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Canadian Journal of Cardiology

Primary Care Clinical Volumes, Cholesterol Testing, and Cardiovascular Outcomes

  • Author Footnotes
    ∗ Co-primary authors.
    Jacob A. Udell
    Correspondence
    Address for Correspondence: Jacob A. Udell, Peter Munk Cardiac Centre, Toronto General Hospital and Women’s College Hospital, 76 Grenville Street, Toronto, ON M5S 1B1. Tel: 416-351-3732; Fax: 416-351-3746;
    Footnotes
    ∗ Co-primary authors.
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    ICES, University of Toronto, Toronto, Ontario, Canada

    Cardiovascular Division, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, University of Toronto, Toronto, Ontario, Canada
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  • Author Footnotes
    ∗ Co-primary authors.
    Arielle R. Brickman
    Footnotes
    ∗ Co-primary authors.
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    ICES, University of Toronto, Toronto, Ontario, Canada

    Cardiovascular Division, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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  • Anna Chu
    Affiliations
    ICES, University of Toronto, Toronto, Ontario, Canada
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  • Laura E. Ferreira-Legere
    Affiliations
    ICES, University of Toronto, Toronto, Ontario, Canada
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  • Maya S. Sheth
    Affiliations
    Dalla Lana School of Public Health, University of Toronto, University of Toronto, Toronto, Ontario, Canada
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  • Dennis T. Ko
    Affiliations
    ICES, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, University of Toronto, Toronto, Ontario, Canada

    Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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  • Peter C. Austin
    Affiliations
    ICES, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, University of Toronto, Toronto, Ontario, Canada
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  • Husam Abdel-Qadir
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    ICES, University of Toronto, Toronto, Ontario, Canada

    Cardiovascular Division, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, University of Toronto, Toronto, Ontario, Canada
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  • Noah M. Ivers
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    ICES, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, University of Toronto, Toronto, Ontario, Canada

    Department of Family Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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  • R. Sacha Bhatia
    Affiliations
    Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    ICES, University of Toronto, Toronto, Ontario, Canada

    Cardiovascular Division, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, University of Toronto, Toronto, Ontario, Canada
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  • Michael E. Farkouh
    Affiliations
    Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
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  • Thérèse A. Stukel
    Affiliations
    ICES, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, University of Toronto, Toronto, Ontario, Canada
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  • Jack V. Tu
    Affiliations
    ICES, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management, and Evaluation, University of Toronto, University of Toronto, Toronto, Ontario, Canada

    Schulich Heart Centre, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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  • Author Footnotes
    ∗ Co-primary authors.
Published:December 23, 2022DOI:https://doi.org/10.1016/j.cjca.2022.12.016

      ABSTRACT

      Background

      It is unknown whether the annual number of primary care physician (PCP) unique outpatient assessments, hereto termed clinical volume, translates into better cardiovascular preventive care. We examined the relationship between PCP outpatient clinical volumes and cholesterol testing and major adverse cardiovascular event rates among guideline recommended eligible patients.

      Methods

      This was a retrospective cohort study conducted as part of the Cardiovascular Health in Ambulatory Care Research Team (CANHEART) cohort, a population-based cohort of almost all adult residents of Ontario, Canada, followed between 2008 and 2012. For each clinical volume quintile, we compared cholesterol testing and major adverse cardiovascular events, defined as time to first event of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke.

      Results

      The 10,037 PCPs evaluated had an annualized median volume of 2303 clinical encounters (IQR, 1292-3680). Among 4,740,380 patients, 84% underwent guideline-concordant cholesterol testing at least once over 5 years, ranging from 73% among the lowest clinical volume quintile physicians to 86% among the highest. After multivariable adjustment, there was a 10.5% relative increase in the probability of cholesterol testing for every doubling of clinical volumes (95% CI, 9.7-11.4, P<0.001). Patients treated by the lowest volume physicians had the highest rate of major adverse cardiovascular outcomes, compared with the highest quintile volume physicians (adjusted HR 1.15; 95% CI, 1.10-1.21; P<0.001).

      Conclusions

      Patients of physicians with the lowest clinical volumes received less frequent cholesterol testing and had the highest rate of incident cardiovascular events. Further research investigating the drivers of this relationship is warranted.

      Graphical abstract

      Keywords

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