CARDIAC HEALTH FDN BULLETIN FALL EDITION Issue #7

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Cardiac Health Fdn Bulletin

FALL Edition

Volume 7

PREVENTION, EDUCATION & CARDIOVASCULAR REHABILITATION ISSUE 7

Welcome to the seventh edition of the bulletin! We dedicate this bulletin to our Founder, The Father of Cardiac Rehabilitation, Dr. Terry Kavanagh, who died in his sleep at home as a result of complications from scalp cancer. He has left us an incredible legacy that has transformed lives and helped to heal damaged hearts. An announcement of his contribution and the celebration of his life that was held on October 4th is on our website www.cardiachealth.ca. We hope the format and information that we will share with you are interesting and motivational in encouraging you and loved ones to adopt a healthy lifestyle. We also hope to inspire you to become involved in your local Walk of Life programs and to advocate for access to cardiovascular rehabilitation. One of our goals includes strengthening our network by enlisting your support and feedback on our activities. We encourage you to share this Bulletin with patients, family, friends and colleagues.

We also encourage you to send us news on activities, research and patient/client challenges in accessing cardiac rehabilitation, treatment services, or other challenges currently confronting your programs. Feel free to send us email

addresses of individuals who wish to receive the Bulletin or would like to become more involved with the Cardiac Health Foundation of Canada. Join through our website or send details to Christina Mellos, our Operations Manager, at cmellos@cardiachealth.ca.

Within this edition we will focus on the GTA Walk of Life, highlights from the National Walk of Life across Canada, provide an overview of the Ontario Trillium Foundation Project submitted jointly with the Children’s Hospital of Eastern Ontario, news from Cardiac Corner, highlights on the National Office activities along with some heart healthy recipes.

GTA Walk of Life

Our 34th Walk of Life held on May 26th at the Ontario Science Centre with our partners, Cardiac Kids in support of Sick Kids Foundation, Canadian Congenital Heart Alliance, The Mikey Network, and the University of Toronto Dr. Terry Kavanagh Heart Health Lab was another huge success. We wish to thank our Sponsors, the many Volunteers, the Mascots including Paw Patrol (Marshall & Rubble), our host Roger Petersen co-host of CityTV’s Breakfast Television, Toronto EMS, Toronto Police Service,

Andrew Beg & The Honey Tones, the Ontario Science Centre and the walkers, runners, chair exercisers who in combination made this a fabulous fun filled family affair!

We want to highlight the efforts of Brian Blair our Bagpiper who once again led the walkers and runners through the starting gate that was provided by the Running Room and arranged through George W. Hubbard. We salute George and his volunteers from Long-Boat Roadrunners Club along with student volunteers who set up and monitored both the runners and the walking courses for participants. These contributions add incredible value to this fun filled family event.

Kids Fun Run at the 2018 Walk of Life

______________________________________Editor: John Sawdon

Digital Design & Layout: Christina Mellos Executive Director: Sarah Smith

WELCOME to the 7th edition! Walk of Life 2018

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Brian has maintained a commitment to supporting Cardiovascular rehabilitation for many years, as has Roger Petersen who has been our host for the last 8 years. We are grateful for their contribution to this charitable cause that was started by Dr. Terry Kavanagh and his wife Johanna.

The attendees were once again greeted by the more than 100 volunteers who staffed the registration booths, the breakfast table, who set up route signs, markers, organized water and the tribute board. For the third year in a row Stephenson’s Rental provided the Tribute boards, the tables, the stage, chairs and the fencing that enabled us to create some separation for our event. The Tribute Wall allows walkers/runners and family members to honour someone who has been impacted by Heart Disease. It could be a private message or an acknowledgement of someone who has provided the motivation for walking.

As usual the staff of the Ontario Science Centre was incredibly helpful in assisting with the setup for the Walk of Life 2018. We salute our Board member’s team from Urban Poling who organized the Kids Fun Run which witnessed high enthusiasm, lots of giggles and proud parents. Diana Oliver, one of the principals of Urban Poling provided medals for the children and also organized the Chair exercises with Seniors who utilized Nordic poles within their exercise routines.

We were privileged to once again enjoy incredible food provided by our sponsors. The Real Canadian Superstore at Eglinton and Don Mills Road under Rod Costa provided apples, bananas, and water; Marigolds & Onions provided gourmet coffee; while LARABAR provided Fruit & Nut energy bars. Maple Lodge Farms handled lunch with an incredible selection of chicken dogs, spicy & smokies. Families once again enjoyed the bouncy castles and slides, and

the Toronto Police Service who allowed the children to serenade the neighbourhood.

We would be remiss if we did not single out Toronto EMS who provides volunteer paramedics to watch over our health needs. We applaud this contribution including the large contingent of walkers and runners who once again turned out to support the Mikey Network. Herity Homes President Hugh Heron, has sponsored this life saving charity that provides Mikeys (AED) to children and individuals with failing hearts. We salute your efforts in addition to our other partners who provided tents and also organized walkers and runners to support their causes. This includes the Canadian Congenital Heart Alliance, Cardiac Kids, and the U of T Dr. Terry Kavanagh Heart Lab.

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This year Innovicares.ca which provides drugs cards in accessing brand name medications provided green goody bags for all participants along with news about signing up for their cards. BMO provided pens, while Tridel provided cell phone pop sockets. Boehringer Ingelheim & Eli Lilly also inserted a card to direct people to myheartmatters.ca in explaining the link between diabetes and cardiovascular disease. Cardiac Kids arranged for spinners to be inserted, while Rogers, the Printing House and catchheartdiseaseearly.ca all added paper inserts. We thank all of the sponsors who contributed to these handouts for our participants.

