U of C professor advancing patient-centred management of heart disease

By Leonie O’Sullivan, June 21 2023

Coronary artery disease (CAD) is the accumulation of plaque in the heart’s arteries, which can result in arteries narrowing over time with increased risks of heart attacks and heart failure. In Canada, CAD is the second highest cause of death. 

Professor Tolu Sajobi from the University of Calgary spoke with the Gauntlet about his research in patient-centred care for CAD. Sajobi was awarded more than one million dollars from Alberta Innovates and the Canadian Institutes of Health Research (CIHR) to employ artificial intelligence for the development of a shared decision-making platform. This platform will enable personalized care for patients suffering from CAD. 

“There is value in making sure that we share decision-making. Care providers can provide personalized care for each individual [to bring] the right treatment, to the right patient, at the right time,” Sajobi explained. 

Sajobi is an associate professor of biostatistics in the Department of Community Health Sciences and Clinical Neurosciences in the School of Medicine at the U of C. Their work revolves around developing statistical methods to make sense of data. Patient-reported outcomes (PROMs) or health outcomes directly reported by patients are critical for this research. 

“My special area of interest is around patient-reported outcomes [or] data self-reported by patients,” said Sajobi. “I did my Ph.D. at the intersection of quality of life and machine learning. That was where I began to see the value of patients reporting their quality of life and the potential value that this kind of information [and how this] could be useful for supporting clinical decision making for improved shared decision making.” 

Sajobi explained his experience in clinical trial design and developing clinical decision support based on statistical models or risk calculators. 

“In those risk calculators are mathematical models that are basically trained and validated at estimating risks. I am very interested in how we can use that to support clinical decisions,” said Sajobi. 

This work is significant for patients with complex CAD. Complex CAD is defined as CAD but with higher risk, sometimes because the patient is too frail to undergo invasive treatment to manage their CAD, or they may have comorbid conditions such as diabetes or risk of hypertension, which increases their mortality risk. Sajobi recommends presenting the options available to patients.

“Patients have to make these decisions,” Sajobi said. “What we are trying to do [is] capture what is important to patients to start with, before they get to [complex CAD status], and find a standardized way that clinicians can use clinical information and incorporate patient preferences [to] then provide a more robust discussion for each particular patient.”

An example of this, provided by Sajobi, is a situation where a 79-year-old patient may need to decide whether to have open heart surgery, which can take years to recover from. 

“I’m 79 years old already. I’ve had a good life. I don’t want five to 10 years to recover from open heart surgery, just based on medication, I want to have a better quality of life.” Sajobi said. “If I chose medical management, based on my age of 79, how long do people like me, with my condition — how long do they survive?”

Sajobi’s platform could incorporate this preference and estimate their life expectancy to allow patients to make more informed decisions about their health care.  

“The whole idea is to make sure that our process of shared decision-making is solid, informative and easier for both patients and their care providers to navigate,” Sajobi said. 

Some of Sajobi’s earlier work that got them started on this journey was discovering how PROMs can be used to predict hospital readmissions and even mortality.

“That got us thinking if we can do this, then we should be going beyond just collecting this data [for] scientific analysis and publishing papers,” said Sajobi. “That got us on the journey with the APPROACH research group.” 

The Alberta Provincial Project for Outcome Assessment in Coronary Heart (APPROACH) disease registry is a data-rich population-based cardiac registry in Alberta. This registry holds clinical information of 122,000 Albertans who have had cardiac catheterization and/or revascularization procedures and of 32,000 patients with hospital admissions due to acute coronary syndromes.

“They [have received] surveys by mail for more than 25 years,” said Sajobi.

This survey collection led to the IMPROVE CV care project. The paper-based data collection has been migrated to an electronic platform. Once the survey has been completed, it is sent directly to the individual’s physician.

“The physician can use that to inform discussions at the next follow-up visit,” Sajobi described. “That platform is already developed, and we are just in the process of doing a clinical trial to show that this works — this is really going to work when we roll it out across cardiology clinics and across Alberta as a whole.” 

This initiative for implementing an electronic platform arose after Sajobi met with patients and their carers. After presenting the APPROACH outcomes, they asked the patients for their opinions on how this data should be used. 

“The first thing that patients said was that they would like to see the results sent to their doctors [to facilitate discussions] in follow-up visits.” Said Sajobi. “That was kind of a Eureka moment for all of us.” 

Now, Sajobi wants to pair patient preferences with clinical risk information to support shared decision-making. Sajobi’s project was awarded funding in January, and they are currently undergoing recruitment. Sajobi’s team is recruiting 400 patients across Alberta to gain further perspective on patient preferences. 

“If anyone is out there and has a lived experience of heart disease, of course, they can definitely reach out,” Sajobi said. “We are excited to get going, and we really are thankful for [the] support from Alberta Innovates and CIHR.” 

In Sajobi’s closing remarks, they highlighted that working with such a multidisciplinary team of medical doctors, academic professors, students and researchers has been fun. They also feel privileged to work with the APPROACH investigators.

“[It has] really been a fruitful and lovely collaboration,” Sajobi said. “The key is working with the best minds and working in an environment where everyone is committed to improving care and making sure that care is patient-centred.” 

More information about Sajobi’s research can be found here.