A sponsored feature by Mediaplanet

September 2015

TAVI INNOVATION An alternative to open heart surgery. p03

SuddeN CArdIAC ArreST New minimally invasive protection for the heart. p10

ATrIAl FIbrIllATION NOACs offer a new class of treatment options. p12

Heart attack survivor,

Sue Williams, advocates for

women’s heart health after

her near-death experience.

Cardiovascular HealthPerSONAlheAlThNewS.CA

For us, every innovation starts with a human inspirationAt Edwards Lifesciences, everything we do comes from a very human place. We’re driven by a passion to help restore patients’ lives. And empower the caring clinicians who treat them. Together, they inspire us to create medical technologies that transform care in structural heart disease and critical care monitoring.

Innovation is what we do. Humanity is why we do it.

To learn more about Edwards Lifesciences visit us at www.edwards.com

Edwards, Edwards Lifesciences, and the stylized E logo are trademarks of Edwards Lifesciences Corporation.

© 2015 Edwards Lifesciences Corporation. All rights reserved. AR10345/CAN

Edwards Lifesciences (Canada) Inc. | edwards.com6750 Century Avenue, Suite 303 | Mississauga, ON, L5N 2V8 CANADA USA | Switzerland | Japan | China | Brazil | Australia | India

IN THIS ISSUE

2 personalhealthnews.ca MEDIAPLANET

editors pickLearn how your pharmacist can help optimize your heart health.p08

cancer and heart Disease In the fight against cancer, knowledge gaps regarding the toxicity of therapies on the heart exist. p11

special thanks to the canadian cardiovascular societyThe CCS is the national voice for cardiovascular physicians and scientists in Canada.

YOU HAVE YOUR MOTHER’S EYES.

WHAT ABOUT HER HEART DISEASE?

The Heart and Stroke Foundation funds the best medical minds in genetic research. But we can’t do it alone. With your support, we’ll continue to find answers and create more survivors.

Is your family at risk? Get a free assessment at heartandstroke.ca

April and AndrewKawaguchi share thesame deadly heart defect.

Publisher: carlo ammendolia Business Developer: Brandon cleary Managing Director: Martin Kocandrle Production Manager: sonja Draskovic Lead Designer: Matthew senra Designer: andres esis Contributors: Dr. lyne cloutier,Dr. susan Dent, randi Druzin, Dr. Justin ezekowitz, Dr. Mark Gelfer, Dr. Michael hartleib, D.F. Mccourt, Ishani nath,

Dr. eileen o’Meara, Dr. robert D. reid, Dr. heather ross, David sculthorpe, Michele sponagle Cover Photo: elif rey photography Photo credits: All images are from Getty Images unless otherwise accredited. Send all inquiries to ca.editorial@mediaplanet.com This section was created by Mediaplanet and did not involve National Post or its Editorial Departments.

Please recycle after readingstay in touch facebook.com/MediaplanetCA @MediaplanetCA @MediaplanetCA pinterest.com/MediaplanetCA

H eart disease and stroke ta-ke a life every seven minu-tes in Cana-da. This reali-ty persists de-

spite astonishing research breakt-hroughs over the past 60 years — life-saving advances that have im-proved prevention, diagnosis, treat-ment and care.

While we can be proud of this progress, the toll of heart disease and stroke is still too high. It’s counted in lives as well as dollars, as our healthcare system consumes 40 percent or more of provincial and territorial budgets.

Breakthrough discoveries Now the 21st century is escalating newer threats: an aging population,

Innovation Is Our Best Hope Against A Persistent Adversary

David sculthorpeCEO, Heart and Stroke Foundation of Canada

Dr. eileen o’MearaCo-chair of the Canadian Cardiovascular Society Heart Failure Guidelines; Cardiologist at the Montreal Heart Institute and Associate Professor of Medicine at the Université de Montréal

By Dr. Justin ezekowitzCo-chair of the Canadian Cardiovascular Society Heart Failure Guidelines; Cardiologist and Director of the Heart Function Clinic at the Mazankowski Alberta Heart Institute in Edmonton

“We must have innovative public policies to create environments in which we can regain, and retain, our health."

the striking rise in obesity and sed-entary lifestyles, and reliance on sugar-packed, processed foods and drinks all endanger the cardiovascu-lar health of Canadians.

At the same time, our era offers un-precedented opportunity for innova-tion that will help us change the face of these diseases through technology, research and public policy.

Digital technology is empowering more Canadians to actively manage their health — and potentially reduce the burden on our healthcare system. For example, the Heart & Stroke Risk Assessment — one of a suite of free on-line eTools available — has helped more than 850,000 people understand their risk for heart disease and stroke, and find simple ways to reduce it. We’re also excited to be developing virtual peer-to-peer support communities for people living with our diseases.

Scientific discovery is the epit-ome of innovation, and research has never been more important. Gen-etics is one area of furious progress, as scientists work to uncover the genes that can pass heart disease risk from one generation to the next. To-day, we know only about 20 percent of those genes. Across the country Foundation-funded researchers are sleuthing out the hereditary causes behind such life-threatening condi-tions as atrial fibrillation, long Q-T syndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC) and more, so we can learn how to overcome what our genes have in store for us.

Innovative public policiesBreakthrough discoveries cannot fight cardiovascular disease alone. Nor can individuals. We must have

innovative public policies to create environments in which we can re-gain, and retain, our health. It’s hor-rifying that in just 30 years, childhood obesity rates have tripled, with chil-dren facing the same risk factors as their parents and grandparents. The Foundation is advocating for public policy changes to address these kinds of issues; policies like restricting mar-keting of foods and beverages to chil-dren, and introducing measures to re-duce sugar consumption, in particu-lar sugary drinks.

If we can capitalize on these and other innovations, the future looks bright. I’m confident that — working with partners who share our vision of healthy lives free of heart disease and stroke — we will make it happen, together.

The Myths and Facts of Heart Failure

an estimated 500,000 canadians are living with heart failure, and 50,000 new patients are diagnosed annually. Yet many myths still surround this condition. canadians can take steps to improve their heart health by understanding the realities of heart failure.

Myth #1heart failure will kill you because your heart has stopped beating.

Fact: Heart failure is serious but survivable. It happens when your heart muscle or valves are damaged. That means your heart can’t pump blood optimally. So “failure” is really loss of function.

Myth #2heart failure is just part of aging.

Fact: While most people who develop it are over the age of 60, heart failure isn’t an inevitable part of getting older. The dangers of this myth? People might think that noth-ing can be done to avoid eventual heart failure, or that it can’t happen to younger people. In fact, taking prevent-ive measures – like exercising regularly, eating a healthy diet and managing blood pressure – can reduce your risk.

Myth #3people with heart failure shouldn’t exercise — it will only make things worse.

Fact: While this is a common fear, several studies point to the effectiveness and safety of exercise for those with heart failure. Talk to a doctor to find an exercise program that fits your condition and fitness level.

Myth #5If you don’t have chest pain, you can’t have heart failure.

Fact: Patients with heart failure can have many symp-toms. Chest pain is only one. Other symptoms can in-clude: palpitations; shortness of breath; fainting and/or dizziness; rapid weight gain; feeling bloated all the time; increased swelling of the legs/ankles/feet; increased fa-tigue; and cough or cold symptoms that last longer than a week. These can be warning signs of other conditions as well, but may be heart-related. If symptoms are mild, see your doctor; if they’re severe, go to the emergency department.

