Quality Of Cardiac Care Research Articles

Non-surgical Techniques for Combined Rheumatic Severe Aortic and Mitral Stenosis – Case Series and Brief Review of Literature

Rheumatic heart disease persists as a significant concern in developing regions, often resulting in multivalvular heart conditions. Treatment options are limited, though percutaneous transvenous mitral commissurotomy effectively addresses rheumatic mitral stenosis. Non-surgical interventions for aortic stenosis include balloon aortic valvotomy and Transcatheter aortic valve replacement (TAVR), tailored to patient factors like age and comorbidities. We describe two cases of Rheumatic multivalvular disease which were managed non-surgical. The first case is a pioneering procedure performed on a young patient combined percutaneous transvenous mitral commissurotomy with balloon aortic valvotomy, guided by 4-dimensional transoesophageal echocardiography (4D TEE). This represents the first documented instance in medical literature, showcasing the potential of integrated interventions and advanced imaging techniques. In the second challenging case involving a heavily calcified, retrovirus, and Hepatitis B positive 55-year-old, a staged approach was adopted, involving percutaneous transvenous mitral commissurotomy followed by Transcatheter aortic valve replacement (TAVR). Despite complexities, this sequential strategy demonstrates the adaptability of transcatheter techniques in managing complex valvular pathologies. These cases highlight the evolving landscape of interventional cardiology and underscore the importance of tailored, multidisciplinary approaches in optimizing outcomes for patients with rheumatic heart disease and multivalvular involvement, especially in resource-limited settings. Further exploration and dissemination of such innovative strategies hold promise for enhancing cardiac care quality and expanding treatment options globally.

Заболеваемость острым коронарным синдромом в Российской Федера- ции и в Республике Башкортостан.

Purpose of the study. Based on an analysis of the medical and demographic situation and the incidence of acute coronary syndrome in the Russian Federation, in the federal districts and constituent entities of the Russian Federation, as well as in the pilot territory of the Republic of Bashkortostan, proposals are given for the development of management decisions at the regional and federal levels. Materials and methods: statistical, analytical. We used statistical materials of the Federal State Statistics Service (2014–2021), statistical materials: M., TsNIIOIZ of the Ministry of Health of the Russian Federation (2023) and the Republic of Bashkortostan MIAC, Ufa (2022). Results. The leading cause of mortality in the Republic of Belarus, as well as in the Russian Federation as a whole, is diseases of the circulatory system (CVD). In 2022, the mortality rate of the population from CVD in the Republic of Belarus was 459,5 per 100 thousand population, in the Russian Federation the figure was higher – 560,8‰oo. Fluctuations in indicators in the constituent entities of the Russian Federation are 7,6 times. The primary morbidity rate of the adult population in the Republic of Bashkortostan was BSK (2022) 4948,6‰oo. Acute coronary syndrome (ACS) is a group of clinical symptoms or signs suggestive of acute myocardial infarction (MI) or unstable angina (UA). The primary incidence rate of the adult population of the Republic of Belarus with unstable angina pectoris was (2022) 113,8‰oo, acute myocardial infarction – 97,7‰oo, in the Russian Federation the figures are higher – 106,7 and 140,8‰oo, respectively. The difference in the incidence of myocardial infarction among the adult population in the constituent entities of the Russian Federation is 9,3 times; the difference in unstable angina is huge – 54 times, which to a certain extent indicates the ambiguity of the coding of unstable angina. The study indicates the need for an in-depth analysis of the incidence of acute coronary syndrome in the constituent entities of the Russian Federation. Conclusions. It is necessary to develop management decisions, including improving the accessibility and quality of cardiac care to thepopulation, including patients with acute coronary syndrome, at the regional and federal levels.

Using real-world data to monitor and improve quality of care in coronary artery disease: results from the Netherlands Heart Registration.

