• Acute coronary syndrome
• Clinical practice guideline
• Pharmacotherapy

• NA22-010 National Evidence-based Healthcare Collaborating Agency
• NA23-011 National Evidence-based Healthcare Collaborating Agency

• Humans
• Medication Adherence/ethnology
• New Zealand
• Female
• Qualitative Research
• Emigrants and Immigrants/psychology
• Male
• Middle Aged
• Hypertension/ethnology
• Hypertension/drug therapy
• Diabetes Mellitus, Type 2/ethnology
• Diabetes Mellitus, Type 2/drug therapy
• Adult
• Aged
• Dyslipidemias/ethnology
• Dyslipidemias/drug therapy
• Cardiovascular Diseases/ethnology
• Interviews as Topic
• Self Care
• Health Knowledge, Attitudes, Practice/ethnology
• Asian People/ethnology

• ASCVD
• Asia
• LDL-C lowering
• PCSK9
• inclisiran
• lipid-lowering therapies
• siRNA

• BNIM
• Immigrants and migrants
• Narrative methods
• Polypharmacy
• Qualitative
• United Kingdom

• Humans
• Middle Aged
• Aged
• Ethnicity
• Polypharmacy
• London/epidemiology
• Pakistan/epidemiology
• Physician-Patient Relations
• Minority Groups
• Qualitative Research

• EP-C-15-004 EPA
• NIHR Nottingham Biomedical Research Centre

• ASCVD risk prediction
• South Asian
• Statin

• Angiotensin II Type 1 Receptor Blockers/therapeutic use
• Angiotensin Receptor Antagonists/therapeutic use
• Angiotensin-Converting Enzyme Inhibitors/therapeutic use
• Hospitalization
• Humans
• Myocardial Infarction/drug therapy
• Prescriptions
• Secondary Prevention

South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.

• Cardiovascular risk
• South Asians
• Diabetes
• Dyslipidemia
• Metabolic syndrome
• Health behavior
• Novel cardiovascular risk factors

• arrhythmia
• cardiovascular disease
• ethnicity
• heart failure
• hypertension
• race

• South Asians
• ethnicity
• hypertension
• medication adherence
• motivational interviewing

Background: Medication non-adherence can lead to significant morbidity and mortality. This 4-week feasibility study aims to demonstrate that the eDosette intervention can be implemented with older adults in primary care. Method: Fifty-six older adults from four primary care sites in Southwestern Ontario, Canada participated. The intervention involved generating, for pharmacist review, weekly medication administration records based on transmitted data captured by the eDosette. The primary outcome is implementation feasibility defined by recruitment, adherence rates, frequency of captured missed and late doses, descriptions of clinical work resulting from the intervention, and participant feedback. Results: The recruitment rate was 24% (57/240); one withdrew due to personal reasons. The mean observed adherence rate was 82% (range 49%-100%). Overall, participants missed 505 and took 2,105 doses late; 118 clinical decisions occurred with 72 unique medication changes in 31 participants. Participants found the eDosette easy to use and did not feel that they were viewed negatively because of their potential non-adherence. Conclusion: The eDosette intervention could be feasibly implemented in primary care with older adults. Providing information about when an older adult takes their medications could play a role in medication adherence by prompting more informed discussions between the older adult and primary care clinicians.

• drug monitoring
• elderly
• medication adherence
• primary care

• Adherence
• Cardiovascular medication
• Coronary heart disease
• South Asians
• United Kingdom

• Adult
• Aged
• Asian People/ethnology
• Asian People/psychology
• Coronary Disease/drug therapy
• Coronary Disease/ethnology
• Coronary Disease/psychology
• Female
• Humans
• Male
• Medication Adherence/psychology
• Middle Aged
• Pilot Projects
• Surveys and Questionnaires
• United Kingdom/ethnology

• Cholesterol
• Health care disparities
• New York City

• Cardiac disease
• Cardiac event
• Chinese ethnicity
• Chinese immigrants
• Coronary heart disease
• Ethnic minorities
• Experience
• Self-management

• Australia
• Canada
• China/ethnology
• Emigrants and Immigrants
• Female
• Heart Arrest/ethnology
• Heart Arrest/therapy
• Humans
• Male
• Middle Aged
• Self-Management
• United Kingdom

• APP1072223 NHMRC Early Career Fellowship

• AHA Scientific Statements
• Asian continental ancestry group
• cardiovascular diseases
• genetics
• prevalence
• risk factors
• sociological factors

• American Heart Association
• Asia, Western/ethnology
• Asian People
• Atherosclerosis/diagnosis
• Atherosclerosis/ethnology
• Atherosclerosis/mortality
• Atherosclerosis/therapy
• Comorbidity
• Culturally Competent Care/standards
• Emigrants and Immigrants
• Evidence-Based Medicine/standards
• Health Status
• Humans
• Incidence
• Indian Ocean Islands/ethnology
• Life Style/ethnology
• Prevalence
• Prognosis
• Risk Assessment
• Risk Factors
• United States/epidemiology

• Cardiology
• Healthcare cost
• Myocardial infarction
• Rehospitalization

• medication nonadherence
• myocardial infarction
• perceived barriers
• psychology

Ethnicity is an important predictor of coronary artery bypass graft surgery (CABG) outcomes. South Asians (SA), one of the largest ethnic groups with a high burden of cardiovascular disease, are hypothesized to have inferior outcomes after CABG compared to other ethnic groups. Given the paucity and controversy of literature in this area, the objective of this study was to examine the impact of SA versus the general population (GP) on long‐term outcomes following CABG.