Myth #4If you have heart failure, little can be done to treat it.

Fact: Healthy lifestyle choices can make a difference, and so can treatments like medication (ACE inhibitors that widen the blood vessels to improve blood flow) and implantable defibrillators (a type of pacemaker).

These treatments aren’t cures, but can reduce symp-toms and delay the progress of heart failure. Some of the biggest breakthroughs are relatively new, and heart ex-perts are learning more about effective interventions all the time.

InnovatIon

MEDIAPLANET 3

Maria Sermer was 85 years old when she was di-a g n o s e d with aortic stenosis, a

common and often fatal heart condi-tion that causes shortness of breath, pain, and loss of mobility. Without a procedure to replace the faulty valve in her heart, Maria, already painfully immobilized by her symptoms, had very little time ahead of her.

“It’s a deadly condition,” says Dr. Eric Horlick, Cardiologist, Peter Munk Cardiac Centre. “Once you develop symptoms of aortic stenosis and are found to be inoperable, you have about a 50 percent 12-month mortal-ity rate. And those 12 months will be miserable.”

Ten years ago, the only treatment available for aortic stenosis was open heart surgery. For young and healthy patients the success rate of this sur-gery is high, but for older patients, or patients with additional condi-tions such as lung disease, the risk of the surgery is prohibitive and the re-covery very difficult. Maria had seen the toll surgery can take first hand. “My husband had to have an open heart bypass surgery,” Maria says, “so I know what it is like. It took him three months to recover. And the other thing is that it is horribly pain-ful. It made me so unhappy to see how he suffered.”

The new world of TAVIFortunately, a new treatment known as transcatheter aortic valve implant-ation (TAVI) meant that there was an option for Maria other than open heart surgery. “TAVI is a way to take a person who is too high risk for conventional surgery, go into the artery in their leg, go up through the aorta, and position a stent with a valve sewn into it,” ex-plains Dr. Horlick. “The whole proced-ure takes 35 minutes. The patient is up and ambulating later in the day. They go home the next day. It’s incredible.”

When TAVI was first proposed there was concern that it might be dan-gerous or ineffective, and so it was used only on the highest risk pa-tients: those who could neither sur-vive surgery nor survive without it. The results were impressive. A large increase in overall survival was seen among these high-risk patients and, as the technology has improved, mak-ing the procedure less and less in-vasive, TAVI is now being explored as an alternative for moderate risk pa-tients as well.

“I couldn’t walk because of my heart”Surgery was considered very risky for Maria due to her age and scar-ring from previous surgeries, so TAVI was put forward as the treatment of choice for her. Dr. Horlick performed the procedure on her in December of 2014, and the effect on her quality of life was immediate and profound.

“Before the procedure, I was short of breath. I had irregular heart beats and skipped beats. I couldn’t walk because of my heart,” says Maria. “After the procedure, I recovered very quickly and now I can do everything that I did before. In three weeks I was swim-ming again. I can exercise. I can cook and bake by myself.”

Joy and gratitude are evident in the voices of Maria and her husband Vic-tor as I speak with them. “Dr. Horlick was so kind,” says Maria. “I would rec-ommend this procedure 100% to any-one who is a candidate for it. Especially with Dr. Horlick.”

Dr. Horlick says that the most im-portant thing is to be aware that there are safe and effective alternatives to open heart surgery for many patients. “There are options if you have aortic stenosis. And the people best able to advise you about these options are the people who actually use all the tech-nologies.” He urges anyone with this condition to seek advice from a doc-tor who is part of a multidisciplinary team, and who is familiar with both surgical treatments and TAVI.

Which therapy is best for an indi-vidual patient can depend on many factors. Only by talking to a doctor with a deep understanding of all the options can a patient ensure they get the best treatment.

By D.F. McCourt

Life is back to normal for Maria Sermer after a receiving a transcatheter heart valve from Dr. Eric Horlick of the Peter Munk Cardiac Centre. Photos: Elif Rey Photography

New innovative procedures like TAVI are helping Canadian families live longer lives together.

T obacco use (primari-ly in the form of ci-garettes, cigars and pipe smoking) cau-ses heart attacks and strokes as well as lung diseases

and many forms of cancer. Quitting smoking is the best way to prevent cardiovascular disease or to slow its progression if you have already been diagnosed. If you are like most smokers, who would like to quit but haven’t been able to despite several concerted attempts to do so, tobacco addiction is likely the culprit.

Cigarettes and other forms of tobac-co are addictive because of the nicotine contained in tobacco smoke. When in-haled, nicotine travels quickly to the brain where it causes the release of the

neurotransmitter dopamine. Dopamine release causes a pleasurable sensation that is powerfully rewarding. Nicotine actually changes smokers’ brains, caus-ing smokers to have strong cravings when they are unable to smoke. Smok-ing also becomes tightly embedded in-to daily routines and social interactions, both of which become potent triggers to light up. Many smokers experience symptoms of tobacco withdrawal when they try to quit, including cravings to smoke, restlessness, irritability, de-pressed moods, sleep disturbances and changes in appetite. Withdrawal symp-toms can cause people to relapse back to smoking when they try to quit.

If you want to quit smoking, re-search shows that the best way to quit is with a combination of smoking ces-sation medication and counselling

from a healthcare professional. Medications work by reducing the

severity of tobacco withdrawal symp-toms. There are three approved forms of smoking cessation medication available in Canada. Nicotine replacement ther-apy (NRT) is available over the counter at your pharmacy, while varenicline (Champix) and bupropion (Zyban) are available by prescription. Compared to continued smoking, all forms of smok-ing cessation are safe, even for smokers with existing cardiovascular diseases.

Counselling works by teaching smok-ers how to make a plan to cut down and quit, use medications effectively, identify triggers to smoke, develop coping skills to help manage situations and cravings, and find alternatives to smoking. Counselling is available one-on-one, in groups, over the telephone or on the Internet.

Some smokers can’t contemplate a life without smoking and resist making plans to quit. If smokers are unable to set a specific quit date, they can approach quitting in a more gradual fashion by using smoking cessation medication and behaviour modification techniques to gradually cut down their smoking. They can make more definite plans to quit for good once they have gained con-fidence in their ability to manage their life without smoking.

By Dr. Robert D. Reid

Deputy Chief, Division of Prevention and Rehabilitation, University of Ottawa Heart Institute

Fixing Ailing Heart Valves Without Surgery

“A new treatment known as transcatheter aortic valve implantation (TAVI) meant that there was an option for Maria other than open heart surgery.”

NICODERM® is the most recommended patch by Canadian doctors and pharmacists1,2

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References:1. Pharmacy Practice+ & L’actualité pharmaceutique 2015 Survey on OTC Counselling & Recommendations2. The Medical Post & L’actualité médicale 2015 Survey on OTC Counselling & Recommendations

McNeil Consumer Healthcare, a division of Johnson & Johnson Inc.,Markham, Canada L3R 5L2© Johnson & Johnson Inc. 2015

Smokers have double the stroke

risk of non-smokers

Estimated increase in risk for stroke from exposure to

secondhand smoke.

