Competition Results 2018

For the fourth consecutive year, the Canadian Cardiovascular Society (CCS) is proud to announce the results of the 2018 CCS Atrial Fibrillation (AF) Research Award competition. This program, created to encourage clinical, health systems and population health research in the field of AF, has become an important initiative supporting CCS members and early-career investigators.

Once again, 3 awards of $100,000 have been granted. Since 2015, CCS and our program partner, the Bristol-Myers Squibb/Pfizer Alliance, have invested over $1,200,000 in this program.

All proposals are reviewed by an independent peer review committee comprised of CCS members. We are pleased that all projects are being funded to their full recommended amounts. Awards include funds for salaries, supplies, and/or equipment. The start date for these awards is July 1, 2018. Principal Investigators are named below. Co-Applicants and/or additional authors may also be associated with these grants.

Andrew Ha
  Douglas Lee

Principal Investigators: Andrew Ha and Douglas Lee, University of Toronto, Toronto, ON

Proposal Title: Association between Oral Anticoagulation Use and Outcomes for Older Patients with New Onset Post-operative Atrial Fibrillation after Cardiac Surgery: A Population-based Analysis from Ontario, Canada

Award amount: $100,000

Term: July 2018 - July 2020

Abstract: Post-operative atrial fibrillation (POAF) occurs commonly after cardiac surgery and is associated with adverse outcomes (e.g. stroke/death) in both short- and long-term follow-up. While there is strong evidence supporting the use of oral anticoagulation (OAC) to reduce the risk of stroke for patients in the non-surgical setting, it remains unclear if these benefits can be translated to the POAF population. Accordingly, research focusing on the short- and long-term risks and benefits of OAC in cardiac surgical patients with POAF will help inform clinical practice. Objectives: We sought to examine the association between early OAC use (vs. non use) among cardiac surgical patients with POAF and adverse outcomes (e.g. stroke/death/bleeding). Also, we will examine the association between long-term use (vs. discontinuation) of OAC and clinical outcomes among cardiac surgical patients who are anticoagulated for POAF. Methods: Retrospective analysis using health administrative data in Ontario, Canada. We will include cardiac surgical patients (≥66 years old) with new-onset POAF. Information on OAC use will be collected from the Ontario Drug Benefits database. Clinical outcomes will be ascertained via linkage with databases such as the Registered Persons Database (RPDB) and Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD). Multivariable Cox regression models will be used to examine the association between OAC use and clinical outcomes. Impact: The results of this study will provide important insights on the impact of OAC for cardiac surgical patients with POAF. This may help inform clinical practice and/or inform design of randomized trials in this arena.

Jacqueline Joza
  Dr Jonathan Afilalo

Principal Investigators: Jacqueline Joza and Jonathan Afilalo, McGill University, Montreal, QC

Proposal Title: Association of Muscle Mass with Direct Oral Anticoagulant Activity in Older Adults

Award amount: $100,000

Term: July 2018 - July 2021

Abstract: Direct oral anticoagulants (DOACs) are increasingly used to treat older adults with atrial fibrillation (AF), however there remains uncertainty about balancing the risk of stroke and the non-trivial risk of bleeding in frail patients. While current dosing recommendations are based on total body weight, the plasma levels of these hydrophilic drugs are rather determined by lean muscle mass. The age-related loss of muscle mass, known as sarcopenia, causes DOACs to be distributed less in lean tissues and more in plasma. We conducted a pilot study of 62 patients and demonstrated that sarcopenic patients had a 4-fold increase in risk of supra-therapeutic DOAC plasma levels. Based on the pharmacokinetic link between muscle mass and DOAC levels, we hypothesized that sarcopenic older adults would be at higher risk for bleeding complications. The current study will test this hypothesis by enrolling 500 older adults with AF, and measuring their muscle mass by bioimpedance and their DOAC levels by a validated anti-Xa assay. We will longitudinally follow patients for the occurrence of major and non-major bleeding complications, and adjust for known confounders. The study setting will be representative of university and community-based cardiology practices in Montreal. If our hypothesis is correct, this could lead to future randomized clinical trials that would test the safety and effectiveness of DOAC dose reduction based on muscle mass. The “one size fits all” concept of dosing is gradually being replaced by strategies aimed at delivering “personalized medicine”, especially for the heterogeneous group of frail older patients.



Jorge Wong
  Stuart Connolly

Principal Investigators: Jorge Wong and Stuart Connolly, McMaster University, Hamilton, ON

Proposal Title: Subclinical Atrial Fibrillation in Patients with Heart Failure with Preserved Ejection Fraction and the Risk of Heart Failure Re-hospitalization

Award amount: $100,000

Term: July 2018 - July 2020

Abstract: Heart failure (HF) is one of the leading causes of hospitalization and readmission rates after hospital discharge are high. HF hospitalization is associated with high mortality and cost of care. Half of HF hospitalizations are in patients with HF with preserved ejection fraction (HFpEF). HFpEF is difficult to manage and has no therapies with demonstrable efficacy. Development of new strategies to reduce HF re-hospitalization HFpEF patients would revolutionize the care of a patient population with few evidence-based therapeutic options. Subclinical atrial fibrillation (AF) refers to short, asymptomatic episodes of AF that are typically only identified with long-term cardiac monitoring. AF is an important cause of HF exacerbation, however, in more than half the cases, the cause for the HF exacerbation cannot be identified. We hypothesize that subclinical AF is highly prevalent in patients with HFpEF and that that it is temporally associated with HF exacerbation. Aims: To determine the prevalence of subclinical AF ≥30 min in HFpEF patients, and examine its relationship with HF re-hospitalization. Methods: We will prospectively enroll 240 patients in 3 Hamilton Hospitals. Patients with a history of HFpEF who are admitted with a primary diagnosis of acutely decompensated HF, but who have no prior history of AF will be eligible to enroll. Patients will be monitored for subclinical AF for 28 days after discharge. The primary outcome is 30-day hospital readmission for HF. Rationale: This study will provide key data to be used in the design of a randomized controlled trial to determine whether monitoring for subclinical AF in patients with HFpEF and early intervention during the month after hospital discharge decreases 30-day readmission rate.

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