ICONS

Improving Cardiovascular Outcomes in

Nova Scotia

What is ICONS?

ICONS is a province-wide study of heart disease and is one of the largest studies ever undertaken to measure and improve health care for heart disease. The purpose of the study is to examine whether using the most effective evidence-based practices to treat heart disease will measurably improve the health of Nova Scotians.

The partners in this study include the Government of Nova Scotia (Department of Health), Community Health Care Professionals (physicians, nurses, pharmacists), the Division of Cardiology, QEII Health Sciences Centre, and Merck Frosst Canada Inc. (Patient Health Management Division). The budget for the study is six-million dollars over five years contributed by Merck Frosst Canada Inc.

Who is involved?

ICONS was launched in February, 1997 and involves the participation of ten major referral centres across Nova Scotia. These centres include Halifax Regional Municipality, Sydney, Amherst, Antigonish, New Glasgow, Bridgewater, Truro, Kentville, and Yarmouth.

What's the point?

There are several reasons for undertaking a study of this magnitude at this time:

1. Approximately 40% of Nova Scotians die from cardiovascular disease which is slightly higher than the national average of 38%.
2. Cardiovascular disease is responsible for billions in direct and indirect costs each year in Canada (eighteen billion dollars overall in 1994 alone).
3. The 1995 Nova Scotia Health Survey showed that 70% of Nova Scotians had one or more of the major risk factors for cardiovascular disease (hyperlipidemia, hypertension, smoking).
4. Canada's population is aging and health care services utilization as well as costs are expected to rise proportionately.
5. Governments need help understanding where to allocate resources for the best health outcomes.
6. The present approach to treating patients with heart disease is not standardized.
7. There is not always uniformity in prescriptive practices and so-called evidence-based therapies known to improve patient health are under-utilized.
8. Rising health care costs and budgetary restraints are challenging funders of the health care system to turn to more innovative solutions, such as determining which interventions work best to improve health outcomes at the most reasonable cost.

Why Nova Scotia?

Nova Scotia has been chosen for this study as it's size makes it perfect for a world-class study of heart disease and treatment. There is considerable interest and expertise in the study and treatment of cardiovascular diseases at Dalhousie University and its affiliated teaching hospitals.

Nova Scotia's population of close to one million is large enough to ensure the study will have statistical power yet small enough to enable the study to track people with cardiovascular disease and document their treatment and outcome. In addition, Nova Scotia has a comparatively stable population base which is a key requirement for this kind of long-term, comprehensive population-based study.

How will Nova Scotia benefit?

Nova Scotia can be expected to benefit from this study in a number of ways. Through participation in this study, patients with heart disease will receive enhanced care and it is expected that this will result in improved health outcomes. Health care costs for the management of cardiovascular disease will be analyzed and the most efficient and effective patterns of practice will be emphasized. Local expertise and infrastructure for the conduct of health services and outcomes research will be developed and the methods formulated to promote more efficient patient management will have the potential to be exported to other disease areas and geographic locations.

In the first year approximately 1.2 million dollars from the ICONS budget has been designated to support the program and create approximately 20 new jobs in the province.

Who will be studied?

All Nova Scotians admitted to hospital with heart disease, heart failure or atrial fibrillation, as well as patients in the community at high risk of a major initial or recurrent event such as myocardial infarction, unstable angina, heart failure, stroke, diabetes or previous heart surgery will be approached for enrollment in the study. Several thousand Nova Scotians are expected to be enrolled and have their health monitored during the five-year program.

Clinical information will be collected on all patients hospitalized with heart disease at acute care institutions in the province as well as high-risk community-dwelling patients, using a variety of coordinated data sources across Nova Scotia. Total anonymity will be built into the program.

All patients who are hospitalized with heart disease will be included in the ICONS program and followed long-term as a means of assessing the quality of acute care services throughout the province. Non-hospitalized patients at high risk for cardiovascular disease will be given the opportunity to participate. These patients will be asked for signed permission to allow the study researchers to access their medical records for the ICONS database. The ICONS program recognizes the importance of and will take measures to ensure patient anonymity in the collection of individual clinical data.

How will the study proceed?

Before improvements can be made in the treatment of heart disease, it is necessary to measure what is going on now. Therefore, in the first year ICONS will monitor all aspects of care relating to patients with heart disease, patient health outcomes, and costs of treatment.

Over the remaining four years there will be a series of interventions aimed at patients and health care providers and geared towards achieving a stepwise improvement in patient health outcomes. This "enhanced" care will be monitored along with patient health outcomes and associated treatment costs across the province. ICONS will then use these data to determine the most effective management strategies (those which result in the best outcomes for the most reasonable cost).

- Graham Miles