Informing Coronary Revascularization Decisions in Diabetic Patients: Moving Knowledge to Action

Principal Investigators

Dr. Kimberly Miller, Assistant Professor, Simon Fraser University
Dr. Krishnan Ramanathan, Clinical Assistant Professor, UBC Division of Cardiology, St. Paul’s Hospital

Co-Investigators

Dr. James Abel, Clinical Associate Professor, UBC Division of Cardiovascular Surgery, St. Paul’s Hospital
Ms. Pamela Aiken Ramsay, Interim Provincial Executive Director, Cardiac Services BC
Dr. Karin Humphries, Scientific Director, ICVHealth and Associate Professor, UBC

Funding

Heart and Stroke Foundation of Canada (2015 – 2016)

Background

People with diabetes are prone to coronary artery disease, a progressive build-up of cholesterol plaques in blood vessels, reducing blood flow to the heart. People with coronary artery disease can suffer angina (chest pain), myocardial infarction (heart attack) and they sometimes die. Revascularization treatments to improve blood flow to the heart in people with diabetes include: percutaneous coronary intervention (PCI), where small drug releasing scaffolds are placed in the narrowed blood vessels to hold them open; and coronary artery bypass grafting (CABG) surgery, where healthy arteries or veins are used bypass the narrowed portions of the coronary arteries that supply the heart.

In 2012, the landmark international Future Revascularization Evaluation in Patients with Diabetes Mellitus Optimal Management of Multi-vessel Disease (FREEDOM) trial reported revascularization treatment involving CABG surgery greatly reduced the risk of death from any cause and myocardial infarction compared to PCI in patients with diabetes. The FREEDOM ‘Real World’ study recently completed here in BC confirmed that BC patients with diabetes and multi-vessel coronary artery disease who underwent CABG were less likely to die or to have a myocardial infarction than those who underwent PCI.

The message is: If a patient with diabetes has multi-vessel coronary artery disease and he/she requires a revascularization treatment to improve blood flow to the heart, heart surgery (CABG) may be the best treatment option if the patient can safely have surgery.

Objectives

  1. Raise awareness, increase knowledge and influence the use FREEDOM Real World evidence to inform coronary revascularization treatment decisions for patients with diabetes (Target audience: physician, surgeons, nurses, and administrators involved in clinical decisions).
  2. Identify the challenges to applying FREEDOM Real World evidence in coronary revascularization decisions in different BC healthcare organizations (Target audience: physician, surgeons, nurses, and administrators involved in clinical decisions)
  3. Identify the information needs of patients and their preferences for how they would like to receive information to support them in discussing coronary revascularization treatment options with their doctors. (Target audience: patients making decisions about coronary revascularization with their doctors).

Methodology

In collaboration with the Cardiac Services BC VICOR Group, educational outreach workshops are planned in 2016 to share and discuss FREEDOM Real World study findings with physician, surgeons, nurses, and administrators involved in clinical decisions at the 5 regional cardiac centres in BC (St Paul’s Hospital, Vancouver General Hospital, Royal Columbian Hospital, Royal Jubilee Hospital and Kelowna General Hospital). Following the workshops, questionnaires will be administered to the participants to evaluate changes in knowledge and intentions to use the presented evidence in practice and program planning. Questions will be also be asked about challenges and potential solutions to applying FREEDOM Real World evidence in coronary revascularization decisions in the different BC healthcare organizations. This data will be used to inform future knowledge translation initiatives.

In partnership with the Ministry of Health Patient Voices Network, two Patient Partners groups will be invited to participate in focus groups/ interviews: 1. People who have diabetes and have undergone revascularization treatment (PCI or CABG); and 2. People aged 60 and 70 years who have not undergone heart revascularization treatment. These Patient Partners will tell us the information needs of patients and their preferences for they would want to receive information, such as the FREEDOM Real World evidence, to support them in discussing coronary revascularization treatment options with their doctors.

Significance

The overall goal of this project is to share the findings of the FREEDOM Real world study so this knowledge may be translated into evidence-informed decisions for treatment of patients with diabetes and heart disease across the province.