Andrew L Pipe

University of Ottawa, Ottawa, Ontario, Canada

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Publications (76)201.66 Total impact

  • Andrew L Pipe
    Current opinion in cardiology. 07/2014;
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    Jennifer L Reed, Andrew L Pipe
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    ABSTRACT: This review focuses on recent literature examining the validity and reliability of the talk test for prescribing and monitoring exercise intensity. The utility of the talk test for high-intensity interval training and recently proposed exercise training guidelines for patients with atrial fibrillation is also examined.
    Current opinion in cardiology. 07/2014;
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    ABSTRACT: To report on the delivery of evidence-based smoking cessation treatments (EBSCTs) within a sample of 40 Ontario family health teams (FHTs).
    Canadian family physician Médecin de famille canadien. 07/2014; 60(7):e362-71.
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    ABSTRACT: http://www.cmaj.ca/content/early/2014/07/07/cmaj.131778
    Canadian Medical Association Journal 07/2014; · 6.47 Impact Factor
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    ABSTRACT: Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD).
    Tobacco control. 06/2014;
  • Andrew L Pipe
    Evidence-based medicine. 06/2014;
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    ABSTRACT: Quitting smoking is the single most effective strategy to reduce morbidity and premature mortality in smokers. Research has demonstrated the effectiveness of pharmacotherapy in smoking cessation, but few studies have directly compared varenicline and monotherapy nicotine replacement therapy (NRT) and none have examined varenicline and combinations of NRT products. The majority of smoking cessation trials involve carefully circumscribed populations, making their results less generalizable to those with severe medical conditions or psychiatric comorbidities. This paper reports on the rationale, methodology and participant characteristics of a randomized controlled trial designed to: (1) determine which pharmacotherapy - NRT, long term combinations of NRT, or varenicline - is most effective in achieving abstinence; (2) investigate the incidence of neuropsychiatric symptoms among participants over the course of their quit attempt; and, (3) assess whether there is a significant difference in the incidence of neuropsychiatric symptoms in those receiving differing pharmacotherapies, and between those with or without psychiatric illnesses. The primary outcome was carbon monoxide confirmed abstinence from weeks 5-52 following a target quit date. Secondary outcomes included neuropsychiatric (i.e., depression, suicidal ideation, anxiety, anger) and withdrawal symptoms. Smokers (N=737) were randomly assigned to one of three treatment conditions, and were scheduled to attend 8 follow-up appointments over 12months. All participants received 6-15 minute practical counseling sessions with nurse counselors experienced in treating tobacco dependence. We expect that the results will lead to an enhanced understanding of the efficacy of these pharmacotherapies, including those with a history of psychiatric illness.
    Contemporary clinical trials. 05/2014;
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    ABSTRACT: Background Heart disease is a leading cause of morbidity and mortality in both men and women. Our understanding of heart disease stems chiefly from clinical trials on men, but key features of the disease differ in women. This paper reports findings from the first Canadian national survey of women that focuses on knowledge, perceptions and lifestyle related to heart health. Methods A cross-country survey using an adaptation of an instrument used in the United States was undertaken in spring of 2013. Based on online (208) and telephone (1446) responses from a randomly selected sample of women aged 25 or older, a total sample of 1,654 weighted percentage estimates were produced. The overall response rate was 12.5%. Results Just under half of women were able to name smoking as a risk factor of heart disease, and less than one-quarter named hypertension or high cholesterol. Fewer than half of women knew the major symptoms of heart disease. The majority of women prefer to receive information on heart health from their doctor, but only slightly more than half report that their doctor includes discussion of prevention and lifestyle during clinical consultations. Conclusions The majority of women lack knowledge of heart disease symptoms and risk factors, and significant proportions are unaware of their own risk status. The findings underscore the opportunity for patient education and intervention regarding risk and prevention of heart disease.