Our top fundraiser for 2018 was again Irving Buchbinder who raised $11,460. We are both grateful and indebted to Irving and his family who has now raised over $153,000 during the last 18 years. We also extend a heartfelt thank you to BMO’s Corporate Team who was again Corporate Champions with $12,400 raised. These funds will assist us to support Cardiac Rehabilitation Programs across Canada including the Exercise Medicine Room & Cardiac Rehab Program at the Hospital for Sick Children. We thank our Sponsors, the walkers/runners, and the many volunteers for your efforts in supporting cardiac rehabilitation programs across Canada that continue to heal diseased hearts.

For more pictures, please visit our website, www.walkoflife.ca, or facebook page.

National Sponsors: Tridel, BMO Bank of Montreal, Great-West Life/London Life/Canada Life, LIUNA Local 183, The Printing House, The Mikey Network, The Brand Factory. National Educational Sponsors: Amgen, Boehringer Ingelheim-Lilly Diabetes Alliance.

Special Event Sponsors: Rogers Communications, Chartwell Retirement Residences, Toro Aluminum. Local Sponsors: Stephenson’s Rental, Maple Lodge Farms, Real Canadian Superstore Don Mills, Marigolds & Onions, Kidomo Inc, Spin Master Ltd, Media Planet, InnoviCares, Travelers Canada, Dorsay Development Corp, Cervini Painting & Decorating, Mr. Marble, Litemode, RBC Royal Bank, Sigmund Soudack & Associates, Kirkor Architects, Graziani & Corazza Architects Inc, Herity, Urban Poling, Freeman & Peter Signs, Del Property Management, Del Condominium Life, Chairman Mills, Cardiac Safe City, and The Running Room. Special Contributors: Ozz Electric, Ontario Science Centre, Dr. Terry & Johanna Kavanagh, Body & Soul Fitness, Bousfields Inc, Delmanor Communities, Deltera, Don Cameron, Gervais Party Rentals, Goodlife Fitness, Jones Brown Insurance, Larabar, Longboat Roadrunners Club, Pizza Nova, Toronto EMS, Toronto Police Service (Motor Squad, Mounted Unit, 54 Division), Travers Communications.

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This is the second year I have written to programs asking for pictures and/or articles about their WALK OF LIFE events held across Canada. Although the GTA Walk of Life is large, we have 25 Walk of Life events that were held across Canada by cardiac rehabilitation programs. The pictures which follow provide some insights into the volunteering efforts of programs in organizing their Walk of Life events. I thank you for sending us these pictures, and congratulate you, your staff, your volunteers and the hundreds of walkers and runners supporting your programs across Canada! Your mission to heal damaged hearts makes all Canadians proud.

Walk of Life – Sept 29th, Upper River Valley Cardiac Rehab in Waterville, NB

Walk of Life – Sept 16th, Cape Breton Heart & Lung Wellness Centre in Membertou, NS

Walk of Life – June 2nd, Clinique de Readaptation cardiaque de Hotel Dieu St. Joseph in Saint-Quentin, NB

National Walk of Life Campaign 2018

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Left to right: Dr. Patricia Longmuir, Denise Melo, Kevin Moncion & Tyler Kung

On September 10th, 2018 at the age of 91, Dr. Terry Kavanagh died in his sleep at home from complications from scalp cancer. As the founder of this organization and the Father of Cardiac Rehabilitation, Dr. Kavanagh touched the lives of thousands of people around the world in providing hope that one could recover from a Heart Attack and or serious intervention including Bypass Surgery, Percutaneous Coronary Intervention, and Valve Surgery among other heart disease procedures.

In 1973, he trained 7 Heart Attack survivors who ran in and completed the Boston Marathon. If that accomplishment were not sufficient to change the worlds thinking about Heart Disease, in 1985 he then trained a Heart Transplant survivor to also run and complete the Boston Marathon. This individual lived for 33 years after his transplant. These two examples underscore the contribution of Dr. Terry Kavanagh to the world and to those of us who have experienced Heart Disease and subsequently attended Cardiac Rehabilitation.

On September 1st, 2017, the Cardiac Health Foundation of Canada in partnership with the Children’s Hospital of Eastern Ontario (CHEO) applied for and was approved for SEED funding grant from the Ontario Trillium Foundation in the amount of $71,700 to “assess Physical activity in Paediatric Cardiomyopathy Patients”. The announcement of this grant was made at the Hospital for Sick Children with MPP John Fraser who was at that time, assistant to Minister of Health on hand to represent the Provincial Government in addition to being the MPP for Ottawa region in which CHEO is located. (In fact, for those who do not know, John Fraser has been given credit for keeping the cardiac unit at Children’s Hospital of Eastern Ontario open). The principals involved in this study for CHEO were Patricia Longmuir, PhD, a scientist supervisor of the project, and Kevin Moncion, who was

On October 4th, a Celebration of Dr. Kavanagh’s Life was held at the Mount Pleasant Funeral Centre in Toronto. Robin Campbell of the University of Toronto and a long-time colleague and friend served as moderator and host. Among those speaking and paying tribute to Dr. Kavanagh were Bruce Avery, Vice President of the Cardiac Health Foundation of Canada spoke on behalf of the President Leo DelZotto, Professor Jack Goodman, Director of Dr. Terry Kavanagh Heart Health Lab at U of T, Jack spoke on behalf of Professor Roy Shepherd the previous department head at U of T; Professor Larry F. Hamm, George Washington University, Washington DC; Dr. John Schaman, Ontario Aerobics Center; and Quentin Broad, Managing Director Capitalize for Kids who spoke on behalf of the family.

A more complete overview of the history can be found on our website www.cardiachealth.ca.

completing his Master’s degree at the University of Ottawa and was attached full time in coordinating the project.

