Sept. 1, 2024

Turning data into better patient care

APPROACH database helps shape cardiac research
Dr. Merril Knudtson sits in his office
Dr. Merril Knudtson developed the APPROACH database to improve cardiac care in Alberta.

The  APPROACH (Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease) cardiac registry is widely recognized as having helped shape cardiac research in Alberta and beyond. Launched in 1995 by cardiologist and researcher Dr. Merril Knudtson, MD, the registry has collected information on more than 300,000 Albertans who have undergone cardiac procedures in Alberta. Nearly three decades later, the registry continues to deliver on its original vision of improving care and transforming outcomes for Albertans with heart disease with cutting-edge precision medicine projects that promise a better future for patients. Continue reading for a glimpse into how APPROACH has and continues to contribute to patient care in Alberta.  

About the registry 

APPROACH is one of the largest and most comprehensive cardiac registries in the world. To date, it has gathered information, such as hospital admission statistics, procedure rates, quality of life information and vital statistics, on more than 300,000 Albertans who have undergone cardiac procedures in the province. 

The database, co-led by clinician researchers Dr. Matthew James, MD, PhD, and Dr. Stephen Wilton, MD, and backed by contributions from management, staff and health care providers, provides important insights about care and outcomes for many groups of patients, including the elderly and women, facilitating decision making and improvements in clinical practice. 

The APPROACH model has been such a success that it was selected by the Canadian Institutes of Health Research in 2011 as one of six top achievements in health research and it has been adopted by other provincial health-care systems and at hospital sites in most provinces across Canada. 

Today, collecting data at the point of care and using that information to assess health outcomes and improve patient care is a fundamental part of caring for patients, but when APPROACH was developed, it was truly innovative,” says James. “It was way ahead of its time in so many ways.” 

Although the APPROACH team is small, it is able to accomplish a great deal due, in part, to collaborations. Not only does it have excellent buy in from health care providers and staff, who are often responsible for collecting the data at the point of care, Wilton notes the group has worked with researchers from a variety of fields, businesses and other databases. These collaborations have resulted in some unique projects, including one that looked at the link between air pollution and heart attacks. 

Yesterday’s accomplishments: Uncovering health care disparities

APPROACH researchers discovered that women in Alberta with heart disease were less likely than men to receive cardiac procedures, and not as likely to be referred to or participate in cardiac rehabilitation programs. The findings were used to raise awareness of the discrepancy by identifying barriers to treatment for women, such as caregiving responsibilities and low income, and showing access to cardiac procedures and rehab can improve quality of life and increase longevity.

APPROACH data recently revealed another disparity: patients with acute coronary syndromes (ACS) in rural Alberta are less likely to receive an important heart procedure than patients in cities, despite the increased risk of dying within 30 days if the procedure isn’t done. 

“These findings about disparities in treatment for different groups are important for clinicians and patients, and they can help inform health policy decisions that improve access to appropriate care for all Albertans,” says James. 

CARAT: Bringing data to life

Developed alongside APPROACH, CARAT (Coronary Artery Reporting and Archiving Tool) is a graphic recording and communication tool for medical caregivers. The software has been used in hundreds of thousands of patients to create anatomically accurate diagrams of an individual’s heart complete with blockages, narrowing, lesions, hardening and other features. The diagram can be printed or shared online or via email. In Alberta, the CARAT diagram is exported to the recently implemented Connect Care system for immediate access by clinicians. 

Wilton says CARAT was truly ahead of its time when it was developed and has stood the test of time. 

“It’s an intuitive and patient-friendly way of demonstrating and reporting complex findings that works in conjunction with APPROACH,” says Wilton. “APPROACH likes to take data and turn it into useable information that can improve patient care, and CARAT is an example of this.” 

Impacting precision medicine 

APPROACH is now being used in real time to help clinicians make better informed and personalized treatment decisions for individual patients. Researchers are tapping into APPROACH data to create tools to predict risk for a new patient receiving care, allowing for better decision making. 

One such tool helps clinicians prevent acute kidney injury in patients undergoing an angiogram or angioplasty (procedures to identify narrowing or blockages in arteries supplying blood to the heart and widen narrowed or blocked arteries). The dye injected during angiograms and angioplasties can lead to acute kidney injury, which can be serious and unpredictable. Some patients recover and return to normal kidney function, while others develop kidney failure, which, if not treated, can be fatal. 

Developed by James over 11 years using APPROACH data, the risk assessment tool warns clinicians when a patient is at risk of acute kidney injury. The tool calculates the risk and makes recommendations of how much contrast dye to use in real time, allowing health care providers to lower the risk of kidney injury. The tool is being used across the province. 

Looking forward

The APPROACH team plans to continue its integration with the new provincial model, Connect Care, and other health information systems to provide an even richer, more accessible data source. The team’s shift to using electronic systems for data collection is also opening doors for novel tools.

The team is fully embracing precision medicine ideals and is keen to develop more tools to support patient care. On the horizon is a clinical trial of a tool developed using APPROACH data that uses patient reported health measures (PROMS) and quality of life surveys. the tool provides a report to physicians, allowing them to better monitor their patients’ overall wellbeing and provide appropriate follow up. The tool has the potential to shift the focus to patient-centred care. 

“We are passionate about continuing the legacy of APPROACH,” says James. “It’s critical to maintain and sustain the collection of data across all levels. This will enable us to undertake practical projects that impact patient care.”

Read more about the Libin Cardiovascular Institute's Top 20 Achievements of the last 20 years here


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