    The Canadian journal of cardiology 01/2014; · 3.12 Impact Factor
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    ABSTRACT: Atrial fibrillation, the most common sustained cardiac arrhythmia, is associated with significant morbidity and mortality. Chronic exercise training is a recognized form of treatment for those with many forms of heart disease. There might also be a role for exercise in the management of permanent atrial fibrillation; few studies have explored the effects of chronic exercise training in persons with this condition. The purpose of this study was to systematically evaluate and summarize the evidence surrounding the effects of chronic exercise training in persons with permanent atrial fibrillation. A systematic and comprehensive literature review was undertaken of all English language literature. A total of 6 studies, 3 randomized controlled trials with a total of 118 participants, and 3 observational studies with a total of 93 participants, were identified. The literature suggests that short-term chronic exercise training of low, moderate, or vigorous intensity in adults with permanent atrial fibrillation significantly improved rate control, functional capacity, muscular strength and power, activities of daily living, and quality of life. The effect of short-term chronic exercise training on aerobic capacity in adults with permanent atrial fibrillation is conflicting. Chronic exercise training appears to play a promising role in the management of permanent atrial fibrillation. Future studies examining the effect of various forms of exercise training interventions in improving clinical outcomes and exercise tolerance in those with permanent atrial fibrillation are needed.
    The Canadian journal of cardiology 12/2013; 29(12):1721-1728. · 3.12 Impact Factor
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    ABSTRACT: BACKGROUND:Family members of patients with coronary artery disease (CAD) have higher risk of vascular events. We conducted a trial to determine if a family heart-health intervention could reduce their risk of CAD. METHODS:We assessed coronary risk factors and randomized 426 family members of patients with CAD to a family heart-health intervention (n = 211) or control (n = 215). The intervention included feedback about risk factors, assistance with goal setting and counselling from health educators for 12 months. Reports were sent to the primary care physicians of patients whose lipid levels and blood pressure exceeded threshold values. All participants received printed materials about smoking cessation, healthy eating, weight management and physical activity; the control group received only these materials. The main outcomes (ratio of total cholesterol to high-density lipoprotein [HDL] cholesterol; physical activity; fruit and vegetable consumption) were assessed at 3 and 12 months. We examined group and time effects using mixed models analyses with the baseline values as covariates. The secondary outcomes were plasma lipid levels (total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol and triglycerides); glucose level; blood pressure; smoking status; waist circumference; body mass index; and the use of blood pressure, lipid-lowering and smoking cessation medications. RESULTS:We found no effect of the intervention on the ratio of total cholesterol to HDL cholesterol. However, participants in the intervention group reported consuming more fruit and vegetables (1.2 servings per day more after 3 mo and 0.8 servings at 12 mo; p < 0.001). There was a significant group by time interaction for physical activity (p = 0.03). At 3months, those in the intervention group reported 65.8 more minutes of physical activity per week (95% confidence interval [CI] 47.0-84.7min). At 12 months, participants in the intervention group reported 23.9 more minutes each week (95% CI 3.9-44.0 min). INTERPRETATION:A health educator-led heart-health intervention did not improve the ratio of total cholesterol to HDL cholesterol but did increase reported physical activity and fruit and vegetable consumption among family members of patients with CAD. Hospitalization of a spouse, sibling or parent is an opportunity to improve cardiovascular health among other family members. Trial registration: clinicaltrials.gov, no NCT00552591.