This particular project ran from September 1st, 2017 to September 30th, 2018. On August 15th, I drove to Ottawa to interview Kevin and Patricia on their learning’s and achievements in assessing physical activity and capacity of children/adolescents with cardiomyopathy. I learned that this project is intended to respond to gaps in the research literature on exercise capacity of children with cardiomyopathy. This project was designed to answer the following questions: a) Are children / adolescents with cardiomyopathy active? b) What is their capacity to be active? c) What activities are these children/ adolescents doing? d) What causes these children/ adolescents to not be active? e) Do

The Field of Cardiac Rehabilitation & the Cardiac Health Foundation has lost a legend

Ontario Trillium Foundation, Cardiac Health Foundation of Canada & Children’s Hospital of Eastern Ontario collaboration on assessment of “Physical Activity in Paediatric Cardiomyopathy Patients”

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these children/adolescents have physiological limitations and/or other barriers that might limit their physical activity?

I learned that Cardiologists serving these children often do not know what these children/adolescents are doing in terms of physical activities. When asked Parents often indicate “she/he is always active” “they never stop”. When pressed on this, we learned from the literature that most of us overestimate activity by between 20 to 40%. If we think of playing soccer for instance, a normal soccer game is usually an hour and half. If we place an activity monitor on a child, we might find they were active for approximately 15 minutes. This study which was approved by the Children’s Hospital of Eastern Ontario (CHEO) Research Ethics Board and the University of Ottawa Research Ethics Board and signed off by parents included a screening for eligibility by all paediatric cardiomyopathy patients from CHEO. Children were included if they were between 5 and 17 years of age and had one of the following criteria: a) a medical diagnosis of Hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), or chemotherapy induced cardiomyopathy (CCM); b) carrying a genetic risk for cardiomyopathy without current evidence of disease known as genotype-positive phenotype negative for HCM (G+P-); or c) children with congenital heart defect having repaired atrial septal defect (ASD) or ASD not requiring repair. Recruitment and data collection occurred between March and August 2018. In total 45 potential participants were identified with 40 deemed eligible resulting in 22 participants being deemed ineligible. This left 18 participants until the end of July, and fortunately with two more individuals completing assessments in August for a total of 20 children/ adolescents.

In terms of the actual project design, each participant was asked to wear an accelerometer for all waking hours for 7 consecutive days. Each participant was also given a physical activity log to record periods of accelerometer removal. To be considered valid each child had to wear an accelerometer for 10 hours a day for a minimum of three days. Each child also had to complete an ECG, heart rate, blood pressure, and were fitted with rubber mouthpiece for breath by breath analysis of metabolic variables such as oxygen (Vo2) and respiratory exchange (RER) while siting for 10 minutes. All participants then completed a treadmill walking exercise process. This started with a warm up, and three 5-minute bouts of exercise with workload designed to achieve 40%, 60% and 80% of estimated maximum heart rate. There was a rest period

between each exercise stage with a 2-minute cool down period at the end of the test.

The third segment of the project involved the completion of semi structured interviews in identifying barriers to physical activity and or exercise. Only ten participants were interviewed, 5 with cardiomyopathy and 5 with G+P- who are at risk for cardiomyopathy.

Children and adolescents with cardiomyopathy and/or severe disease often have parental and teacher restrictions placed on them that restrict physical activity. Children/adolescents often report being out of breath, fear of injury or cannot keep up with their friends which then lead to a lack of confidence in their ability to engage in physical activity. We also discovered that most children have restrictions which limit involvement in gym class. I then asked the question what did you learn personally, professionally and in response to the questions you were attempting to answer during your project.

Personal Learning: Kevin replied that he learned lots about himself and how to plan and allocate time for a project of this nature. I learned to work with a team and to adjust to demands of other units that I worked with in which I had little control. I learned about assessing exercise. My school courses did not prepare me for this, kids are very nervous and parents are also anxious. I realized you had to make people comfortable. I have coached in the past and those experiences helped me to relate to the children. I learned that giving everyone the questionnaire helps to reduce the anxiety. It gives them something to focus on while keeping their hands busy.

Learning about the children: during the testing, the children were very anxious about the mouthpiece and the treadmill. As we started the tests and interacted with the children, they moved from being shy, highly anxious to grabbing the side rails, to relaxing and then to having fun. Most of them wanted to do more.

What was the take away for parents and children from this project? The children/ adolescents and their parents came to the conclusion this was not hard. One individual, who could not do their last stress test, remarked that this was fun and I did better this time. All of the children completing the treadmill tests were leaving with considerably more confidence. The parents were somewhat skeptical about the testing initially. They also indicated they were concerned about day to day activities. When they go out to do activities, they take the automated defibrillator with them, this

action rather than eliciting confidence elicits fear and undermines the children’s self-confidence. Parents expressed enthusiasm about the study; often these parents have cardiomyopathy (HCM) and are limited in what they can do. One parent whose son has HCM indicated this study creates hope for both her son and herself. If we can get kids with cardiomyopathy to be active as kids, they are more likely to be active as adults. The key is identifying activities that are safe.

Learning’s about Children/Adolescents with Cardiomyopathy capacity to engage in physical activity: Participants with cardiomyopathy achieved on average 4.5 +_ 3.1 METS at a heart rate of 150 beat per minute. Since moderate physical activity is defined as 3-6 METS, children with cardiomyopathy may have capacity to perform a variety of sports and physical activity that are of moderate intensity. Moderate intensity exercising includes hiking, swimming, doubles tennis, Frisbee, and catch.

