose of this study was to determine the impact of fast tracking on post-operative outcomes following cardiac surgery. Methods: In a retrospective study, all patients undergoing first-time, on-pump, non-emergent coronary artery bypass grafting, valve, or coronary artery bypass grafting + valve at a single centre between 2010 and 2017 were included. Patients were considered to have been fast tracked if they were extubated and transferred from intensive care to a step-down unit on the same day as their procedure. The risk-adjusted effect of fast tracking on a 30-day composite of all-cause mortality, stroke, renal failure, infection, atrial fibrillation, and readmission to hospital was determined. Furthermore, propensity score matching was used to match fasting track patients in a 1-to-1 manner with their nearest "neighbor" in the control group and subsequently compared in terms of 30-day post-operative outcomes. Results: 3252 patients formed the final study population (fast track: n = 245; control: n = 3007). Patients who were fast tracked experienced reduced time to initial extubation (4.3 vs. 5.6 h, p < 0.0001) and lower median initial intensive care unit length of stay (7.8 vs. 20.4 h, p < 0.0001). Fast tracked patients experienced lower 30-day rates of the composite outcome (42.4% vs. 51.5%, p = 0.008). However, following propensity score matching, fast tracked patients experienced similar 30-day rates of the composite outcome as the control group (42.4% vs. 44.5%, p = 0.72). After risk adjustment using multivariable regression modeling, fast tracking was predictive of an improved 30-day composite outcome (OR 0.75, 95% CI 0.57-0.98, p = 0.03). Conclusion: Fast track clinical pathways was associated with reduced intensive care unit, overall length of stay and similar 30-day post-operative outcomes. These results suggest that fast tracking appropriate patients may reduce resource utilization, while maintaining patient safety.
MeSH term(s)	Airway Extubation ; Cardiac Surgical Procedures/adverse effects ; Coronary Artery Bypass ; Humans ; Length of Stay ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Retrospective Studies
Language	English
Publishing date	2022-04-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-022-01815-9
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