Worldwide, quality registries for cardiovascular diseases enable the use of real-world data to monitor and improve the quality of cardiac care. In the Netherlands Heart Registration (NHR), cardiologists and cardiothoracic surgeons register baseline, procedural and outcome data across all invasive cardiac interventional, electrophysiological and surgical procedures. This paper provides insight into the governance and processes as organised by the NHR in collaboration with the hospitals. To clarify the processes, examples are given from the percutaneous coronary intervention and coronary artery bypass grafting registries. Physicians who are mandated by their hospital to instruct the NHR to process their data are united in registration committees. The committees determine standard sets of variables and periodically discuss the completeness and quality of data and patient-relevant outcomes. In the case of significant variation in outcomes, processes of healthcare delivery are discussed and good practices are shared in a non-competitive and safe setting. To create new insights for further improvement in patient-relevant outcomes, quality projects are initiated on, for example, multivessel disease treatment, cardiogenic shock and diagnostic intracoronary procedures. Moreover, possibilities are explored to expand the quality registries through additional relevant indicators, such as resource use before and after the procedure, by enriching NHR data with other existing data resources.Supplementary InformationThe online version of this article (10.1007/s12471-022-01672-0) contains supplementary material, which is available to authorized users.

Outcomes following the percutaneous coronary intervention in contemporary Vietnamese practice: Insight from a single centre prospective cohort

BackgroundEvidence regarding the outcomes of percutaneous coronary intervention (PCI) in low-and-middle incomes countries remains limited. ObjectivesTo report the outcomes post PCI at discharge, 30 days and 12 months in Vietnam and identify the key factors associated with adverse outcomes at 12 months. MethodsWe used data from a single centre prospective cohort in Vietnam. Data regarding demographics, clinical presentation, procedural information, and outcomes of patients were collected and analysed. Primary outcomes were mortality and major adverse cardiac and cerebrovascular events. ResultsIn total, 926 patients were included. Poor outcomes were relatively low in those undergoing PCI. Predictors of mortality and major adverse cardiac and cerebrovascular events at 12 months post-PCI included being older than 75, being male, having acute myocardial infarction, left ventricular ejection fraction ≤ 40%, prior cerebral vascular disease and having an unsuccessful PCI. ConclusionsAdverse outcomes of patients undergoing PCI in Vietnam are relatively low in comparison with those reported in other countries across the Asia Pacific region. Identification of factors associated with poor outcomes is beneficial for improving the quality of cardiac care and developing the prediction model of outcomes post-PCI in Vietnam.

Management of patients after coronary artery bypass grafting surgery: a guide for primary care practitioners.

KEY POINTS About 15 000 people in Canada undergo coronary artery bypass grafting (CABG) surgery each year.[1][1] According to the 2019 Canadian Institute for Health Information Cardiac Care Quality Indicators Report, 9.4% of these patients are urgently readmitted to hospital within 30 days of CABG

The Role of the European Society of Cardiology in improving the quality of cardiac care at the level of national cardiac societies

The Role of the European Society of Cardiology in improving the quality of cardiac care at the level of national cardiac societies

COMPARISON OF CARDIAC SURGERY MORTALITY REPORTS USING RISK ADJUSTMENTS FROM ADMINISTRATIVE VERSUS CLINICAL DATA SOURCES

Quality of care outcomes for cardiac surgery are increasingly being publically reported. These reports employ regression models and use data from either administrative sources or clinical registries for risk-adjustment and to account for differences in case mix. However, the impact of the type of data used in risk-adjustment models on accuracy of outcomes reporting and perceived performance of a given operator has not been fully examined. In the same patient cohort, we compared the performance of two different risk-adjustment models using administrative or clinical data sources. The administrative-only risk-adjustment model which uses the International Classification of Diseases diagnosis codes (CIHI Cardiac Care Quality Indicator [CCQI]) and the Society of Thoracic Surgeons [STS] risk-adjustment model using clinical data were tested on patients undergoing cardiac surgery at a single centre between 2013-2016 (N=1,635). Comparing both risk-adjustment models, the STS model included more data on cardiac function/status prior to the procedure and clinical cardiovascular conditions while the CIHI model included more variables pertaining to non-cardiac comorbidities. The primary outcome was in-hospital mortality within 30 days of the operation. Model performance was established by comparing predicted and observed mortality, model calibration and handling of critical covariates. Observed mortality rate was 1.96% (95%CI: 1.40-2.75%) which was similar to STS predicted mortality (1.96%) but significantly higher than CCQI-predicted mortality (1.03%). Despite both models having similar c-statistics (0.756 CCQI; 0.758 STS), the CCQI model showed significant underestimation of probability of mortality at the higher end of the risk spectrum. There was significant miscalibration (underestimation in the CCQI model) of risk, which was largely driven by seven important pre-operative covariates: NYHA class IV; prior congestive heart failure; left ventricular ejection fraction <20%, prior atrial fibrillation; acute coronary insufficiency; cardiac compromise (defined by the presence of shock, myocardial infarction <24 hours, intra-aortic balloon pump in situ, cardiac resuscitation prior to surgery, or pre-procedure circulatory support); and creatinine concentration ≥100mg/dL. Together, these factors accounted for 84% of the variation in predicted mortality between the CCQI and STS models. Risk prediction using administrative data underestimated mortality risk compared to a validated clinical model. The use of administrative data sources for risk-adjusted mortality reporting may inflate observed to predicted mortality ratios at hospitals with patients who are more ill, more complex, or are at the higher end of the clinical risk spectrum. Caution is warranted when hospital outcomes reports of cardiac surgery are based on administrative data alone.