    Canadian Medical Association Journal 11/2013; · 6.47 Impact Factor
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    ABSTRACT: Objective: To develop and evaluate the validity and reliability of a questionnaire to measure intentions and beliefs about healthy eating in individuals at risk for coronary heart disease. Method: The Healthy Eating Opinion Survey was developed using the theory of planned behavior. An open-ended elicitation questionnaire was administered to 21 participants, and a 46-item questionnaire was developed for further testing. Test-retest reliability of each question on the survey was assessed by calculating the correlation coefficients between the responses over a 2- week period in 17 participants. Internal consistency was assessed using Cronbach's alpha, and factor analysis was used to assess the construct validity of the questionnaire in a sample of 388 participants. Results: The responses to the elicitation questions were used to develop behavioral beliefs, normative beliefs, and control beliefs questions for the final questionnaire. Test-retest reliability ranged from 0.22-0.90, with the majority (89%) of correlations being moderate to strong. Internal consistency was good, with Cronbach's alpha ranging from 0.74-0.92. All intentions questions loaded onto a single factor; attitude questions loaded onto two factors; subjective norm questions loaded onto two factors; perceived behavioral control questions loaded onto one factor; behavioral beliefs questions loaded onto one factor; normative beliefs questions loaded onto one factor; and control beliefs questions loaded onto one factor. Conclusion: The questionnaire was found to be a reliable, valid questionnaire to assess beliefs and intentions toward eating a healthy diet in individuals at risk for coronary heart disease. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Health Psychology 08/2013; · 3.95 Impact Factor
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    ABSTRACT: BACKGROUND: Patients with heart failure are a growing population within cardiac rehabilitation. The purpose of this study was to compare, through a single-centre, parallel-group, randomized controlled trial, the effects of Nordic walking and standard cardiac rehabilitation care on functional capacity and other outcomes in patients with moderate to severe heart failure. METHODS: Between 2008 and 2009, 54 patients (aged 62.4 ± 11.4 years) with heart failure (mean ejection fraction = 26.9% ± 5.0%) were randomly assigned to standard cardiac rehabilitation care (n = 27) or Nordic walking (n = 27); both groups performed 200 to 400 minutes of exercise per week for 12 weeks. The primary outcome, measured after 12 weeks, was functional capacity assessed by a 6-minute walk test (6MWT). RESULTS: Compared with standard care, Nordic walking led to higher functional capacity (Δ 125.6 ± 59.4 m vs Δ 57.0 ± 71.3 m travelled during 6MWT; P = 0.001), greater self-reported physical activity (Δ 158.5 ± 118.5 minutes vs Δ 155.5 ± 125.6 minutes; P = 0.049), increased right grip strength (Δ 2.3 ± 3.5 kg vs Δ 0.3 ± 3.1 kg; P = 0.026), and fewer depressive symptoms (Hospital Anxiety and Depression Scale score = Δ -1.7 ± 2.4 vs Δ -0.8 ± 3.1; P = 0.014). No significant differences were found for peak aerobic capacity, left-hand grip strength, body weight, waist circumference, or symptoms of anxiety. CONCLUSIONS: Nordic walking was superior to standard cardiac rehabilitation care in improving functional capacity and other important outcomes in patients with heart failure. This exercise modality is a promising alternative for this population.
    The Canadian journal of cardiology 06/2013; · 3.12 Impact Factor
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    ABSTRACT: OBJECTIVE: To determine whether telephone-based smoking cessation follow-up counseling (FC), when delivered as part of a multi-component intervention program is associated with increased rates of follow-up support and smoking abstinence. METHODS: A cluster randomized controlled-trial was conducted within family medicine practices in Ontario, Canada. Consecutive adult patients who smoked were enrolled at two time points, the baseline period (2009) and the post-intervention period (2009-2011). Smoking abstinence was determined by telephone interview 4months following enrollment. Both groups implemented a multi-component intervention program. Practices randomized to the FC group could also refer patients to a follow-up support program which involved 5 telephone contacts over a 2-month period. RESULTS: Eight practices, 130 providers, and 928 eligible patients participated in the study. No statistically significant difference in 7-day point-prevalence abstinence was observed between intervention groups. There was a significant increase in referral to follow-up in both intervention groups. Significantly higher rates of smoking abstinence [25.7% vs. 11.3%; adjusted OR 3.1 (95% CI: 1.1, 8.6), p<0.05] were documented among the twenty-nine percent of FC participants who were referred to the follow-up support program compared to the MC group. CONCLUSION: Access to external follow-up support did not increase rates at which follow-up support was delivered.