Stroke risk decreases signifi-cantly within 2 years of quitting

2 YEARS

Source: Surgeon General’s Report on Smoking & Health

30%

Quitting Smoking The Best Way to Protect Your Cardiovascular Health

INSIGHT

4 personalhealthnews.ca

No medical proce-dure is more com-mon than blood pressure measu-rement, and yet there is a distur-bing lack of in-

terest in Canada about its effective-ness as a diagnostic tool. The sphyg-momanometer — a recognizable de-vice with an inflatable cuff and a mer-cury or aneroid manometer that is used, along with a stethoscope, to me-asure blood pressure — was populari-zed around the year 1900 and remains in common use today. That’s a start-lingly long lifetime for any technolo-gy; we consider flip phones from 2005 to be bona fide antiques.

In fact, healthcare professionals have known for many years that bet-ter and more accurate methods for blood pressure measurement exist. Getting Canada’s healthcare profes-sionals to use them needs to be a top priority for universities, profession-al associations and governments.

Diagnosis is trickySeven and a half million Canadians — that’s one in five — are living with high blood pressure, or hypertension. The only way to diagnose hypertension is through accurate blood pressure meas-urement, since high blood pressure has no signs or symptoms at the outset. The

antiquated use of sphygmomanometers in clinics means that tens of thousands of Canadians are misdiagnosed with hypertension every year. This misdiag-nosis results from the ‘white coat effect,’ and applies to as many as 25 percent of people who are diagnosed with hyper-

tension. Their blood pressure meas-ures high in clinics but is normal when measured in non-clinical settings, either by ambulatory 24-hour measure-ment or by themselves at home.

“Missed” diagnosis is just as big a problem: 25 percent of people liv-ing with hypertension have ‘masked’ hypertension, making their high blood pressure undetectable with in-office blood pressure measurement. “People

with masked hypertension are at a sim-ilar risk for cardiovascular disease as people who have uncontrolled hyper-tension. With accurate diagnosis, these complications can often be avoided,” explains Angelique Berg, CEO of Hyper-tension Canada.

Misdiagnosis reverberates throughout the healthcare system: scarce pharmacare dollars end up spent on medicating people need-lessly and these needless medica-tions can have a negative impact on people’s well-being. Meanwhile, hypertension silently puts the un-diagnosed at risk of cardiovascular events such as strokes, heart attacks and heart failure.

Methods need updatingHypertension Canada has updated its CHEP Guidelines for the treatment and control of hypertension in order to promote the use of current in-office (automated) and out-of-office (ambu-latory or home-based) technologies that will help to end the scourge of hypertension misdiagnosis. What’s needed now is a coordinated effort to turn common practice around by bringing blood pressure measurement into this century and in line with the latest research and technologies.

Medical, nursing and pharmacy schools should integrate Canadian best practice guidelines to their cur-ricula. Professional associations can help by dispelling the common myths and misunderstandings that accompany all new technologies. Governments need to support the im-plementation of best practices with appropriate incentives for healthcare professionals. The result of these co-ordinated actions will be a more cost-effective and focused response to hypertension, which is currently the leading cause of death and disability around the world.

By Dr. lyne cloutier and Dr. Mark Gelfer

“The antiquated use of sphygmomanometers in clinics means that tens of thousands of Canadians are misdiagnosed with hypertension every year.”

Blood Pressure Measurement: Calling for a Turn of the Century

about the authorsDr. Lyne Cloutier is a profes-sor at the nursing depart-ment of Université du Québec à Trois-Rivières and is Direc-tor of the Groupe interdisci-plinaire de recherche ap-pliquée en santé. Her main research interests are opti-mizing blood pressure meas-urement and developing and evaluating multidisciplinary interventions for the care of people with hypertension.

Dr. Mark Gelfer is a family physician based in Vancouver, British Columbia with more than thirty years of medical experience. He has served as President of the BC College of Family Physicians and is currently a Clinical Assistant Professor at the University of British Columbia in the De-partment of Family Practice.

Together, Dr. Gelfer and Dr. Cloutier co-chair Hyper-tension Canada’s CHEP Guidelines Blood Pressure Measurement and Diagnosis subcommittee.

Fewer than 1/10 Canadian adults and 1/5 youth were in ideal cardiovascular health from

2003-2011

is the estimatednumber of heart attacks each yearin Canada

Every

7minsomeone dies from heart disease or stroke in Canada

lives per year

Up to

40,000cardiac arrests occur each year in Canada

of Canadians have at least one risk factor for heart disease or stroke

Smoking, alcohol, physical inactivity, obesity, high blood pressure, high blood

cholesterol, diabetes

That’s one cardiac arrest every

12 minHeart disease and stroke costs the Canadian economy more than

every year in physician services, hospital costs, lost wages and decreased productivity

Source: Heart & Stroke Foundation

MEDIAPLANET 5

Dietitian and Becel margarine spokesperson Gina Sunderland paused a moment when a client boasted about following a fat-free diet, but she knew it was important to set the record straight. She explained to the client, a health-conscious woman in her early 60s, that some fat is part of a healthy diet and she advised the woman to incorporate a little into her meals.

“As dietitians, we did huge disser-vice with our messaging in the 80s and early 90s,” says Sunderland, who is based in Winnipeg, Manitoba. “We should not have been emphasizing low-fat this and low-fat that. We told people not to eat fat, and that message was way too simple.”

To be healthy, we need to embrace fats that are good for us while avoid-ing fats that are not.

Unsaturated fat can help lower bad cholesterol (LDL) levels and, by ex-tension, the risk of heart disease. It can be found in vegetable oils, nuts, seeds and fish. Unsaturated fat, which is liquid at room temperature, in-cludes two groups.

The first, monounsaturated fat, is found in olive, canola and some other oils as well as avocados and various

nuts, including almonds, peanuts and cashews. The second, polyunsatur-ated fat, is found in sunflower, soy-bean, corn and safflower oil as well as fish, walnuts, flax and other seeds.

Many of the items in the second group have omega-3 and omega-6 fatty acids, which the body can’t produce on its own. Plant sources provide the essential omega-3 fatty acids that the body needs to function, which are al-so being investigated to determine their importance for heart health. Fatty fish like salmon, tuna and sardines are a great source of these fatty acids as well.

Canadian healthcare providers en-courage people to eat unsaturated fat in moderation. They have also sound-ed the alarm over two fats that in-crease bad cholesterol and heighten the risk of heart disease: saturated fat and trans fats.

Saturated fat, which is solid at room temperature, is found in red meat, whole milk, cheese, coconut oil and many commercially-pre-pared foods. Trans fats appear nat-urally in small quantities in some foods, such as meats and dairy, while industrially-processed trans fats are

sometimes found in items like cook-ies, crackers, packaged snack foods and deep-fried foods.

Butter isn’t betterThe butter-versus-margarine debate has been a flashpoint in the ongoing conver-sation about fat. While some people pro-mote butter as an “all-natural choice,” most dietitians advise to use less of it.

“We’ve all heard the slogan, ‘Butter is Better.’ Well, that is just not true!” says Sunderland. She points out that butter is high in saturated fat, while margarine is made from a blend of plant and seed oils and therefore con-tains the “good” polyunsaturated and monounsaturated fats.

