OHRI

Saturday, July 31, 2010

Graham Nichol, MD, MPH, FRCP(C)
gnichol@ohri.ca

Not available (see Contact page for maps)

Affiliate Investigator, Clinical Epidemiology, Ottawa Hospital Research Institute

Associate Professor, Departments of Medicine and, Epidemiology and Community Medicine

Research Interests

Decision Analysis

Cardiac Drugs and Devices

Sudden Cardiac Arrest

Quality of Life

Economic Analysis

Major Research Activities

Dr. Nichol has focussed his career on the application of decision analysis to the evaluation of cardiac drugs and devices, and to quantitative health policy analysis.

Critical Pathways.

Dr. Nichol completed a collaborative study which involved the development and evaluation of an evidence-based critical pathway for management of patients with acute chest pain at low risk for myocardial ischemia. These critical pathways define and manage the timing and sequence of the rate-limiting steps in the process of providing health care to improve patient outcomes, and to permit physicians to be much more efficient in their use of tests and treatments and thereby significantly reduce health care costs. Using the same methodology, Dr. Nichol has derived a critical pathway for congestive heart failure. Decision analysis was used to evaluate the relative importance of different possible outcomes, such as death or admission to hospital. Then the ranking of these outcomes was used to choose which tests and treatments should be incorporated into the pathway. He is now heading a study to prospectively evaluate the effect of the pathway on clinical outcomes, resource use and costs.

Therapy for Cardiac Arrest. Dr. Nichol previously completed a collaborative study which used meta-analysis and decision analysis to evaluate the effectiveness and cost-effectiveness of treatments for out-of-hospital cardiac arrest. This analysis confirmed that treatments for out of hospital cardiac arrest are expensive and are not very effective. He is now incorporating more recent evidence into the meta-analysis and cost-effectiveness analysis so as to provide more current and precise estimates of the effectiveness of treatment. (Funded by Ontario Ministry of Health.)

Antiarrhythmic Drugs. Using the same methodology as above, he is using meta-analysis to evaluate the effectiveness of antiarrhythmic drugs in atrial fibrillation. He is concurrently using decision analysis to evaluate the cost-effectiveness of antiarrhythmic drugs in atrial fibrillation.

Future Research:

He will use decision analysis to evaluated the effectiveness and cost-effectiveness of other cardiac drugs and devices. He will also continue to evaluate use of health care need to value health and to balance health care costs versus quality of life.

Major Awards

Grants:

Institute for Clinical Evaluative Sciences in Ontario 1997-1998
Heart Institute Research Foundation 1997-1999
Heart and Stroke Foundation of Canada 1998-1999
Canadian Health Services Research Foundation, Ontario Ministry of Health,
Emergency Health Services 1998-2000
National Heart Lung Blood Institute 1999-2004
Canadian Institute for Health Research 2000
Canadian Institute for Health Research 2000-2001
Laerdal Research Foundation 2000-2001
Heart and Stroke Foundation of Canada 2000-2002
Network of Centers of Excellence 2000-2003
Medical Research Council of Canada 2000-2003
Heart and Stroke Foundation of Canada 2000-2003
Canadian Institute for Health Research 2001
World Health Organization 2001 – 2002
Canadian Institutes of Health Research 2002-2003
Canadian Institutes of Health Research 2002-2005
Canadian Institutes of Health Research 2002-2007
The Agency for Healthcare Research and Quality 2002-2007

Recent Publications

Nichol G, Hallstrom A, Ornato J, Riegel B, Stiell IG, Valenzuela T, Wells G, Weisfeldt ML. Potential Cost-Effectiveness of Public Access Defibrillation in the United States. Circulation 1998; 97(13): 1315-1320

Cummins RO, Hazinski MF, Kerber RE, Kudenchuk P, Becker L, Nichol G, Malanga B, Aufderheide T, Stapleton E, Kern K, Ornato JP, Sanders A, Valenzuela T, Eisenberg M. Low-Energy Bipahsic Waverform Defibrllation: Evidence-based Review Applied to Emergency Cardiac Care Guidelines. A Statement for Healthcare Professionals From the American Heart Association Committee on Emergency Cardiovasculare Care and the the Subcommittees on Basic Life Support, Advanced Cardiac Life Support, and Pediatric Resuscitation. Circulation 1998 97(16):1654.

Riegel B, and the AHA Automatic External Defibrillator Task Force. Training Nontraditional Responders to Use Automated External Defibrillators. American J Critical Care 1998; 7(6):402-410.

Nichol G, Green M. Commentary on "Cardioversion followed by aspirin alone or with amiodarone was cost-effective for nonvalvular atrial fibrillation" Evidence-Based Medicine 1999;4(1):30. Comment on Eckman MH, Falk PH, Pauker SG. Cost-effectiveness of therapies for patients with nonvalvular atrial fibrillation. Arch Intern Med 1998;158:1669-77.

Nichol G, Kerber R, Moss AJ, Ornato J, Palmer D, Riegel B, Smith S Jr, Weisfeldt ML. American Heart Association Report on the Second Public Access Defibrillation Conference. April 17-19, 1997. Circulation 1998; 97(13): 1309-1314

Nichol G, Stiell IG, Hebert P, Wells G, Vandemheen K, Laupacis A. What is the Quality of Life of Survivors of Cardiac Arrest? A Prospective Study. Academic Emergency Medicine 1999;6:95-102.

Man-Son-Hing M, Nichol G, Lau A, Laupacis A. Choosing antithrombotic therapy for elderly persons with atrial fibrillation who are at risk for falls. Arch Intern Med 1999;159:677-685.