In summing up our interview, I asked what should we do in the future? The feedback is, we should conduct research with a larger pool of children/adolescents using multi-sites. We should take our learning from this project, expand an educational component and potentially approach the Ontario Trillium Foundation for a GROW grant for a three-year project. One of the learning’s emergent from this project was the realization that children/adolescents with cardiomyopathy are often excluded from physical activity which in effect isolates them at school. While there have never been any studies to assess this, this type of isolation can often set these children/adolescents up for bullying. By becoming involved in physical activity and exercise, we reduce the risk of these children/adolescents from developing comorbidities such as obesity, diabetes, hypertension, dyslipidemia and atherosclerosis. We also assist in their integration with others while reducing isolation and potential for bullying.

The Cardiac Health Foundation of Canada expresses our deepest appreciation to Children’s Hospital of Eastern Ontario, to Patricia Longmuir Scientist, Kevin Moncion Graduate student coordinating this project, to Denise Melo ECG Technician and Tyler Kung Exercise testing for enhancing our understanding of children/adolescent’s capacity to engage in physical activity and exercise. We look forward to working together again in addressing the challenges of exercise and physical activity of children/adolescents with cardiomyopathy.

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DEPRESSION AND HEART ATTACKS By: Dr. Shane Marshall

Do you get frustrated by all those pills you have to take? Maybe part of the reason is not understanding what the purpose of each is. A medication should benefit you in one of three ways - it should make you feel better (e.g. pain killers), it should prevent bad things from happening (in the way blood pressure pills prevent strokes), or it should lengthen life (in the way aspirin does after a heart attack). In doctor’s lingo we refer to these things as alleviating symptoms, preventing morbidity, and having a favorable mortality effect. Feel better, do more, live longer. In my experience, Bermudians don’t mind taking pills that make them feel better - they know what they’ve signed up for, and they can judge whether it works. They’re more skeptical when they’re prescribed pills to prevent some bad future-thing from happening, and more ambivalent still when you tell them the pill will make them live longer. I think some people interpret living longer as spending their last years with dementia or some other equally disabling disorder. No one wants that. If you’ve had a heart attack, chances are your cardiologist has prescribed a cocktail of medications that don’t make you feel better, but have been proven to prevent further heart attacks and lengthen life – some of these are the beta-blockers (for example, metoprolol, atenolol, and others), angiotensin receptor blockers (losartan, candesartan, and others), statins (atorvastatin, rosuvastatin - aka Lipitor and Crestor, etc.), and aspirin. That’s a lot to swallow.

Well, as of last month, another pill may be joining the cocktail. This one doesn’t make you live longer, but it makes you feel better and may prevent another heart attack. The good news is that, unlike the other cardiac cocktail pills, you don’t have to take it for years or forever. You only take it for 6 months, and there’s only one stipulation: you have to be depressed. The pill’s name is escitalopram. You may

know it as Lexapro. It’s a common antidepressant and it was used in a Korean study published in last month’s Journal of the American Medical Association. Dr. Jae-Min Kim and colleagues studied 300 patients with an acute coronary syndrome - that’s people who had a heart attack or came close to having one - who became depressed shortly after being diagnosed with their heart problem. Half were given citalopram for 6 months and half got placebo. If your mind is wandering because you think this is of little relevance to you, now’s a good time to pay attention! This wasn’t a study to see if an antidepressant would make post-heart attack patients less depressed, it was a study to see whether treating their depression could prevent future heart attacks. The researchers found that 6 months of an antidepressant reduced the likelihood of having another heart attack by 31%, and the benefit lasted up to 8 years. Eight years! That’s impressive. Just one little problem: I don’t know anybody who’s happy after a heart attack. So how do you tell if you’re just despondent or whether you’re clinically depressed? In the Korean study they used a questionnaire called the Beck Depression Inventory. It’s a 21-item multiple choice test about how you felt in the last week. It takes about 10 minutes. Each question has a 4-point response from 0 to 3 where 0 is no symptoms and 3 is severe symptoms, so the highest anyone can score is 63. If you scored higher than 10, you were referred to a psychiatrist who made you tick more boxes, this time using the Mini International Neuropsychiatric Interview (MINI). This confirmed or refuted the diagnosis and classified your depression as major or minor. If deemed officially depressed, you were enrolled in the study to receive either the escitalopram or the placebo. Seems like a lot of work. The fallout from this study is that suddenly cardiologists are asking lots of questions about depression. One obvious question is: how can taking an antidepressant for 6 months prevent heart attack for 8 years? Is it because if you’re depressed, you’re less likely to do your rehab so you don’t recover fully? Or maybe that pervasive “why bother?” Attitude means you start skipping your heart medications. Another reason may be the simple fact that, in addition to being an antidepressant, escitalopram is a gentle blood thinner and by boosting the blood-thinning effect of aspirin, it may help prevent a second heart attack. A second big question cardiologists are asking is: “Why me?” Cardiologists like to think about pumps, fuel, and electrics. But it’s also their job to make sure you receive all the cardiac cocktail components that could improve your prognosis. This creates a minor conundrum because many cardiologists feel there’s plenty to do with the heart without having to sort out whether the brain is coping, too. That’s why, immediately following the release of this study, one could hear a collective sigh emanating from cardiologists everywhere as they lamented, “Am I now supposed to be a shrink, too?” In addition to everything else – like, oh, I don’t know...SAVING LIVES – must I discuss... (pause here and wince) ...feelings? As one colleague put it, the news caused him to stare intently at the escitalopram samples on his desk, wondering if he, too, would soon need the drug.