In fact, the results of a recent study by the Danish Dairy Research Foun-dation established that even moder-ate levels of butter consumption could result in higher LDL cholesterol. The study also showed that butter raises blood cholesterol levels more than ol-ive oil, a plant-based alternative.

Responding to consumers’ health concerns, manufacturers have moved away from hydrogenation, a process that solidifies liquid vegetable oil but al-so can generate trans fats. Instead, they use a small amount of modified palm and palm kernel oil to get the job done. Non-hydrogenated margarine is more spreadable than its predecessor and

contains no trans fats and up to 80 per-cent less saturated fat than butter. Sun-derland, a consulting dietitian, advises her clients to use it.

Avoiding fat a ‘big mistake’Not surprisingly, some of her clients remain skittish about fat in gener-al because of its calories, so Sunder-land emphasizes that a small amount, two to three tablespoons, of good fat per day is the right amount. You could get much of your daily requirement by spreading soft margarine on toast and a sandwich, and by adding ground flax seeds on top of a salad or into your oatmeal.

Also, fat creates a feeling of fullness, so people who go without it often get hunger pangs that send them running for prod-ucts that contain refined carbohydrates, which leads to weight gain. White bread, refined flour crackers, white rice and other products that fall into this category cause a surge in blood sugar. If the sugar is not used for fuel, it can become stored and result in weight gain.

“The bottom line,” says Sunderland, summing up the message she conveys to health-conscious clients, “is to enjoy two to three tablespoons of healthy unsaturated fat every day. Avoiding fat altogether is a big mistake.”

By Randi Druzin

Replace butter with Becel® 1:1 for 80% less

saturated fat, and zero trans fat.

Go to Checkout51.com for $1.50 coupon.

Go to Becel.ca to sign up for our Heart Healthy Newsletter.

BECEL is a registered trade-mark of Unilever Canada.

“The butter-versus-margarine debate has been a flashpoint in the ongoing conversation about fat. While some people promote butter as an “all-natural choice,” most dietitians advise to use less of it.”

CommerCial feature

insight

6 personalhealthnews.ca

Heart Attack 101 What You Need To Defend Against A Heart Attack.

Each year, there are an estimated 70,000 heart attack cases in Canada – translating to one victim approx-imately every 7 minu-tes. Each year, heart at-

tacks claim the lives of 16,000 people across the nation, according to the Heart and Stroke Foundation.

Know your riskHeart attacks are complicated and combine multiple aspects of who you are and how you live.

“There are certain [risk factors] that can’t be changed and certain ones that can be, you have to look at them all,” explains Barbara Kennedy, the executive director of the Cardiac Health Foundation of Canada. “They all interact.”

Inherent risks that can increase the chance of suffering a heart attack in-clude family history or advanced age. However, factors like smoking, un-healthy diet, lack of exercise, obesi-ty, high blood pressure, high choles-terol, diabetes, and stress can be con-trolled or treated to lower the risk to the heart.

Though heart attacks are often con-sidered to be a concern for the un-healthy or elderly, cardiologist Dr. Rob-ert Welsh says that is a misperception.

“I think we all live in a little bit of denial, but if you look hard at yourself or at people around you, there are very few people who have none of the clas-sic risk factors for heart attack,” he says. “Everyone should be cautious of their risk.”

act quickly A heart attack occurs when one of the arteries that supply blood to the heart

becomes blocked, stopping the flow of oxygen and nutrients. When this hap-pens – prompting signs such as chest discomfort, nausea, or shortness of breath – time is of the essence.

“The symptoms of a heart attack aren’t always devastating and cata-strophic,” says Welsh, explaining that some signs can be easily misunder-stood as indigestion or other minor health issues. “People don’t think the problem is as serious as it is until they start to get really unwell from it.”

Without prompt treatment, heart attacks can be fatal. Even if a patient lives, delaying medical attention can injure the heart, causing life-long complications.

“The long-term risk is that if you weaken the heart muscle, then you’re both exposed to congestive heart fail-ure – where you have lack of energy, shortness of breath on exertion, in-ability to live a high quality of life due to limited heart function – and ab-normal heart rhythms because the more damage you have to your heart, the more scarring you have and the more at risk you are of lethal heart rhythms,” explains Welsh.

You simply need a doctor’s re-ferral to access it after your heart attack.

Cardiac rehab is designed for peo-ple who have experienced a car-diac event, such as a heart attack. The program has evolved over the years from a simple monitoring for a safe return to physical activities to a multidisciplinary approach that focuses on patient education, in-dividually tailored exercise train-ing, modification of the risk factors and overall well-being of the cardi-ac patients. The program educates and encourages patients to make lifestyle adjustments with exercise prescriptions; nutrition counsel-ling; cholesterol, hypertension and obesity management; symptom and medication strategies; smok-ing cessation; control of diabetes; and stress and anxiety reduction.

Patients in a cardiac rehab pro-gram feel safer, stronger and more confident as a result of their partic-ipation. But cardiac rehab isn’t just about making patients feel good; it produces concrete results. Evi-dence-based research has concluded that providing that transition back to independence greatly improves pa-tient outcomes in both the short and long-term.

Benefits of cardiac rehab■■ Improves exercise tolerance and

strength■■ Reduces blood fat levels

If a patient experiences a heart at-tack and the arteries are completely blocked, Welsh estimates that they have between three to six hours to get medical therapy otherwise perma-nent damage can be caused.

His advice: as soon as you spot symptoms, call 911. “By activating the system, you greatly reduce your risk of death and disability,” he says.

stay healthy Kennedy advises Canadians to know their risk factors for a heart attack by talking to their healthcare profes-sional. Though some factors are be-yond a patient’s control, others can be improved through diet, exercise, and lifestyle changes. “To us, exercise is medicine,” says Kennedy, adding that this applies to people of all ages.

By Ishani nath

the warnIng SignS

Learn to recognize the signs of a heart attack so you can react quickly to save a life. Warning signs can vary from person to person and they may not always be sudden or severe.

Nausea Light- headedness

Sweating

Shortness of breath

Chest discomfort

Discomfort in other

areas of the

SOURCE: HEaRt & StROkE FOUndatiOn

!

“as soon as you spot symptoms, call 911. By activating the system, you greatly reduce your risk of death and disability.”

■■ Improves psychological well-being■■ Improves quality of life■■ Speeds up the ability to return to

work■■ Increases awareness of cardiac risk

factors■■ Reduces stress■■ Reduces blood glucose for diabetes

Many individuals are not aware that cardiac rehab programs are available to them for free after their heart at-tack. All that is required is a simple referral to a program by a doctor. The Cardiac Health Foundation of Canada’s website ( www.cardiachealth.ca) is an excellent source of information as to which hospitals and sites across Cana-da offer a cardiac rehab program.

what happens upon arrival at a typical cr program? The first meeting usually involves: a stress test, an electrocardiogram (EKG), blood pressure and oxygen level tests. These tests allow the cardiologist to prescribe the starting exercise regi-men along with identifying the sched-ule for the individual to follow. Some programs offer an eight-week program three times a week; others offer a six month program for one day a week; and still others offer a three month plan twice a week.

