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One in four Ontarians not tested for diabetes or high cholesterol before their first heart attack


Many opportunities to prevent coronary disease are being missed, according to a new study by scientists at the Institute for Clinical Evaluative Sciences (ICES) in Ontario.

ICES senior scientist Jack Tu says that the study showed approximately one in four patients who had a heart attack had not been screened previously for diabetes or hyperlipidemia. “We found that 27 per cent of heart attack patients in Ontario in 2004 did not get their cholesterol levels checked in the five years before their first heart attack, and 27 per cent did not have their blood sugar levels checked for diabetes in the three years before their first heart attack.”

It is far better for patients to be screened earlier, and to treat those at high risk to prevent a first heart attack from occurring, than it is to treat them after a heart attack has occurred and the heart muscle has already been damaged.

Overall, Tu, a staff cardiologist at Sunnybrook Schulich Heart Centre and Canada Research Chair in Health Services Research at the University of Toronto, says there are many opportunities to improve the rate of cardiac risk factor screening prior to a first heart attack.

Clinical guidelines recommend that the adult general population at risk for heart disease get screened for cardiovascular risk factors such as diabetes and high cholesterol every few years. 

However, it is now known how frequently these guidelines are adhered to.

“We found that 95 per cent of patients who suffered a heart attack in Ontario had seen a family doctor in the five years prior to their heart attack, but many did not get tested for high blood sugar or cholesterol as recommended.” says Tu. “The rates of risk factor screening were higher in women than men, the elderly compared to the young, and in those who visited their family doctor more often.” 

Risk factor identification prior to a heart attack is important because it can lead to lifestyle and medical interventions that may prevent a heart attack from occurring in the first place.

Dr. Tu believes Ontario should consider adopting a universal cardiac risk factor screening program, similar to those in place for cancers such as breast cancer and colorectal cancer. “Healthcare professionals do an excellent job in treating heart attacks, but we need to do better in trying to prevent them from occurring in the first place.” 

The study was funded by the Canadian Institutes of Health Research

“This study alerts us to the continuing need to bridge the gaps in the research-to-practice continuum,” said Dr. Jean Rouleau, Scientific Director of the CIHR Institute of Circulatory and Respiratory Health.  “Through research, we have known for a long time that cholesterol screening can help to prevent future heart attacks. We must now work to ensure that this knowledge is integrated into healthcare practice, to improve health outcomes for Canadian patients.”

About the study:

Retrospective, cohort analysis of 5,688 patients admitted to 96 acute care hospitals in Ontario, with their first myocardial infarction (heart attack) occurring between April 2004 and March 2005.

Data from the Enhanced Feedback For Effective Cardiac Treatment clinical study database, with linkages to the Ontario Health Insurance Plan database.

Screening rates were analyzed by age, gender, socioeconomic status and number of primary care visits

Data were not available on how frequently patients were screened for high blood pressure, another important cardiac risk factor 

The study “Quality of Diabetes and Hyperlipidemia Screening Prior to a First Myocardial Infarction” appears online in the Canadian Journal of Cardiology.

Author block: Peter Lugomirski, Helen Guo, Nicole K. Boom, Linda R. Donovan, Dennis T. Ko, Jack V. Tu 

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.



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