Cardiac Corner

“…researchers found that 6 months of an antidepressant reduced the likelihood of having another heart attack by 31%”

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For now, it’s worth noting that this was just one study, done in Korea, and it needs to be repeated before becoming standard practice. But until then, it at least has cardiologists talking about depression. Undoubtedly, we’ll need the help of family doctors and psychiatrists, but now, more than ever, we have good reason. The escitalopram heart/brain study supports something I think many have suspected for a long time: there’s a special connection between the heart and brain. They’re like a little old married couple, and we have to make sure that both are looked after if the individuals are to thrive. But to me, the most intriguing thing about this study isn’t the heart/brain connection, it’s whether the findings might be applicable to other diseases. Imagine, for example, if the same study was done in patients with newly diagnosed cancer, and if identifying and treating their depression resulted in a 31% higher cure rate. In addition to blowing the “escitalopram prevents heart attacks because it’s a blood thinner” hypothesis out of the water, this news would have every oncologist diligently screening their patients for depression. As for cardiologists, until now we’ve not been at the forefront of diagnosing mental illness, even something as common as depression. Often, it’s the family doctor. Sometimes the spouse or a family member raises the question. It’s hardly ever the patient. One reason the diagnosis slips by is that everyone thinks depressed people reveal themselves by sobbing all day. Unh-uh. Lots of depressed people wake in the morning, get dressed, and go to work. In Bermuda we are expert at hiding our feelings behind designer sunglasses, Dark ‘n’ Stormies, and mandatory “Good mornings.” So, it’s worth taking a little test, if only to familiarize yourself with the symptoms. The Beck test used in last month’s study isn’t widely available because it’s copyrighted and you have to pay for it (can we possibly insert any more obstacles between the mentally ill and their treatment?). But here’s a similar one you can take for free – it’s called the Patient Heath Questionnaire (PHQ-9). Check it out: https://bit.ly/20vKHN3. Who knows what you learn about depression today might help prevent a future heart attack in someone you love.

Questions featured on the Patient Health Questionnaire:

- Do you have little interest or pleasure in doing things? - Are you feeling down, depressed, or hopeless? - Do you have trouble falling asleep, staying asleep, or do you sleep too long or too often? - Do you feeling tired or having little energy? - Do you have a poor appetite or overeat? - Do you feel bad about yourself — or that you are a failure or have let yourself or your family down? - Do you have trouble concentrating on things, such as reading the newspaper or watching television? - Do you move or speak so slowly that other people have noticed? Or have become so fidgety or restless that you have been moving a lot more than usual? - Do you have thoughts that you would be better off dead, or thoughts of hurting yourself in some way? - How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?

Visit https://bit.ly/2OvKHN3 to receive your score, learn more about the creator and review the supporting literature.

Dr. Shane Marshall is an award-winning cardiologist and co-author of the medical textbook On Call: Principles and Protocols, now in its sixth edition. He is currently at work on his second book, Indispensable Heart: An Insider’s Guide to Recovery. He will be a regular contributor to the Bulletin under the Cardiac Corner. Is there a topic you would like to hear about? Please address correspondence and /or requests for his newsletter “The Annals of Cardiology” to info@shanemarshallmd.com.

Within this edition of the bulletin, we have lots of news about the activities we have engaged in since the spring edition of the newsletter. We also have some important announcements on some changes that are occurring with the Cardiac Health Foundation of Canada. The first announcement is the retirement of current Executive Director, Barbara Kennedy. Barbara celebrates ten years with the Cardiac Health Foundation of Canada and is responsible for the rebranding of this organization. We will miss Barbara’s charismatic leadership, enthusiasm and determination in attracting sponsors to support the Walk of Life and the Healthy Hearts Chef’s Challenge that was launched to celebrate Heart Month. Although she is leaving, she has assured us that her ongoing support will be unwavering. In demonstrating this she has agreed to serve as one of the judges for the Healthy Hearts Chef Challenge. We wish her well as she celebrates life in her retirement with her new husband Russ Robertson. We wish to introduce our new Executive Director Sarah Smith. Sarah comes to us with significant fund development and fundraising experience. See the Board of Directors and Executive Director’s Press Release for additional information as follows. Press Release from Board of Directors & Executive Director, Cardiac Health Foundation of Canada Announcement: Executive Director Retirement – Barbara Kennedy (2008-2018)

Barbara Kennedy has had the honour of serving as the Executive Director of The Cardiac Health Foundation of Canada for the past 10 years. She launched a successful re-branding of the Foundation with its new name, website and tagline – ‘Prevention, Education & Cardiovascular Rehabilitation’. She worked with the Board of Directors to revise the mission to include cardiovascular disease prevention (adding primary to the secondary prevention focus) and also to add public education with respect to cardiovascular issues and related chronic conditions. And more recently cardiac health advocacy has been championed with the Foundation’s involvement in Patient Advocacy Groups, White Papers, Charity Coalitions and partnerships and fundraising collaborations with several related organizations including:- the Mikey Network; SickKids Hospital and Cardiac Kids; University of Toronto’s Dept. of Kinesiology & Physical Education; the Canadian Congenital Heart Alliance; University of Guelph-Humber; University of Ottawa Heart Institute /Heartwise; the Children’s Hospital of Eastern Ontario /CHEO; and Brock University.

News from the National Office

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She greatly expanded the National WALK OF LIFE Campaign to involve 7,000 participants across Canada, supporting and giving grants to over 30 centres collectively raising $ 1 Million annually for cardiac rehab, education and prevention of cardiovascular disease. Funds generated were used across the country for public forums, professional lectures, patient education and resources, facilities and medical equipment. She successfully grew and diversified the GTA WALK OF LIFE to include people from all ages participating not only in various WALKS, but also adding competitive runs, chair exercises, urban poling, kids-dance-a thons; bouncy castles; healthy food fests and a much-anticipated KIDS-FUN- RUN.

She has spearheaded several fundraising campaigns and new initiatives over the years including:

1) Beginning a student intern program at the Foundation’s office and involving and mentoring over 50 University Students and also greatly reducing

administrative costs.