Using administrative databases and a surname algorithm, 83 850 patients (SA: 2653, GP: 81 197) who underwent isolated CABG in Ontario, Canada from 1996 to 2007 were identified; mean follow‐up was 9.1±3.9 years. SA were younger (SA: 61.7±9.4, GP: 64.1±10.0 years, standardized difference=0.25) with more cardiac risk factors, including diabetes (SA: 54.1%, GP: 34.9%, standardized difference =0.40). Propensity‐score matching resulted in 2473 matched pairs between SA and GP with all baseline covariates being balanced (standardized difference <0.1). Being a SA compared to the GP was protective against freedom from major adverse cardiac and cerebrovascular events, defined by all‐cause death, myocardial infarction, stroke, or coronary reintervention: Adjusted Cox‐proportional hazard ratio 0.91, 95% CI (0.83–0.99), adjusted‐P=0.04; this was also true for freedom from all‐cause mortality: hazard ratio 0.81, 95% CI (0.72–0.91), adjusted P=0.0004. The adjusted proportion of major adverse cardiac and cerebrovascular events was lower in the SA (SA: 34.7%, GP: 37.8%, McNemar P=0.03), driven largely by all‐cause mortality (SA: 20.4%, GA: 24.3%, McNemar P=0.001).

Contrary to existing notions, our study finds that being a SA is protective with respect to freedom from long‐term major adverse cardiac and cerebrovascular events and mortality after CABG. More studies are required to corroborate and explore causal factors of these findings.

• coronary artery bypass graft surgery
• ethnicity
• morbidity/mortality
• outcomes research
• population studies
• propensity score

• acute myocardial infarction
• heart failure
• in-hospital cardiovascular events
• in-hospital mortality

Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.

We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR) and usual provider continuity index (UPI) for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.

36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04–1.06) for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15–1.54).

Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

• Continuity of Patient Care
• Dyslipidemias/drug therapy
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
• Male
• Medication Adherence
• Middle Aged
• Primary Health Care
• Prospective Studies
• Risk
• Treatment Outcome

• Acute coronary syndrome
• Medication adherence
• Pharmacotherapy
• Secondary prevention
• Systematic review

• Adult
• Aged
• Aged, 80 and over
• Angiotensin Receptor Antagonists/therapeutic use
• Angiotensin-Converting Enzyme Inhibitors/therapeutic use
• Asia, Western/ethnology
• Asian People/statistics & numerical data
• British Columbia
• China/ethnology
• Diabetes Mellitus, Type 2/drug therapy
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
• Hypoglycemic Agents/therapeutic use
• Male
• Medication Adherence/ethnology
• Middle Aged
• Practice Patterns, Physicians'/statistics & numerical data
• Social Class
• White People/statistics & numerical data

• Canadian Institutes of Health Research

• antihypertensive medications
• drug adherence
• pharmacy
• population-level
• socioeconomic status

• Antihypertensive Agents/administration & dosage
• Antihypertensive Agents/economics
• Antihypertensive Agents/therapeutic use
• Humans
• Hypertension/drug therapy
• Hypertension/economics
• Income
• Medication Adherence
• Models, Statistical
• Research Design
• Risk Factors
• Social Class

• South Asian
• adolescence
• asthma
• childhood
• ethnicity
• wheeze

Little is known on whether there are ethnic differences in outcomes following percutaneous coronary intervention (PCI) and coronary artery bypass grafting surgery (CABG) after acute myocardial infarction (AMI). We compared 30-day and long-term mortality, recurrent AMI, and congestive heart failure in South Asian, Chinese and White patients with AMI who underwent PCI and CABG.

Hospital administrative data in British Columbia (BC), Canada were linked to the BC Cardiac Registry to identify all patients with AMI who underwent PCI (n = 4729) or CABG (n = 1687) (1999–2003). Ethnicity was determined from validated surname algorithms. Logistic regression for 30-day mortality and Cox proportional-hazards models were adjusted for age, sex, socio-economic status, severity of coronary disease, comorbid conditions, time from AMI to a revascularization procedure and distance to the nearest hospital.

Following PCI, Chinese had higher short-term mortality (Odds Ratio (OR): 2.36, 95% CI: 1.12-5.00; p = 0.02), and South Asians had a higher risk for recurrent AMI (OR: 1.34, 95% CI: 1.08-1.67, p = 0.007) and heart failure (OR 1.81, 95% CI: 1.00-3.29, p = 0.05) compared to White patients. Risk of heart failure was higher in South Asian patients who underwent CABG compared to White patients (OR (95% CI) = 2.06 (0.92-4.61), p = 0.08). There were no significant differences in mortality following CABG between groups.

Chinese and South Asian patients with AMI and PCI or CABG had worse outcomes compared to their White counterparts. Further studies are needed to confirm these findings and investigate potential underlying causes.

• epidemiologic determinants
• medication adherence
• pharmacoepidemiology
• statins

• Literature review
• South Asian
• cardiovascular
• medication adherence

South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population.

South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar’s test (proportions) and paired t-tests (continuous measures).

Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff.

SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer–led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.