During the exercise portion, in-dividuals may be on a treadmill, or a bike which has handles for moving the arms while peddling, or be as-signed to a rowing machine. During the activity, blood pressure and oxy-

gen levels are constantly moni-tored and recorded. Additional-ly some may use a heart monitor halter which is worn for 24 to 48 hours, monitoring the heart rate and rhythm of the heart. In addi-tion to counselling, individuals are encouraged to develop a sup-port network amongst the oth-er members who are attending the cardiac rehab program with them. Some programs may in-clude special events to promote networking such as golfing and or family sessions on nutrition along with other cardiac rehab members.

Cardiac rehabilitation pro-motes lifestyle change. We en-courage everyone to get a referral from your family doctor or a walk-in clinic, to participate in a pro-gram that offers help and hope.

co-authored by Barbara Ken-nedy – executive Director car-diac health Foundation of can-ada and John sawdon – gta Director of heart wise exer-cise/ a special project of the cardiac health Foundation oF canada made possible through an otF grant

Did You Know That Cardiac Rehab Is Free Across Canada, At Select Hospitals And Clinics?

inspiration

MEDIAPLANET 7

Hearty MealsMasterChef Canada judge and restaurateur, Claudio Aprile, shares his passion for healthy home cooking.

Mediaplanet How have your careers as a restaurateur and MasterChef Canada judge allowed you to share your passion for food with Canadians?Claudio Aprile MasterChef Canada has given me an amazing platform to share some of my greatest passions — food and mentoring. As I get older, I find myself wanting to give far more than I receive and I really enjoy being part of something that is greater than its individual parts, something that has the power to change the outcome of someone’s life.

The opportunity to be a judge on MasterChef Canada came at the per-fect time in my life. I was looking for a new challenge, I wanted to be the student. I now get the rare chance to express how I feel about food to mil-lions of people — that is profound. Along with that comes a huge sense of responsibility and privilege that I don’t take lightly.

MP Food labels can often be overwhelming. What are the top three things that heart health-conscious shoppers should look for?CA One of my rules when I read food labels is expiry dates. If the expiry date is longer than a few days, I avoid it. I always smell all my food before I eat it, that’s a very chef-y thing to do. I don’t trust that it’s fresh unless I verify through smell. If I get any off smells, I won’t go near it. The other thing is long lists of chemicals and stabilizers that I don’t understand. If I can’t spell it, I won’t eat it. High levels of sugar and fat are also red

As the vice president of a major construction company, Greg Nevison almost never calls in sick, but two years ago, he knew something was wrong.

It was nearing the end of the summer and Nevison was out for his regular swim, but his body didn’t feel up for it. “It felt sort of like the flu,” he says, explaining that he brushed it off and continued with his workout. As he swam, the discomfort worsened.

“It felt muscular, sort of in my shoulders and arms, which you use tremendously in swimming, so I thought it was related to the swimming,” he recalls. After finishing his workout, he planned to go to his next appointment, but on the drive over, he was still feeling off so he rerouted and went home to rest and search for answers.

“It was a sensation I’d never really

flags for me. Never buy pre-made salad dressings, they are so easy to make at home.

MP How can home cooks make their meals more heart healthy without sacrificing flavour?CA I never add salt to my meals when I cook at home. A great trick is using acidity such as fresh lime or lemon and fresh herbs to your food. Adding fresh herbs and acidity elevates the flavour profile of all your food without the added sodium. I also try to eat more frequently. Another great method is cooking vegetables for a long period of time. Cook your vegetables slow and low; allowing vegetables to caramelize increases the flavour.

MP What are some easy dietary changes that all Canadians can make?CA Try to only use your freezer for ice cream and ice cubes. Reduce processed frozen meals. Reduce animal fats and eat more vegetables, fruits and grains.

Cook with your kids, teach them how to prepare a meal.

MP What words of wisdom do you have for aspiring home cooks across Canada?CA Canada is the most multi-cultural country in the world, and we have one of the most exciting food cultures anywhere. Explore as many ethnic cuisines as possible. If you have a local restaurant that you frequent, ask the chef if you can spend time in the kitchen. Experiment at home with flavours and techniques, there’s no right or wrong.

The word “perfect” has no place in a home kitchen. Don’t be afraid to make mistakes – the most important lesson is to have fun. Practise moderation, and that includes moderation itself – every once in a while I think it’s ok to cave in to your guilty pleasures.

“Adding fresh herbs and acidity elevates the flavour profile of all your food without the added sodium.”

Healthy competition MasterChef Canada. Follow Claudio on Twitter @claudioaprile. Photos: CTV networks

Taking A Beat: A Heart Attack Survivor’s Story had before so that’s why I pulled out my phone and started looking,” he says. The pain was persistent and worsening, mostly concentrated to his chest area and radiating down his arm. Nevison Googled his symptoms and discovered they were classic signs of a heart attack.

He called 911 and chewed two low dose tablets (81mg) of acetylsalicylic acid (ASA), and headed to the hospital.

Medical tests confirmed that Nevison had experienced a heart attack.

“I was shocked,” he says. “I didn’t really think it was that bad.”

The cardiologist told Nevison that taking low dose ASA as soon as he suspected a heart attack was “the smartest thing you did.” In Canada, low-dose Aspirin are approved for emergency use during a heart attack and may stop blood clots from forming. Nevison’s cardiologist said that it’s likely that these pills may

have helped save his life. At the time of his heart attack,

Nevison was 56 and thanks to exercising regularly, his doctors considered him to be in good health. He had no family history of heart attacks, but he had been under prolonged stress – considered a risk factor for heart attacks – while his family built their new home.

“I’m kind of high strung to start with,” says the senior vice president of Tridel Corporation.

According to the Heart and Stroke Foundation, every seven minutes, someone experiences a heart attack and each year, heart attacks claim nearly 16,000 lives.

If it wasn’t for his friend who had suffered a massive heart attack only a few months before, Nevison says he wouldn’t have taken action. “I probably would’ve ignored it and gone to bed,” he says.

Knowing the signs and symptoms, Nevison now tells all of his friends to take precautions, including keeping low dose ASA in easily accessible places like your bag, or in an office drawer.

Nevison says that often times, people will think they’re fine, attributing symptoms to the flu or a

workout, like he did, but he encourages people to take these signs seriously. “If you have any suspicions, call 911 and then crush and chew two low dose ASA,” he says.

By Ishani Nath

“At the time of his heart attack, Nevison was 56 and thanks to exercising regularly, his doctors considered him to be in good health.”

ReseaRch

8 Personalhealthnews.ca

heart disease kills six times more canadian women than breast cancer and it’s the leading cause of death among women. this doesn’t have to be the case. Boosting awa-reness and embracing new education tools and knowled-ge can help curb the upward trend of the disease.

Sue Williams, a retired nurse and pro-fessor from Ryerson University in To-ronto, was one of the lucky ones. In 2007, at age 60, she suffered a full car-diac arrest during a vacation to Eng-land. She had a family history of heart disease, but no other risk factors. She did the right things to monitor her health, like having her cholesterol and blood pressure monitored, underwent a stress test and got annual check-ups. But, she says, “I went from quite fine to nearly dead in 30 minutes.”

Because of her nursing background, Williams knew the early signs of a heart attack – pain in the neck, jaw, back and arms, nausea, sweating, shortness of breath and lightheadedness. Her hus-band got her to the nearest hospital quickly where doctors were able to re-suscitate her and insert a stent into her heart. After a period of rest, Williams made the trip home and got her general practitioner to refer her to a cardiac re-habilitation program (designed specif-ically for women) at Women’s College Hospital to continue her journey back to health.