    Preventive Medicine 02/2013; · 3.50 Impact Factor
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    ABSTRACT: PURPOSE:: Despite well-documented positive benefits, cardiac rehabilitation (CR) is an underutilized resource for patients following a cardiac event or intervention. Bias in the CR referral process has led to programs designed to ensure that all eligible patients receive a referral. The purpose of the current investigation was to describe the implementation of a nurse-delivered automatic bedside referral process and to examine the effectiveness on referral and intake rates for CR. METHODS:: In 2007, an automatic CR referral system was implemented at the University of Ottawa Heart Institute. A nurse-delivered automatic bedside referral process was implemented in 2008. A CR nurse screened all inpatient charts, discussed CR benefits and program options with patients, triaged the patient to the appropriate program, and facilitated booking of the CR intake appointment. Data were analyzed to determine the effectiveness of this approach. RESULTS:: Only 15.5% to 19.7% of eligible patients participated in CR program prior to 2006. Implementation of an automatic referral process increased participation to 26.7%. The nurse-delivered bedside automatic referral process increased participation to 32.6%. The proportion of patients receiving CR referrals almost tripled following the implementation of the nurse-delivered referral process from 26.7% in 2003 to 79.0% in 2008. CONCLUSIONS:: A nurse-delivered automatic bedside referral process had a positive impact on both referral and intake to CR. Future challenges for CR programs will be to ensure optimal participation in programs, while managing the growth associated with increased rates of involvement.
    Journal of cardiopulmonary rehabilitation and prevention 02/2013; · 1.59 Impact Factor
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    ABSTRACT: Introduction La fibrillation auriculaire, qui est l’arythmie cardiaque soutenue la plus fréquente, est associée à une morbidité et une mortalité significatives. L’entraînement physique régulier est un type de traitement reconnu pour ceux ayant diverses formes de cardiopathie. L’exercice pourrait également jouer un rôle dans la prise en charge de la fibrillation auriculaire permanente. Quelques études ont exploré les effets de l’entraînement physique régulier chez les personnes ayant cette maladie. Le but de cette étude était d’évaluer et de résumer systématiquement les données scientifiques entourant les effets de l’entraînement physique régulier chez les personnes ayant une fibrillation auriculaire permanente. Méthodes Une revue systématique et globale de toute la littérature de langue anglaise a été entreprise. Un total de 6 études, dont 3 essais cliniques aléatoires comprenant un total de 118 participants et 3 études observationnelles comprenant un total de 93 participants, ont été sélectionnées. Résultats La littérature suggère que l’entraînement physique régulier à court terme d’intensité faible, modérée ou vigoureuse chez les adultes ayant une fibrillation auriculaire permanente améliorait significativement la maîtrise de la fréquence, la capacité fonctionnelle, la force et la puissance musculaires, les activités de la vie quotidienne et la qualité de vie. L’effet de l’entraînement physique régulier à court terme sur la capacité aérobique chez les adultes ayant une fibrillation auriculaire permanente est contradictoire. Conclusions L’entraînement physique régulier semble jouer un rôle prometteur dans la prise en charge de la fibrillation auriculaire permanente. Des études ultérieures examinant l’effet des diverses formes d’interventions en entraînement physique en vue d’améliorer les résultats cliniques et la tolérance à l’exercice chez ceux ayant une fibrillation auriculaire permanente sont nécessaires.
    The Canadian journal of cardiology 01/2013; 29(12):1721–1728. · 3.12 Impact Factor
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    ABSTRACT: Background: Smoking is a major cardiovascular risk factor, and smoking cessation is imperative for patients hospitalized with a cardiovascular event. This study aimed to evaluate a systems-based approach to helping hospitalized smokers quit and to identify implementation barriers.Design: Prospective intervention study followed by qualitative analysis of staff interviews.Methods: The prospective intervention study assessed the effects of implementing standard operating procedures (SOPs) for the provision of counselling and pharmacotherapy to smokers admitted to cardiology wards on counselling frequency. In addition, a qualitative analysis of staff interviews was undertaken to examine determinants of physician and nurse behaviour; this sought to understand barriers in terms of motivation, capability, and/or opportunity.Results: A total of 150 smoking patients were included in the study (75 before and 75 after SOP implementation). Before the implementation of SOPs, the proportion of patients reporting to have received cessation counselling from physicians and nurses was 6.7% and 1.3%, respectively. Following SOP implementation, these proportions increased to 38.7% (p < 0.001) and 2.7% (p = 0.56), respectively. Qualitative analysis revealed that lack of motivation, e.g. role incongruence, appeared to be a major barrier.Conclusions: Introduction of a set of standard operating procedures for smoking cessation advice was effective with physicians but not nurses. Analysis of barriers to implementation highlighted lack of motivation rather than capability or opportunity as a major factor that would need to be addressed.