Stiell IG, Wells GA, Spaite DW, Nichol G, Munkley DP, Field BJ, Lyver MB, Luinstra LG, Dagnone E, Campeau T, Ward R, Anderson S For The OPALS Study Group. The Ontario Prehospital Advanced Life Support (OPALS) Study Part II: Rationale and Methodology for Trauma and Respiratory Distress Patients. Annals of Emergency Medicine. 1999;34:256-262

Nichol G, Stiell IG, A Laupacis A, Pham B, De Maio V, Wells GA. A Cumulative Metaanalysis of the Effectiveness of Defibrillator-Capable Emergency Medical Services For Victims Of Out-Of-Hospital Cardiac Arrest. Ann Emerg Med. 1999;34(4):517-525.

Anonymous. 31st Betheseda Conference on Emergency Cardiac Care J Amer Coll Cardiol 1999;35(4):825-80. [Coauthor].

Anonymous. American Heart Association Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2000;102(suppl I). [Coauthor].

Valenzuela T, Roe DJ, Nichol G, Clark L, Spaite DW, Hardman RG. Rapid Defibrillation by Security Officers After Cardiac Arrest in Casinos. N Engl J Med 2000; 343:1206-9.

Nichol, G. The International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Can J Cardiol. 2000 Oct;16(10):1209-10. [co-author]

Weil MH, Becker L, Budinger T, Kern K, Nichol G, Shechter I, Traystman R, Wiedemann H, Wise R, Weisfeldt M, Sopko G. WORKSHOP EXECUTIVE SUMMARY REPORT: Post-Resuscitative and Initial Utility in Life Saving Efforts (PULSE) Circulation 2001; 103:1182-1184.

LeMay MR, Labinaz M, Richard FA, Davies RF, Marquis JF, Laramee LA, O'Brien ER, Williams WL, Beanlands RS, Nichol G, Higginson LA. Stenting versus thrombolysis in acute myocardial infarction trial (STAT). J Am Coll Cardiol 2001; Vol. 37(4):985-991.

Jacobs I, Callanan V, Nichol G, Valenzuela T, Mason P, Jaffe AS, Laundau W, Vetter N; American Heart Association; International Liaison Committee on Resuscitation. The Chain of Survival. Ann Emerg Med 2001; 37 (Suppl 4): S5-16.

Weil MH, Becker L, Budinger T, Kern K, Nichol G, Shechter I, Traystman R, Wiedemann H, Weisfeldt M, Sopko G. WORKSHOP EXECUTIVE SUMMARY REPORT: Post-Resuscitative and Initial Utility in Life Saving Efforts (PULSE) Crit Care Med 2001; 29(4):878-9.

Neilipovitz DT, Bryson GL, Nichol G. The Effect of Perioperative Aspirin Therapy in Peripheral Vascular Surgery: A Decision Analysis. Anesthesia & Analgesia 2001; 93(3):573-80.

Beanlands RS, Ruddy TD, Freeman M, Nichol G. Patient Management Guided by Viability Imaging. JACC 2001; 38(4): 1271-1272.

Carrico CJ, Holcomb JB, Chaudry IH and PULSE Trauma Work Group. Scientific Priorities and Strategic Planning for Resuscitation Research and Life Saving Therapy Following Traumatic Injury: Report of PULSE Trauma Work Group. SHOCK 2002; 17(3):165-168.

Nichol G, McAlister F, Pham B, Laupacis A, Shea B, Green M, Tang ASL, Wells G. Meta-analysis of Randomized Controlled Trials of the Effectiveness of Antiarrhythmic Agents at Promoting Sinus Rhythm in Patients with Atrial Fibrillation. Heart 2002; 87(6):535-543.

Becker LB, Weisfeldt ML, Weil MH, Budinger T, Carrico J, Kern K, Nichol G, Shechter I, Traystman R, Webb C, Wiedemann H, Wise R, Sopko G. The PULSE Initiative. Scientific Priorities and Strategic Planning for Resuscitation Research and Life Saving Therapies. Circulation 2002; 105:2562-2570.

Beanlands RSB, Nichol G, deKemp R, Ruddy T, Iwanochko RM, Coates G, Freeman M, Nahmias C, Hendry P Burns R, Lamy A, Mickleborough L, Kostuk W, Fallen E, and the PARR Investigators. PET and Recovery following Revascularization (PARR-1): The Importance of Scar and the Development of a Prediction Rule for the Degree of Recovery of LV Function. J Am Coll Cardiol 2002;40(10):1735-1743

Kajbaf S, Nichol G, Zimmerman D. Cancer Screening and Life Expectancy of Canadian Patients with Kidney Failure. Nephrol Dial Transplant 2002; 17:1786-1789.

Beanlands, RS, Nichol G and the PARR 2 Investigators. PET and Recovery Following Revascularization (PARR-1): The Importance of Scar and the Development of a Prediction Rule for the Degree of Recovery of LV Function. JACC 2002; 40: 1735-43. Editorial: JACC 2002; 40: 1744-47.

Knoll G, Nichol G. Dialysis, Kidney Transplantation or Pancreas Transplantation for Patients with Diabetes Mellitus and Renal Failure: A Decision Analysis of Treatment Options. J Am Soc Nephrol 2003; 14 (2): 500-515.

The PAD Investigators. Public Access Defibrillation Trial Rationale and Design (Member of Writing Committee). Resuscitation 2003; 56 (2): 135-147.

Nichol G, Valenzuela T, Roe D, Clark L, Huszti E, Wells G. Potential Cost-effectiveness of Defibrillation in Public Settings in the United States. Circulation. In Press.