Misdiagnoses in womenFortunately, Williams received proper treatment from her doc-

tors in England, however, there is a lack of recognition for the signifi-cant differences in the way men and women exhibit symptoms of cardiovascular disease and their risk factors. Women tend to develop it about 10 years later than men, with post-menopause being the prime time for onset.

“We absolutely need complete equity when it comes to how we address cardiovascular disease in women,” says Dr. Paula Har-vey, Head of the Division of Cardi-ology, Women’s College Hospital, in Toronto. “I’ve been research-ing cardiovascular disease for dec-ades and we are making progress. Yet women are still being misdiag-nosed and risk factors missed.” It’s also important to note that younger women are developing the disease at an increasing rate.

Identifying risk factors There is still much more knowledge to be gained so that women are prop-erly monitored for the signs of heart disease. Recognizing risk factors is key. They include: a sedentary life-style and co-morbidity with other conditions, like autoimmune dis-orders such as lupus and type-2 dia-betes. For example, a woman with type-2 diabetes has an eight times higher risk of heart disease than one without diabetes. The latest find-ings also examine the connection be-tween a woman’s reproductive his-tory and an increased risk of heart disease. Researchers have deter-mined that issues such as premature menopause, complications during pregnancy and irregular periods may be linked to heart disease.

The fact that men and women do not exhibit the same symptoms of

cardiovascular disease is something that Dr. Harvey says is important to note. A woman presenting symp-toms such as chest pain is some-times thought to have a different condition like angina. There is still some belief that cardiovascular dis-ease is more of a man’s disease. It’s not and statistics back that up with more women than men dying be-cause of it. Even diagnostic tools, like stress tests and ECGs, can result in false positives and inaccurate re-sults for women, which underscores the importance of treating patients according to gender.

Knowledge is the keyDr. Harvey is pushing for greater public awareness, increased educa-tion and more accurate diagnoses for women. “Cardiac disease is life-changing. Women must have the

same access to treatment and care as men,” she says. She emphasiz-es that it’s crucial for women to pay heed to their symptoms, not brush them aside. As caregivers and nur-turers, women often put themselves second and fail to make their own health a priority

Getting the facts about cardio-vascular disease is a crucial first step in saving women’s lives. Women’s College Hospital, in partnership with Shoppers Drug Mart’s women’s health program – Shoppers LOVE YOU, is helping women stay focused on being their best, by offering two sources of expert advice on women’s health topics: womenshealthmat-ters.ca, Canada’s trusted source of information, news and research findings, and myhealthmatters.ca, which offers health information based on personal health priorities and an individual’s stage of life in order to help manage and improve heart health.

Today, Sue Williams, an active grandmother of four, shares her story with other women and does volunteer work with Women’s Col-lege Hospital and other organiza-tions. She tells them, “It could hap-pen to you. It’s important to under-stand your risk factors, and make the necessary life modifications to mini-mize them. And don’t hesitate to seek medical treatment.”

By Michele sponagle

heart attack survivor sue williams with WCH advance practice nurse, Jennifer Price. Women’s College Hospital created North America’s first cardiac prevention and rehabilitation program designed exclusively for women. Photos: Elif Rey Photography

Women receive personalized care plans to help prevent and manage heart disease at Women’s College Hospital.

as part of an integrated health program, pharmacists and doc-tors go hand in hand to optimize treatment for patients dealing with cardiovascular issues.

While Canadians see physicians as trusted sources of information, they should know that pharmacists can al-so provide advice, offer lifestyle modi-fication tips, and support and guidance on getting the most out of their medi-cation. Patients can reap multiple bene-fits from pharmacists’ expertise and wealth of knowledge.

Getting to know your pharmacistThe next time you visit your phar-macy, don’t just grab your meds and go. Talk to your pharmacist about your health. You’ll be surprised by what you can learn.

James Ng, a pharmacist and owner of a Shoppers Drug Mart on West Broad-way in Vancouver, recalls a conversa-tion he had with one customer. “He initially asked me for medicine that would treat his recurring headaches,” Ng says. “I began to ask him questions

about why they were occurring. I sug-gested that we test his blood pressure with the machine we have available in the store. It turned out that his blood pressure was skyrocketing, which ex-plained his headaches. I recommended that he see his doctor right away.”

High blood pressure is a key risk fac-tor in cardiovascular disease, so it was a potentially life-saving exchange. Many patients don’t realize that with a min-imum of five years in university study-ing everything from anatomy to path-ology, pharmacists have a vast, sol-id foundation of knowledge, making them invaluable sources of guidance and information.

Focusing on prevention “Patients are now realizing that we don’t just count pills. We can offer a great deal of support and advice - not just on potential drug interactions, but on things like diet and exercise recom-mendations, too. We focus on treat-ment, but also on the prevention of diseases and that’s first and foremost”, says Ng.

Ng offers a couple of tips for ward-ing off cardiovascular disease. Exer-

cise is a very effective tool, just half an hour of activity – anything that gets your heart pumping – three times a week is a good place to start. Ng al-so notes how patients’ reliance on high-fat and low nutrition fast food is detrimental to health. Since hun-ger and being short on time can lead to bad food choices, Ng recommends that patients plan their meals ahead. “Even small changes in lifestyle can go a long way,” he says.

Pharmacists are there to offer sup-port and pragmatic tips. And, while it can sometimes take time to see a phys-

ician, pharmacists are often accessible in the evenings and on weekends, and are trusted resources available to help with credible, current information.

seeing the big pictureLooking at a patient’s total health pro-file is something pharmacists can do. More than just addressing symptoms, proper healthcare is about looking at underlying conditions and future pre-vention. Ng emphasizes the import-ance of not waiting until symptoms ap-pear before seeking professional input on your overall health.

Having support for lifestyle changes from your pharmacist for a personal health plan can be a source of inspir-ation. To work with your pharmacist effectively, Ng advises that it’s import-ant to know some key numbers – blood pressure, cholesterol, blood sugar and body mass index (BMI). However, many patients don’t always under-stand what the numbers mean. “It’s crucial that they understand what’s happening inside their bodies,” he says. “A proactive approach to health really works, so it’s important to know basic information.”

At many pharmacies, blood pressure and blood sugar testing can be done right onsite. Pharmacists will review the data from logbooks offered to patients to keep track of their blood pressure readings and can discuss results. This helps iden-tify risk factors, an important measure in disease prevention.

By Michele sponagle

Heart Of The Matter

“Looking at a patient’s total health profile is something pharmacists can do. More than just addressing symptoms, proper healthcare is about looking at underlying conditions and future prevention.”

New Risk Factors For Women Underscore The Need For Greater Awareness Of Heart Disease

Pharmacists Play A Key Role In Providing Patients With Heart Health Information

“I went from quite fine to nearly dead in 30 minutes.”

innovation

10 personalhealthnews.ca

when carol Johnson found out she needed an implantable cardioverter defibrillator (IcD), a device that prevents death from sudden cardiac arrest, she did a lot of research.

She decided she wanted to get the new-est version of the device and wouldn’t take no for an answer. Johnson, who suffered three heart attacks before hav-ing bypass surgery in 1999, was delight-ed when she finally found a cardiolo-gist who would refer her to a specialist that could implant the device.