Quality of Cardiac Care in Canada: Recommendations for Building a Sustainable Future

Cardiovascular (CV) disease continues to present a significant disease and economic burden in Canada. To improve the quality of care and ensure sustainability of services, a national quality improvement initiative is required. The purpose of this analysis was to review the evidence for public reporting (PR) and external benchmarking (EB) to improve patient outcomes, and to recommend a strategy to improve CV care in Canada. To incorporate recent literature, the Canadian Cardiovascular Society (CCS) commissioned the Institute of Health Economics to provide a rapid update on the literature of PR and EB. The review showed that EB is more likely to promote positive effects, such as improved mortality, morbidity, and evidence-based clinical practice, and to limit negative effects, such as access restrictions or unintended provider behaviour associated with some forms of “top-down” PR. On the basis of these findings, this we recommend the following: (1) secure funding for the provincial collection of CV quality indicators and the creation of annual National CV Quality Reports; (2) enhance the culture of using CV quality indicator data for continuous quality improvement and opportunities for national or regional EB and sharing best practices; and (3) implement ongoing evaluation and revision of CCS clinical practice guidelines incorporating key quality indicators. This is already under way to a limited extent by the CCS with its Quality Project, but intentional, sustained support needs to be secured to enhance this ongoing effort and improve the quality of CV care for all Canadians.

Comparison of cardiac surgery mortality reports using administrative and clinical data sources: a prospective cohort study.

Outcomes for coronary artery bypass surgery are of broadening interest, but the impact of data type on quality reporting has not been fully examined. We compared the performance of administrative and clinical data-based risk adjustment models at a tertiary-quaternary care hospital. We used a prospective study design to test two risk adjustment models, one from administrative (Canadian Institute for Health Information [CIHI] Cardiac Care Quality Indicator) and one from clinical data (Society of Thoracic Surgeons), on cardiac surgical procedures performed between 2013 and 2016 (n = 1635). Our primary outcome was in-hospital mortality within 30 days of surgery. Model performance was established by comparing predicted and observed mortality, model calibration and handling of critical covariates. Observed mortality was 1.96%, which was the same as that predicted by the Society of Thoracic Surgeons model (1.96%), but significantly higher than that predicted by the CIHI model (1.03%). Despite both models having similar C statistics (0.756 CIHI; 0.758 Society of Thoracic Surgeons), the CIHI model showed significant underestimation of mortality among patients at higher risk. There was significant miscalibration of risk associated with 7 covariates: New York Heart Association class IV, congestive heart failure, ejection fraction less than 20%, atrial fibrillation, acute coronary insufficiency, cardiac compromise (shock, myocardial infarction < 24 h, intra-aortic balloon pump, cardiac resuscitation or preprocedure circulatory support) and creatinine concentration of 100 mg/dL or more. Together, these factors accounted for 84% of the difference in predicted mortality between the administrative and clinical models. Risk prediction using administrative data underestimated risk of death, potentially inflating observed-to-predicted mortality ratios at hospitals with patients who are more ill. Caution is warranted when hospital reports of cardiac surgery outcomes are based on administrative data alone.