2) Setting up a liaison with Toronto Secondary Schools to involve students in volunteering and receiving their volunteers’ hours with the GTA WALK

OF LIFE with over 1,000 students participating.

3) Co-ordinating the Canada-wide Ride For Rehab in 2012 – the 1st cycle across Canada for CR.

4) Participating in the 2015 virtual World Walking Tour with the Cardiac Health Foundation representing Canada adding ‘steps’ from the National

WALK OF LIFE Campaign to the AROUND THE GLOBE WALK to share the message that - “remaining physically active after a cardiac event can

make a world of difference”.

5) Setting up a $50,000 endowment fund at the University of Guelph-Humber - the Cardiac Health Foundation of Canada Scholarships - awarding

two scholarships annually to Exercise Science and Lifestyle Management and Fitness & Health Promotion / Kinesiology students.

6) Establishing the Dr. Terry Kavanagh Heart Health Lab at the University of Toronto in the new Goldring Centre - a commitment of $325,000 from

2015-2025.

7) Raising the profile of the Foundation by acting as its spokesperson - serving as a moderator of several panels of cardiologists at medical

conferences; appearing on TV for publicity; giving quotes for National Post and other media articles and website blogs regarding cardiac health;

and collaborating and co-authoring position papers with various university and hospital institutions.

8) Inaugurating the “Healthy Hearts CHEF Challenge” in 2016 –an educational seminar and culinary gala to promote proper nutrition for cardiac health.

9) Working with the SIckKids Hospital Foundation and partnering with Cardiac Kids and Bike2Play to establish the first Pediatric Exercise Medicine

Room & Cardiac Rehab Program for kids and adolescents in Canada at the Hospital for Sick Children in 2018.

10) Applying for and receiving THREE grants from the Ontario Trillium Foundation (OTC) totaling $275,900 from 2011-2018.

11) Connecting with various Pharma companies as educational sponsors to produce and disseminate educational materials such as a flyer entitled

“Are you concerned about your heart? Cardiac Rehab can help” – Distribution to over 70,000 medical offices in the GTA, public libraries, and

pharmacies and also online. Donations garnered from Pharma – totaling over $455,639, have also aided in public education; patient advocacy;

newsletter productions; webinars and continual updating of the listing of Cardiac Rehab Programs and services across Canada (a critical resource

for physicians and patients).

12) Greatly expanding the “Sponsorship In-Kind” donations to the foundation to over $245,000 annually (total: $1.8 Million).

13) Raising over $5 Million for the GTA WALK OF LIFE and instrumental in raising over $12 Million for Cardiac Rehab across the country through the

National WALK OF LIFE Campaign.

Introducing: NEW Executive Director - Sarah Smith, Nov 2018 Sarah Smith has dedicated her career to the non-profit sector for over two decades, working with underserved populations of children, youth, adults, and seniors to improve their health and social well-being in order to live their best lives. She brings a wealth of leadership experience collaborating with executives and volunteer advisory committees to diversify their fundraising portfolios and increase profitability in support of much needed programs and services. She has held progressively senior positions with organizations such as Hadassah International in New York, the Mount Sinai Hospital Foundation in Toronto, the Dystonia Medical Research Foundation Canada, and the Canadian Mental Health Association (CMHA). In her most recent role at the Daily Bread Food Bank, she spearheaded food and fundraising initiatives that supported the creation of the Farm to Food Bank program and the distribution of more than ten million pounds of healthy, nutritious food across the Greater Toronto Area to those in-need.

Some major successes over Sarah’s career include the management of the Corporate, Foundation, and Government Relations at Hadassah, generating over $10 million annually for the organization in support of their Emergency Medicine and Neonatal Intensive Care programs. She led the Leadership Giving portfolio ($250,000+) and coordinated the Proposal Development department at Mount Sinai Hospital, assisting the fundraising team to reach their $25 million-dollar goal during their Best Medicine Campaign to purchase life-saving medical equipment and patient and family support programs. As the National Director for start-up charities such as the Dystonia Foundation, she worked diligently with the Canadian Institute of Health Research to secure the first-ever dedicated dystonia research funding in Canada from government. At CMHA, she more than doubled the revenue as she developed corporate campaigns that garnered increased visibility of mental health issues in the community to help reduce the stigma associated with these conditions.

Sarah has a proven track record in managing people, programs and special events, crafting innovative proposals, developing major gifts, stewarding donors, and cultivating strategic partnerships with external agencies. Her passion for healthy living, volunteer-driven initiatives, and the creation of sustainable programs makes her the ideal candidate to lead the Cardiac Health Foundation of Canada to a new chapter in its long and successful history and to another level.

In Sarah’s leisure time she enjoys outdoor activities and yoga, volunteering in her community, and spending time with her family.

CARDIAC HEALTH FDN BULLETIN FALL EDITION | Issue 7 10

Advocacy News from National Office

Since our last edition of the Bulletin we have been busy with a number of activities related to Patient Advocacy. Since attending the Drug Pricing Policy Forum, I have been involved with two sub committees, the private payers’ group and the pharma group. The private payers’ group has been searching for individual case studies of individuals who might have been cut off of drug coverage by their Insurance company. This could have occurred while changing Insurance companies or a change in policy where by the Employer and Insurance company agree that the medication would no longer qualify for coverage. We will utilize these in presentations to employers and during Conference presentations. The Pharma group has spent significant time learning about how a drug comes to market and how it comes to be priced. As mentioned in the last edition of the bulletin, we also read Michael Potters and Elizabeth Omsted Teisburg’s book, “Reforming HealthCare”, that became the primer to the Affordable Care Act. On November 13-14th, the third Drug Pricing Policy Summit: Patients Reforming Healthcare was held with patient groups from across Canada being represented. This conference focused on Value-Based Health Care (VBHC) with presentations that covered: VBHC initiatives in Canada and their positive impact on the health of patients

• Social determinants of health, the resulting health inequities and considerations for moving forward

• Health data and its importance in improving healthcare delivery, health systems and the ability to measure health value

I have signed up for two more committees for the fall, thus will keep you informed as we proceed.