In March 2014, Dr. Jeff Healey, an associate professor in the Division of Cardiology, Department of Medicine at McMaster University, fitted Johnson with the subcutaneous implantable cardioverter defibrillator (S-ICD).

Unlike the traditional ICD, which is implanted in the shoulder area and uses leads (wires with electrodes) that extend through the veins into the heart to monitor its rhythm, the S-ICD is im-planted on the side of the chest and the leads are placed under the skin above the breastbone with no components of the S-ICD entering the blood vessels or the heart.

Like many people using the new de-vice, Johnson is happy with it. “For the first few days after the procedure, I walked around worried that I would get a shock any second but then I got used to it,” says the 72-year-old. “Now, I don’t even notice it’s there.”

Undeniable benefitsUse of the traditional ICD became widespread in the late 1990s, more than two decades after it was pioneered by a team of doctors at a hospital in Balti-more, Md. The battery-powered device keeps track of the patient’s heart rate and if it detects an abnormal one, it delivers an electric shock through the leads to restore a normal rate. Without this help, the patient’s heart could stop beating altogether.

Sudden cardiac arrest is a medical emergency. If not treated immediately,

it causes death. It’s one of the leading causes of death among adults over the age of 40.

ICDs have proven very effective in preventing sudden cardiac arrest in pa-tients with various heart conditions. Studies indicate ICDs have a role in pre-venting cardiac arrest in patients who are at risk of having (but have not yet had) life-threatening ventricular ar-rhythmias, which are abnormal heart rhythms that originate in the bottom chambers of the heart.

The ICD also has the ability to func-tion as a pacemaker. In this capacity it can make sure the heart does not beat too slowly and can correct cer-tain types of inappropriate fast heart rhythms.

Use of the traditional ICD has un-deniable benefits but it also has some drawbacks, including possible vascular obstruction (decreased blood flow caused by the obstruction of blood vessels), thrombosis (a clot formed in a blood vessel or heart) and even cardiac perforation (hole in the heart).

Also, it is possible that after a number of years traditional leads may break, which could result in in-appropriate shocks from the ICD or an inability to deliver a life-saving shock. This means some patients may need to have them replaced sev-eral times over the course of their lives. If removal of old leads is need-ed, the procedure can be challenging

and can lead to complications, in-cluding death.

Furthermore, some patients have blocked veins, recurring heart infec-tions and other conditions that rule out the use of a traditional ICD altogether.

a “simple, elegant” solutionThe S-ICD provides the benefits of the traditional ICD without many of the

drawbacks because it leaves the heart and blood vessels alone and intact — so, although it can’t function as a pace-maker, it’s a better option for many heart patients like Johnson.

Also, the device is placed under the armpit, where it can’t be seen while the patient is wearing street clothes, and this makes it especially appealing to fashion-conscious women. Healey de-scribes it as “a simple, elegant solution” for many people.

He emphasizes that by preventing sudden cardiac arrest, ICDs “really do save lives.” He adds that heart patients in Canada have access to quite a few specialists who “are educated about the S-ICD and are good at implanting it.”

Great sense of securityJohnson and her husband Jerry Ran-dall, 69, were installing a sunroof in their trailer in July when they received more heart related news. A medical exam revealed that Jerry, who had suf-fered a massive heart attack in 1991, al-so needed an ICD.

Encouraged by his wife’s glowing reviews and a preference for getting a device to protect him against sudden cardiac arrest that didn’t have to go in-to heart, he requested the S-ICD. Hea-ley performed the procedure and the couple became the first husband-wife team in Canada to both get the new de-vice. Randall’s experience with it has been as positive as that of his wife, who praises Healey for his ability to explain medical procedures and devices in plain language.

“Jerry got his device put in a few weeks ago and he is doing well. I am fine too,” says Johnson, who recently spent a weekend camping in her trail-er near Peterborough, On., along with her husband and other family mem-bers. “With the S-ICD we can still enjoy life’s activities and we feel com-fortable while doing so. This increased sense of security is just great.”

By randi Druzin

A “Simple, Elegant” New Device Saves Heart Patients’ Lives

Transvenous ICD System(electrical wires placed through

the veins into the heart)

IMPLANTABLE DEFIBRILLATOR OPTIONS

Subcutaneous ICD System(electrode placed under the skin

with nothing inside the heart)

carol Johnson and her husband Jerry Randall both have S-ICDS and live life to the fullest. Photo: Submitted.

PersPective

MEDIAPLANET 11

Approximately 40 percent of Canadians will be diagnosed with cancer at some point in their lifetime however there is reason for optimism.

Modern treatment strategies have led to improvement in the chances of surviving a diagnosis of cancer; the five-year surviv-al for early stage breast cancer increased from 79 percent in 1990 to 88 percent in 2012 and similar improvements have been seen with other cancers including non-Hodgkins lymphoma and testicular cancer. Modern cancer treatments how-ever can come at a cost.

Cardiotoxicity, a relatively new term in the medical literature, refers to the impact of cancer therapies on the heart and cardiovascular system. Cardiac complications from cancer treatments can result from multiple factors includ-ing: pre-existing patient factors (e.g high blood pressure), cancer-related factors, and toxic effects of the chemo-therapy drugs. Cardiotoxic manifesta-tions of cancer therapy include left ven-tricular dysfunction (decrease in car-diac contractile function) and heart failure (clinical syndrome resulting from the inability of the heart to supply sufficient blood flow to meet the body’s needs), myocardial ischemia, infarc-tion, hypertension, and bradycardia (low heart rate).

A new branch of medicineCardiotoxicity is now recognized as a leading cause of long-term morbid-ity and is the second leading cause of death among cancer survivors. The in-creasing awareness by healthcare pro-viders of the potential negative impact

of cancer treatments on cardiovascu-lar health has resulted in the develop-ment of a new branch of medicine – Cardio-oncology. Cardio-oncology is a multidisciplinary approach, involv-ing oncologists, cardiologists, phar-macists, nurses and other allied health care providers, developed to provide patients with the best cancer treat-ments available without negatively impacting cardiac health. For patients “at risk” or with a history of heart dis-ease, oncologists and cardiologists work together to develop strategies to avoid or minimize cardiac complica-tions related to cancer treatment.

A collaborative approachOur population is aging: many Can-adians will face a diagnosis of heart disease, cancer or both. Working together we can strive to provide in-dividuals with “state of the art” can-cer therapy while optimizing cardiac health – the cured cancer patient of today does not want to become the heart failure patient of tomorrow. This integrated multidisciplinary ap-proach, has resulted in the establish-ment of several cardio-oncology pro-grams in Canada, the United States, Europe and South America.

While our understanding of how modern cancer therapies impact the heart continues to evolve, many know-ledge gaps persist: how can we predict who will develop cardiotoxicity, what is the best prevention strategy, how should we monitor those at risk of cardiotoxicity and what are the best management strategies? There is an urgent need for collaborative studies to address these questions. Organiza-tions such as the Canadian Cardio-vascular Society (CCS), Canadian Car-diac Oncology Network and the Inter-national Cardiooncology Society, will play an important role in the promo-tion of clinical care models, develop-ment of educational programs (for pa-tients and healthcare providers) and facilitation and promotion of evi-dence-based research.