Quality of Acute Myocardial Infarction Care in Canada: A 10-Year Review of 30-Day In-Hospital Mortality and 30-Day Hospital Readmission

BackgroundThe recently released Canadian cardiac care quality indicators include 30-day in-hospital mortality and readmission rates after percutaneous coronary intervention (PCI) and isolated coronary artery bypass grafting (CABG). We examined long-term trends and provincial variations in these outcomes among acute myocardial infarction (AMI) patients. MethodsWe included patients aged 18 years and older who were hospitalized with a primary diagnosis of AMI between 2004 and 2013 in all Canadian provinces except Quebec. We calculated 30-day in-hospital death and readmission rates after PCI as well as isolated CABG. We used logistic regressions to evaluate baseline-adjusted temporal trends and provincial variations in mortality and readmission. ResultsAmong 341,001 AMI episodes in 323,862 unique patients, 43.1% and 7% received PCI and CABG, respectively. Mortality after PCI (2.8%) remained stable (odds ratio [OR], 1.01; P = 0.399), whereas mortality after isolated CABG (2.5%) decreased over time (OR, 0.96; P = 0.017). Readmission after PCI (8.8%) increased (OR, 1.06; P < 0.001), whereas readmission after isolated CABG (11.4%) remained stable over time (OR, 0.99; P = 0.116). Compared with Alberta, mortality and readmission after PCI were highest in Saskatchewan (mortality: OR, 1.32; P = 0.001; readmission: OR, 1.24; P < 0.001), whereas mortality after isolated CABG was highest in Newfoundland and Labrador (OR, 2.05; P = 0.010) and readmission after isolated CABG was highest in New Brunswick (OR, 1.49; P = 0.001). ConclusionsThere was no change in mortality, and a slight increase in readmission rates after PCI, and modest improvements in mortality and readmission rates after CABG among AMI patients during the study period. Significant interprovincial variations remained. A stronger focus on pan-Canadian coordination in AMI care and a set of standard benchmarks for AMI-specific PCI- and CABG-related quality indicators are needed.

Do practice gaps exist in evidence-based medication prescription at hospital discharge in patients undergoing coronary artery bypass surgery & coronary angioplasty?

Background & objectives:Prescription patterns of guideline-directed medical therapy (GDMT) after coronary artery bypass surgery [coronary artery bypass graft (CABG)] and percutaneous coronary intervention (PCI) at hospital discharge are often not optimal. In view of scarce data from the developing world, a retrospective analysis of medication advice to patients following CABG and PCI was conducted.Methods:Records of 5948 patients (post-PCI: 5152, post-CABG: 796) who underwent revascularization from 2010 to 2014 at a single tertiary care centre in north India were analyzed.Results:While age and gender distributions were similar, diabetes and stable angina were more frequent in CABG group. Prescription rates for aspirin 100 per cent versus 98.2 per cent were similar, while beta-blockers (BBs, 95.2 vs 90%), statins (98.2 vs 91.6%), angiotensin-converting enzyme inhibitors (89.4 vs 41.4%), nitrates (51.2 vs 1.1%) and calcium channel blockers (6.6 vs 1.6%) were more frequently prescribed following PCI. Despite similar baseline left ventricular ejection fraction (48.1 vs 51.1%), diuretics were prescribed almost universally post-CABG (98.2 vs 10.9%, P<0.001). Nearly all (94.4%) post-CABG patients received a prescription for clopidogrel. Patients undergoing PCI were much more likely to receive higher statin dose; 40-80 mg atorvastatin (72 vs <1%, P<0.001) and a higher dose of BB.Interpretation & conclusions:Significant differences in prescription of GDMT between PCI and CABG patients existed at hospital discharge. A substantial proportion of post-CABG patients did not receive BB and/or statins. These patients were also less likely to receive high-dose statin or optimal BB dose and more likely to routinely receive clopidogrel and diuretics. Such deviations from GDMT need to be rectified to improve quality of cardiac care after coronary revascularization.

QUALITY OF ACUTE MYOCARDIAL INFARCTION CARE IN CANADA: A 10-YEAR REVIEW OF 30-DAY HOSPITAL READMISSION

The Canadian Institute for Health Information has recently released new cardiac care quality indicators regarding 30-day readmission after primary percutaneous coronary intervention (PCI) and coronary artery by-pass grafting (CABG). The objectives of our study were to examine temporal trends and provincial variation in the 30-day hospital readmission after PCI and CABG among patients with acute myocardial infarction (AMI) in Canada.

Patients' perspectives of care quality in cardiac outpatient departments

This study explored cardiac patients' perceptions of the factors affecting the quality of cardiac services in outpatient departments in Jordanian hospitals. Semi-structured face-to-face interviews were conducted with 17 patients attending appointments at two cardiac care centres in Amman, Jordan. Thematic analysis of the data resulted in the identification of three themes: physicians spending insufficient time with patients; inadequate explanations by physicians; and organisational issues. Attention to these factors could improve the quality of healthcare. This could include a role for nurses in giving patients information about their condition and treatment, and educating them on lifestyle issues. Health professionals and decision makers should consider patients' views to improve the quality of cardiac care in OPD.

