Leading Through Innovation

Cutting Heart Attack Deaths: STEMI Heart Attack Program

STEMI (ST-Elevated Myocardial Infarction) is one of the deadliest forms of heart attack and opening a patient’s blocked arteries as soon possible is critical to survival. Recognizing the critical need for timely care, Michel Le May, MD, and his colleagues pioneered a city-wide STEMI protocol in Ottawa that now coverers the whole eastern Ontario region. When a person suffering chest pain calls 9-1-1, a crew of advanced care paramedics is immediately dispatched. These squads are trained to diagnose a STEMI in the field and transport these patients directly to the Heart Institute. A specialized cardiology team is on call 24-7 to treat these “code STEMIs.”

Impact:

• Reduced heart attack deaths in the region by 50%
• Published in the New England Journal of Medicine
• Hospitals across Canada now using the Heart Institute’s STEMI model to develop their own protocols

Powerful Program for Quitting Smoking: The Ottawa Model

Quitting smoking is the single most important thing a person can do to improve their heart health. Since 2002, the Ottawa Model for Smoking Cessation (OMSC) has specifically tar­geted smokers admitted as inpatients. The program ensures all patients who smoke are identified and offered evidence-based counseling and smoking cessation medi­cations. The program’s success rate is unparalleled, with 44% of participants remaining smoke free for six months or longer. The Ottawa Model now offers options for outpatient and primary care settings.

Impact:

• Implemented in more than 350 healthcare settings across Canada and adopted internationally
• More than 125,000 smokers treated through the OMSC Network
• Identified as a Leading Practice by Accreditation Canada

Reducing Heart Failure Readmissions: Cardiac Telehome Monitoring

Using home monitoring systems, heart failure patients transmit vital medical data, such as weight and vital signs, daily to the Heart Institute. Data indicating a potential problem or need for more information is flagged by nurses, who call patients immediately. Telehome monitoring helps patients stay healthy and improves access to specialized cardiac care across the Champlain Region and throughout Ontario and Canada.

Impact:

• Reduced hospital readmission of heart failure patients by 54%, saving up to $20,000 for every patient diverted from an emergency visit or a hospital stay 
• Reached over 2,000 patients and is the largest acute home monitoring program of its kind in the country
• Identified as a Leading Practice by Accreditation Canada

Safe Fitness Options: Heart Wise Exercise

The Heart Wise Exercise (HWE) program works with fitness providers to identify and develop programs and classes that are safe and appropriate for people graduating from cardiovascular or other rehabilitation programs, as well as those at risk of developing a cardiovascular or chronic health issue. The program began in the Ottawa region in 2007 and has since broadened its mandate to other chronic health conditions—particularly stroke and diabetes—and is now available across much of Ontario.

Impact:

• Now number more than 230 programs province-wide and reach more than 12,500 Ontarians
• In partnership with KidActive, the National Capital YMCA and the Cardiac Health Foundation of Canada, received several grants from the Ontario Trillium Foundation to help grow the program throughout Ontario

Changing the Standard of Care for Heart Failure: The RAFT Trial

Traditionally, therapeutic implants are employed mainly for patients suffering serious heart failure. The RAFT trial was one of the largest, most extensive worldwide investigations into heart failure. Led by researchers at the Ottawa Heart Institute, the study showed conclusively that use of an implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) in patients with mild and moderate heart failure strengthens a fading heartbeat and reduces the risk of death.

Impact:

• Has led to changes in standard practice and improved outcomes for patients with mild to moderate heart failure worldwide
• Received the Canadian Institutes of Health Research and the Canadian Medical Association Journal Top Achievements in Health Research Award in recognition of its significant benefits to patients 

First Point-of-Care Genetic Test: RAPID GENE

Clopidogrel is a drug widely given to patients with stents to prevent blood clots. However, a significant portion of the population carries a common genetic variation that prevents proper metabolizing of the drug. For emergency stent procedures, this can lead to dangerous outcomes, even death. A team led by cardiologist Derek So, MD, developed the RAPID GENE bedside genetic test to quickly identify these individuals.

Impact:

• The world’s first bedside genetic test, giving physicians and nurses the ability to conduct genetic screening in a clinical setting
• Published in The Lancet, the world’s leading medical journal

Minimally Invasive Cardiac Bypass Surgery

In standard coronary artery bypass graft­ing, the surgeon must make a 25-centi­metre incision in the chest—large enough to place a hand through—and crack several ribs.  Marc Ruel, MD, Chief of Cardiac Surgery at the University of Ottawa Heart Institute, and his colleague Joseph McGinn, MD, of Staten Island University Hospital, introduced an innovative technique in 2005 called minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG). MICS CABG requires only a tiny 4-centimetre “window” incision between two ribs. The surgeon then uses special tools to gently rotate the heart to bring each artery requiring grafting into view.

Impact:

• Recovery times and activity restrictions for patients who undergo MICS CABG are shorter and infection rates of the incision wound are much lower
• Dr. Ruel travels internationally to teach the specialized technique
• Of particular interest to doctors in developing countries where less invasive techniques and quick recovery times are a priority

Leading the Way in Patient Safety: Radiation Reduction

Modern imaging technologies, including CT (computed tomography), SPECT (single-photon emission computed tomography), and PET (positron emission tomography) allow doctors to visualize the heart in great detail without invasive procedures. However, many of these technologies expose patients to a small dose of radiation. The Heart Institute is setting new standards for the targeted and limited use of radiation in medical imaging by dramatically reducing patient exposure across its array of cardiac imaging tests.

Impact:

• Reduced radiation exposure for CT to about a third of what it once was
• Has shown that radiation exposure for cardiac PET scans can be cut in half for a significant number of individuals

Most Significant Known Genetic Risk Factor: 9p21

In 2007, Heart Institute researchers discovered a common genetic variant that increases the risk of heart disease independently of other known risk factors such as cholesterol, blood pressure, diabetes or smoking. Three quarters of the population has at least one copy of the 9p21 risk variant. Those that carry two copies (about 25% of the population) have a 30 to 40% higher risk of heart disease than those individuals with none.

Impact:

• The most significant genetic variant for increasing an individual’s risk for coronary artery disease even when compared to known risk factors
• Researchers throughout the world now focusing on 9p21, trying to understand how it works
• May one day lead to new drugs for the prevention or treatment of coronary artery disease

An Unknown Mechanism for Cholesterol Metabolism

Cholesterol accumulates in the walls of arteries leading to atherosclerosis (coronary artery disease), which causes blockages, reducing blood flow to the heart, and often culminates in heart attacks and strokes. A research team at the University of Ottawa Heart Institute, led by biochemist Yves Marcel, discovered a new function for a known cellular pathway: mobilization and export of cholesterol. The newly discovered function is part of a pathway known as autophagy. The team found that the autophagy process also functions as a pathway to engulf and digest cholesterol accumulated in artery walls.

Impact:

• Deepens our understanding of the underlying biochemical processes related to a leading cause of death
• Points to a potential new therapeutic target for treating the primary cause of heart attack and stroke

International Leader in High-Impact Research

The 2014 global ranking of research organizations from Scimago Institutions Rankings (SIR) has placed the Heart Institute 59th out of 4,851 institutions worldwide, across all fields of study. In Canada, the Institute placed fourth out of the 103 ranked Canadian organizations and was the top cardiac centre. The SIR report measures an institution’s global research impact independent of its size.

Impact:

• Recognized internationally for producing influential research that expands the knowledgebase and changes the way that cardiovascular medicine is practiced