Submission to Cadth (Canadian Agencies for Drugs and Technologies in Health)

This past May and June, we also worked with Hill & Knowlton Strategies, a national communications consultancy to interview patients from across Canada in developing a patient submission to Cadth. This submission was in response to Cadth’s review of Xarelto (Rivaroxaban). Bayer who manufactured the drug conducted a Clinical Drug Trial called COMPASS that assessed Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. Although we were not able to interview any patients who participated in the COMPASS study, we did interview others with cardiovascular disease including peripheral artery disease. These interviews provided the basis for our submission.

National Pharmacare Consultation

On September 25th, I joined with a group of Canadians from Medical Associations, Patient Groups, Professional Associations, Insurance Groups, Pharmaceuticals, Pharmacies and others to provide input on the development of a National Pharmacare in Canada. The consultation was facilitated and included Dr. Eric Hoskins and other members of the Council. This council is mandated to draft a report for presentation to Parliament in January or February 2019. In addition to this consultation, the Cardiac Health Foundation of Canada also sent a brief statement of guiding principles to the council in ensuring that Canadians have access to the medicines and medical devices that they need without regard to where they live in Canada.

Participation in Research Projects largely due to St.Michael’s Patient Involved in Research (PIR) course

Since completing the above-mentioned course which is designed to promote patient’s involvement in research, I have been fortunate to have joined four research group projects. The first one involved a videotaped interview that will be used to support PIR and SPOR (Strategies for Patient Oriented Research) projects. The second one is a research submission to CIHR (Canadian Institute for Health Research) related to Heart Failure. The third one is an updated Cochrane Review on Cardiac Rehabilitation including recommendations and guidelines through an international panel. The fourth research project is again coordinated through St. Michael’s Hospital and involves rapid review decision making.

For patients and caregivers this presents a great opportunity to influence research in Canada, and to ensure that research from formulating the research question through to knowledge translation responds to the lived experience of patients. I encourage those of you who have experienced cardiovascular disease, Coronary Heart Disease, Arrhythmias including inherited arrhythmias, congenital heart defects, and heart valve disease including those with related comorbidities such as living with diabetes, kidney and COPD disease to consider sharing your experiences by becoming involved in PIR and/or SPOR projects.

Canada-wide Cardiac Rehabilitation Program Survey

The Cardiac Health Foundation of Canada is currently involved in a project to update our National Directory of Cardiac Rehabilitation Programs and to learn of the challenges impacting on these programs. Remya Pushparajan Subha, an intern with CHFC, and I have been reaching out to cardiac rehab programs across Canada to learn about their programs, to update information and to identify challenges affecting the operation of the programs. If you have not yet completed a questionnaire, please do so and send it to jsawdon@cardiachealth.ca The directory we publish allows patients and their caregivers to access programs in their areas, with your help we can ensure that individuals have access to resources that they need.

Patients Call to Action

Seeking: Women who have completed Cardiac Rehabilitation within last twelve months

We are seeking women (aged 18+) who have participated in cardiac rehabilitation in Ontario within the last year to take part in a one-time 30-minute telephone interview scheduled at a preferred time. The results will be shared with health facilities and government to help them plan how to deliver patient-centered care, which can improve patient health care experiences and treatment outcomes. Participation in this study is entirely voluntary and will not impact current or future care. You do not have to answer any questions that you do not wish to, and can stop participating at any time. Your answers will be kept confidential.

*You will receive a $25.00 gift card after the interview*

To participate or request more information, contact the Study Coordinator, Bryanna Nyhof, by email: bryanna.nyhof@uhnresearch.ca or by phone: 1 (416) 340-4800 ext.7524.

CARDIAC HEALTH FDN BULLETIN FALL EDITION | Issue 7 11

Are you living with Type 2 Diabetes and would be willing to share your story with media?

If you are a person living with type 2 diabetes who wishes to help others living with diabetes, one of our innovative research based pharmaceutical partners may be interested in speaking with you for an

upcoming announcement to raise awareness about the connection between type 2 diabetes and cardiovascular disease (CVD). They are looking for middle age patients who are at risk for, or who have suffered from a CV event. If you are interested, please contact us at jsawdon@cardiachealth.ca to learn more.

Parmesan Crusted Chicken Breasts with Tomato & Basil and Potatoes with Peppers and Onions