How socioeconomic inequalities impact pathways of care for coronary artery disease among elderly patients: study protocol for a qualitative longitudinal study

IntroductionSeveral studies have identified that socioeconomic inequalities in coronary artery disease (CAD) morbidity and mortality lead to a disadvantage in patients with low socioeconomic status (SES). International studies have shown...

OUTCOMES FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) IN ONTARIO (2007-2013)

The Cardiac Care Network of Ontario (CCN) works to plan, coordinate, implement and evaluate adult cardiovascular care in Ontario, and is responsible for maintaining the CCN Cardiac Registry. Transcatheter Aortic Valve Implantation (TAVI) is a transcatheter procedure to replace diseased aortic valves, without the need for open heart surgery. Ten (10) hospitals in Ontario provide TAVI procedures. All 10 hospitals enter data in the CCN Cardiac Registry. All TAVI procedures in the CCN Cardiac Registry between January 2007 and November 2013 were analyzed. Patient characteristics and procedural details were obtained from the CCN Cardiac Registry. Data from the CCN Cardiac Registry was linked to the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) and the Ontario Registered Persons Database (RPDB) to calculate post-procedural outcomes. The primary outcomes measured were crude unadjusted all-cause mortality and readmission rates and were calculated at varying time points, out to 3-years post-procedure. A secondary analysis was performed focusing on outcomes for more recent TAVI procedures (January 2010 to November 2013). This study was developed by CCN, with data analysis completed by the Institute for Clinical Evaluative Sciences. A total of 1,105 unique TAVI procedures were identified and linked to the CIHI-DAD and RPDB. Analysis of TAVI procedures in Ontario revealed that the majority of procedures performed were done via femoral access (73.7%). In-hospital mortality was found to be 6.2% overall with rates being lower for transfemoral procedures (4.2%) versus non-transfemoral (11.7%). At 1-year post-procedure the overall all-cause mortality rate was 19.4% with an all-cause readmission rate of 49.3%. At 3-years post-procedure, the overall all-cause mortality rate was 43.9% with an all-cause readmission rate of 74.7%. Overall, mortality rates in Ontario following TAVI procedures are comparable to rates reported by other jurisdictions. Although all-cause mortality and readmission rates at 3-years are high, this may be explained by comorbidities and frailty in the TAVI patient population, as well as the fact this registry covers the early experience for most centres. In general we believe based on these outcomes that TAVI is a relatively safe and effective procedure to treat aortic stenosis in patients who are at extreme or high risk for conventional cardiac surgery in Ontario. CCN will continue to report on outcomes following TAVI procedures in Ontario to ensure that all Ontarians have access to the highest possible quality of cardiac care.

SUPPORTING PATIENT ACCESS TO CARDIAC CATHETERIZATION, INTERVENTIONS AND SURGERY: DEVELOPMENT OF A CLINICAL AND ADMINISTRATIVE PROVINCIAL WAIT LIST MANAGEMENT TOOL

The monitoring of patient access and quality of cardiac care in British Columbia is supported by a web-based electronic cardiac information system which captures patients’ journey from referral for cardiac catheterization and surgery in a single clinical information structure. In the past year, this application has enabled significant improvement in patient access to cardiac procedures by providing accurate, real time and site-specific wait list data. Nurses play a pivotal role in health services and system management, utilize administrative and clinical data to monitor and coordinate patients’ access to procedures, promote patient safety, and optimize health resource utilization. We will present the software tool established to enhance provincial waitlist management and reporting for Cardiac Services BC (CSBC). We will describe the initial multidisciplinary project development and implementation. We will demonstrate the application’s use as a common numerical and graphic source of information for provincial waitlist management and planning that allows just-in-time decision-making. We will highlight the availability of transparent cardiac site activity, triage processes, queuing, provincial market share, procedure-specific pressures, and urgency reports. We will discuss the significant progress made in BC to improve triage coordination and optimize access to cardiac procedures enabled by nurses’ use of the wait list application. The implementation of real-time and retrospective accurate representations of wait times, volumes, and the availability of tailored reports has been a powerful tool for nurses to monitor access and waitlist process issues, and facilitate patients’ timely access to cardiac procedures in BC.