    European journal of preventive cardiology. 09/2012;
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    Canadian Medical Association Journal 09/2011; 183(15):E1135-50. · 6.47 Impact Factor
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    ABSTRACT: Background: The CardioFit internet-based expert system was designed to promote physical activity in patients with coronary heart disease (CHD) who were not participating in cardiac rehabilitation. Design: This randomized controlled trial compared CardioFit to usual care to assess its effects on physical activity following hospitalization for acute coronary syndromes. Methods: A total of 223 participants were recruited at the University of Ottawa Heart Institute or London Health Sciences Centre and randomly assigned to either CardioFit (n = 115) or usual care (n = 108). The CardioFit group received a personally tailored physical-activity plan upon discharge from the hospital and access to a secure website for activity planning and tracking. They completed five online tutorials over a 6-month period and were in email contact with an exercise specialist. Usual care consisted of physical activity guidance from an attending cardiologist. Physical activity was measured by pedometer and self-reported over a 7-day period, 6 and 12 months after randomization. Results: The CardioFit internet-based physical activity expert system significantly increased objectively measured (p = 0.023) and self-reported physical activity (p = 0.047) compared to usual care. Emotional (p = 0.038) and physical (p = 0.031) dimensions of heart disease health-related quality of life were also higher with CardioFit compared to usual care. Conclusions: Patients with CHD using an internet-based activity prescription with online coaching were more physically active at follow up than those receiving usual care. Use of the CardioFit program could extend the reach of rehabilitation and secondary-prevention services.
    European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 09/2011; · 2.51 Impact Factor
  • Robert D Reid, Kerri A Mullen, Andrew L Pipe
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    ABSTRACT: Constituents of tobacco smoke are prothrombotic and atherogenic and causative factors in the development of coronary heart disease (CHD). Smoking cessation is the single most important intervention to reduce morbidity and mortality in smokers with CHD. This review presents contemporary information regarding treatments for smoking cessation in the setting of CHD. The beneficial effects of smoking cessation may be mediated by improvements in endothelial function. Failure to quit smoking in those with CHD is a typical consequence of nicotine addiction. Practical counseling and pharmacotherapy [nicotine replacement therapy (NRT), bupropion, and varenicline] are well tolerated and effective treatments for CHD patients attempting to quit smoking. Treatments initiated in hospital following a CHD-related event or procedure are more effective than those initiated outside the hospital setting. Extending medication use beyond the initial treatment phase is the most promising means of preventing relapse. Financial coverage for smoking cessation pharmacotherapy improves quit rates. The routine provision of pharmacotherapy and practical counseling in the CHD setting can be assured by implementing proven, systematic approaches to smoking cessation treatment. Smoking cessation is a fundamental priority in smokers with CHD. Systematic approaches to ensure that cessation assistance is provided by clinicians and to improve cessation outcomes for smokers are effective and available.
    Current opinion in cardiology 09/2011; 26(5):443-8. · 2.66 Impact Factor

Publication Stats

720 Citations
201.66 Total Impact Points

Institutions

  • 1991–2014
    • University of Ottawa
      • Department of Medicine
      Ottawa, Ontario, Canada
  • 2011
    • Universitätsmedizin Göttingen
      • Department of Cardiology and Pneumology
      Göttingen, Lower Saxony, Germany
  • 2010
    • University of Waterloo
      • Faculty of Applied Health Sciences
      Waterloo, Quebec, Canada
  • 1991–1995
    • The Ottawa Hospital
      • Department of Surgery
      Ottawa, Ontario, Canada