By: Rachael Ray Food Network Ingredients: 1 ½ to 2 lbs of fingerling potatoes or red skin baby potatoes 1 small red bell pepper, seeded & cut into strips 1 Italian mild green pepper, cubanelle, seeded & thinly sliced 1 medium yellow skinned onion, thinly sliced 4 large cloves of garlic, cracked away from skin 1 tsp crushed red pepper flakes ¼ cup extra virgin olive oil. Divided Coarse salt & pepper 2 cups shredded parmesan, available in tubes near deli, make certain shredded not grated 4 (6 to 8 oz) boneless skinless chicken breasts 4 plum romana tomatoes vine rip, seeded & chopped 15 to 20 leaves of fresh basil, pile leaves, roll, then thinly slice – chiffonade Directions: 1. Preheat oven to 500°F 2. Cut fingerling potatoes into halves or quarters (thin small fingerlings may also be left whole); or small red potatoes should be halved or quartered. 3. Cover large cookie sheet with foil. Place potatoes on cookie sheet, combine with peppers, onions, garlic, and red pepper flakes. Coat potatoes, peppers & onions with 2 to 3 tablespoons of extra virgin olive oil, and season liberally with salt and pepper. Place potatoes in oven and roast for 20 to 22 minutes, until potatoes are tender and peppers and onions are crisp at edges. Toss mixture with tongs, turning potatoes after 15 minutes. When potatoes are cooked, transfer to serving dish, peel off foil. 4. While potatoes cook, prepare chicken. Roll out a 2-foot piece of wax paper. Heat non-stick skillet to medium high heat – your pan must be when chicken is added. Pile the shredded cheese on the work surface created with the wax paper. Season chicken with black pepper no salt, the cheese will add sufficient salt. Place the breasts firmly into the skillet. Coat both sides with cheese and add 1 tbsp extra virgin olive oil to skillet (1 turn of pan). Set breasts into skillet and cook 7 minutes on each side, until cheese forms an even, golden casing around the breasts. 5. While chicken cooks, combine chopped tomatoes with basil in small bowl. Season with salt and pepper. 6. Drain off any excess oil from chicken as you remove from skillet. Top chicken with big spoonfuls of raw sauce and serve with potatoes, peppers and onions.

Cauliflower and Lamb Chop Curry

By: UnlockFood.ca (Brought to you by Dietitians of Canada)

Ingredients: 8 lean loin lamb chops (1 & 3 quarter pounds) 1 tbsp all purpose flour 2 tbsp vegetable oil 4 tsp curry powder 1 tbsp minced gingerroot 2 cloves garlic, minced 1 – 28 oz. can of tomatoes, undrained & chopped 3 cups of cauliflower florets 1 each red and green pepper, cubed

Heart Health Recipes

CARDIAC HEALTH FDN BULLETIN FALL EDITION | Issue 7 12

Chopped parley Salt and pepper (optional) Directions: 1. Trim chops, pat dry and toss with flour 2. In a large skillet, heat 1 tbsp oil over medium heat. Cook one half of the chops for 2 minutes per side until brown. Transfer chops to plate, cook remaining chops trimming off excess fat. Wipe out skillet with paper towel. 3. In skillet, heat remaining oil over medium heat, cook curry powder, ginger, and garlic stirring constantly for 1 minute or until fragrant. Add tomatoes and return chops to skillet, simmer covered over medium low heat for 45 minutes. 4. Add cauliflower and sweet pepper, cook covered for 10 to 15 minutes or until lamb is tender and vegetables tender crisp. 5. Season with salt and pepper to taste. Sprinkle parsley on top. Serve over egg noddles.

Vegetarian Shephard’s Pie with Cheese and Potato Topping

By: Alison Kent Food Network Ingredients: 2 tbsp olive oil 1 large onion, chopped 2 stalks celery, chopped 3 cloves garlic, minced 1 can (28 oz) diced tomatoes 2 cups vegetable both (500 ml) 1 ½ cups dried brown or green lentils 2 tsp dried basil 1 tsp salt 8 cups sliced mixed mushrooms ½ cup dry white wine or vegetable broth 4 lbs Yukon gold potatoes 1/3 cup milk 2 tbsp butter 1 ½ cups of shredded black diamond old cheddar cheese 2 green onions, thinly sliced Directions: 1. In a large pot, heat half of the oil over medium high heat, sauté onions, celery, and garlic until softened about 5 minutes. Stir in tomatoes, broth, lentils, basil and half salt, bring to boil. Reduce heat, cover and simmer stirring occasionally until thickened and lentils are tender, approximately 30 minutes. Spread into a 13 x 9 inch glass baking dish. 2. In a large skillet, heat remaining oil over medium high heat, sauté mushrooms until golden brown and until liquid evaporates, about 10 minutes. Add wine, boil for 2 minutes. Spread over lentil mix. 3. Meanwhile peel and cut potatoes into 2 inch squares. In a large saucepan of boiling salted water, cover and cook until tender. Drain well, return to dry saucepan and mash together with milk, butter and remaining salt until smooth. Stir in half cheese and green onions. 4. Spread mashed potatoes over the top. Sprinkle with remaining cheese. Bake in preheated oven at 400°F until bubbly for 30 minutes.

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Cardiac Health Foundation of Canada Website with

Did You Know Articles

We encourage you to visit our website and keep abreast of the Heart Health Publications. These articles are intended to provide awareness of the health issues and preventative actions you can take in both managing cardiovascular disease, related comorbidities, and engaging in healthy lifestyle change. We will list the new ‘Did You Know’ Articles in our next newsletter which will come out in January 2019.

If you have a topic area of interest that you wish us to address, please forward these topics to jsawdon@cardiachealth.ca.

CARDIAC HEALTH FDN BULLETIN FALL EDITION | Issue 7 13

4th Annual Healthy Hearts Chef Challenge ~ FEBRUARY 26, 2019

35th Anniversary of the GTA WALK OF LIFE ~ MAY 25, 2019

Cardiac Health

Fdn Bulletin

FALL Edition

Volume 7, Issue 7

Cardiac Health Foundation of Canada

901 Lawrence Ave West, Suite 306

Toronto, ON M6A 1C3

Tel: 416-730-8299 Fax: 416-730-0421

Email: info@cardiachealth.ca

www.CardiacHealth.ca | www.WalkOfLife.ca

www.facebook.com/CardiacHealth | Twitter @CardiacHealth

If you would like to be updated with our foundation’s news and bulletins, you can sign up for our free membership at www.cardiachealth.ca (at the bottom of the homepage). To view previous bulletins on our website, go to the News tab and click on Newsletter.

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