Improving Quality of Cardiac Care: A Global Mandate

Improving Quality of Cardiac Care: A Global Mandate

The year of transparency: measuring quality of cardiac care.

The assessment of quality of care is becoming increasingly important in healthcare, both globally and in the Netherlands. The Dutch Minister of Health declared 2015 to be the year of transparency, thereby aiming to improve quality of care by transparent reporting of outcome data. With the increasing importance of transparency, knowledge on quality measurement will be essential for a cardiologist in daily clinical care. To that end, this paper provides a comprehensive overview of the Dutch healthcare structure, quality indicators and the current and future assessment of quality of cardiac care in the Netherlands.

An Open Source ECG Clock Generator for Visualization of Long-Term Cardiac Monitoring Data

The collection of long-term health data is accelerating with the advent of portable/wearable medical devices including electrocardiograms (ECGs). This large corpus of data presents great opportunities to improve the quality of cardiac care. However, analyzing the data from these sensors is a challenge; the relevant information from $\sim 120$ 000 heart beats per patient per day must be condensed into a human-readable form. Our goal is to facilitate the analysis of these unwieldy data sets. We have developed an open source tool for creating easy-to-interpret plots of cardiac information over long periods. We call these plots ECG clocks. The utility of our ECG clock library is demonstrated through multiple examples drawn from a database of 24-h Holter recordings. In these case studies, we focus on the visualization of heart rate and QT dynamics. The ECG clock concept is shown to be relevant for both physicians and researchers, for identifying healthy and abnormal values and patterns in ECG recordings. In this paper, we describe how to use the ECG clock library to analyze 24-h ECG recordings, and how to extend the source code for your own purposes. The tool is applicable to a wide range of cardiac monitoring tasks, such as heart rate variability or ST elevation. This library, which we have made freely available, can help provide new insights into circadian patterns of cardiac function in individuals and groups.

DEVELOPMENT OF A CLINICAL AND ADMINISTRATIVE PROVINCIAL WAITLIST MANAGEMENT TOOL TO SUPPORT HEALTH SERVICE PLANNING AND PATIENT ACCESS TO CARDIAC CATHETERIZATION AND SURGERY

The monitoring of access and quality of cardiac care in British Columbia is supported by a web-based electronic cardiac information system (HEARTis) which accurately captures patients’ journey from referral for cardiac catheterization, surgery and heart rhythm device procedures to discharge in a single clinical information system. The system has practical clinical utility for data entry concurrent with processes of care, report generation, and simultaneously populates the provincial database. Multiple factors intersect to compound the challenges of ensuring patient access and meeting wait time benchmarks. Associated variations in patient need and clinical capacity can result in disparity in access and delayed treatment, and present opportunities to improve utilization of existing provincial resources. The provincial implementation of HEARTis enabled the development of a software tool to enhance provincial waitlist management and reporting for Cardiac Services BC (CSBC). The purpose of the development of the CSBC Waitlist Viewer was to extract data seamlessly from HEARTis to provide accurate, timely and easily accessible waitlist and wait time information in graphical format for clinicians, administrators and policy-makers to view and manage the challenges of variation in access to care. Integral to the process was achieving consensus among multiple stakeholders to standardize the interpretation of wait time definitions, enhance data quality, and establish performance targets and thresholds for action to improve patient access. The project resulted in the availability of transparent and accurate waitlist data for diverse users at multiple cardiac sites to reference as the common source of information for provincial waitlist management and planning. The uptake of the CSBC Waitlist Viewer was facilitated by the easily available filtering systems to create tailored reports, including cardiac site activity, provincial market share, triage processes, queuing, procedure-specific pressures, and management of urgency, which will be demonstrated. The system allows the user to easily move from summary reports to patient/provider level data allowing for just-in-time decision-making. The CSBC Waitlist Viewer supported the temporary redistribution of referrals between cardiac centres when capacity was provisionally limited and provided the foundation for the development of a comprehensive strategy to improve access and provincial cardiac resource utilization. The implementation of real-time and retrospective accurate graphic and numerical representations of wait times, volumes, and the availability of tailored reports has been a powerful tool to monitor access and waitlist process issues, support the data-driven planning of cardiac resources, and facilitate patients’ timely access to cardiac procedures in BC.