By Dr. Susan DentMedical Oncologist, Depart-ment of Medicine Associate Professor, University of Ottawa Founder and Director, Canadi-an Cardiac Oncology Network

“Cardiotoxicity is now recognized as a leading cause of long-term morbidity and is the second leading cause of death among cancer survivors.”

A New Approach to Treating CHF

Cancer And Heart Disease: Should We Be Concerned?

Congestive Heart Fai-lure (CHF), the con-dition where your heart can’t pump enough blood to meet the demands of your body, has

reached epidemic proportions in Ca-nada with an estimated 1 in 60 people living with it and a national cost to healthcare of at least $3 billion. CHF is the single commonest reason a pa-tient goes to a hospital ER for treat-ment and the single commonest diag-nosis for hospital admission. What’s more, the average life expectancy af-ter a CHF diagnosis is a mere 2.1 years.

Expert insightRecently, two of Canada’s leading cardi-ologists, Ontario Association of Cardiol-ogists (OAC) Board Members Dr. Heather Ross and Dr. Mike Hartleib were inter-viewed to discuss the size of the problem, the enormous healthcare costs associat-ed with it and new ways of approaching CHF to save lives and save money.

“Heart failure is an epidemic. But, it isn’t just a problem for the healthcare system. This is an incredible burden on the patient, their family and their care-givers. We want to, and have to, be able to change that,” said Dr. Ross.

“Both Heather and I work in com-munity care and large hospital environ-ments and we know first-hand that the hospital environment is not always the best place to treat CHF. It’s huge-ly expensive and often adds stress that is more difficult for patients and their families to manage,” says Dr. Hartleib.

“For sure there are times when the

hospital environment is absolutely needed but the goal should be to keep people away from the ER by providing early diagnosis, rapid access to care and support for patient self-management in a far more cost-effective setting than a hospital. And after someone has been treated in hospital, we want to keep them out, to make recovery easier for them and less costly for the system.”

Dr. Hartleib continues, “did you know the cost of treating uncomplic-ated CHF in hospital starts at $12,000 and if it is complicated it can easily rise to at least $42,000?”

New strategy for CHFIn Dr. Ross’ opinion, a new approach is needed. “Given the stark patient out-comes and health system costs associ-ated with CHF, governments across the country must consider funding new ap-proaches to CHF care aimed at keeping patients out of hospital and receiving care closer to home.”

This is at the core of a recent OAC proposal to the Ontario government called the CHF Regional Hubs Initia-tive. It addresses the gap that cur-rently exists between hospital and community-based care. It ensures

timely cardiac specialist expertise is available in the community to high-risk CHF patients recently discharged from the hospital.

“When you put together a program like this, you look to the literature which shows that early access to care, to the health team, rapid response for patients, early access post-discharge… all have been shown to improve outcomes for pa-tients,” Dr. Ross observed. “It is the right care, for the right patient, at the right time, by the right person and that’s what we are trying to do with the Regional Hubs project,” she adds.

The OAC represents the majority of cardiologists in Ontario and is one of the most knowledgeable groups on issues of cardiac care in the province. It continues to meet with the provincial government to offer its expertise in car-diac care in order save dollars and lives. This fall it will launch a public cam-paign to increase awareness of CHF and new methods of treatment.

ontarioheartdoctors.ca

CHF is Killing Us Physically & Financially

A Practical Community Care Solution is Needed

Learn more at: ontarioheartdoctors.ca/stories/chf-hubs/

OAC members researching the effectiveness of a community approach to CHF in Ontario. Photo: Submitted

INSIGHT

12 personalhealthnews.ca

www.bayer.ca

® Bayer and Bayer Cross are registered trademarks of Bayer AG, used under licence by Bayer Inc.Science For A Better Life

Science For a Better Life — It’s our promise and our commitment to all Canadians. Every day, we put science to work to improve the quality of life for people, for animals and for communities.

Our innovations in healthcare lead to breakthroughs that fight diseases and offer healthier alternatives to existing treatments. Our advances in crop science and animal health protect our food supply and improve nutrition. Our high-tech, high-performance materials improve the design and functionality of products we all use regularly.

Who is Bayer? We’re Canadians, we’re inventors. Together, we’re making life better for everyone.

Atrial fibrillation (AF) is a heart condition affecting roughly three percent of all North Americans. AF is characterized by irre-

gular or rapid beating of the heart, and it can lead to serious complications such as stroke. For people suffering from AF, it can be both confusing and frightening.

When Alice first experienced symp-toms of AF, she was sitting on her couch watching TV and suddenly felt her heart racing as though she were running a marathon. She was prompt-ly diagnosed at the ER, but in many ways that was the beginning, not the end, of her troubles. Suggestions from doctors on how to manage her AF seemed to vary with each new doctor she talked to.

At the heart of the matter are the many faces of AF. The potential caus-es of AF are wide-ranging, and the ideal treatment for each individual can be equally varied. Uncertainty about treatment leads to fear. “For the first while I didn’t want my husband to leave the house,” says Alice. “That’s how afraid I was of it.”

convenience and compliance: just as vital as efficacyHistorically, the AF drug of choice has been Warfarin, an anticoagulant. It’s a very effective drug, in use since the 50s, but it has its downsides. There are people who are resistant to it, or who have drug-drug interactions, but most importantly it requires constant mon-itoring of blood thinning levels, which means frequent trips to labs for testing. For many Canadians, this is a substan-tial hardship in terms of time off work as well as travel time and expenses, es-pecially for more remote patients who must travel long distances for lab work.

“Because Warfarin is such a pain in the neck, we had a pretty high bar a pa-

tient had to clear before we would begin on anti-coagulants,” says Dr. Jafna Cox, who has been heavily involved in the development of national guidelines for the treatment of atrial fibrillation. A new class of drugs, known as novel oral anticoagulants (NOACs), however is changing the landscape. “At the end of the day, they are not that much more ef-fective than Warfarin, but what they do offer is marked ease of use. They’re easi-er to take and thus hopefully have better patient compliance.”

And with AF, drug compliance is of paramount importance. A recent study of AF patients in Ontario found that 61 percent stopped taking the drugs with-in five years, drastically increasing their risk of stroke. Furthermore, AF strokes tend to be both larger and more con-sequential than non-AF strokes, with a substantially higher rate of both mor-tality and permanent incapacitation.

real world data trumps allSo, if NOACs can improve compliance, and convenience, without sacrificing efficacy, they have the potential to be a

game changer. As with any new treat-ment, of course, the true test comes from real-life data. “Often in clinical trials, out of 100 patients that you screen, you may only have five accepted into the study because you have exclusion criteria af-ter exclusion criteria,” says Dr. Cox. “So you always wonder, do you have patients that are too uncomplicated, with too few other conditions?”

As these new drugs make their way into clinical use, the good news is that the real-life data is beginning to re-affirm the safety and efficacy of the NOACs that was seen in the clinical trials, with a safety profile substantial-ly better than Warfarin’s. While NOACs will not be the answer for every pa-tient, they benefit everyone by expand-ing the toolkit available to physicians. This is great news for patients like Alice who now have new options for manag-ing their life with atrial fibrillation.

By D.F. Mccourt

Atrial Fibrillation: The Value of Options

350,000 Canadians

20%66%

Atrial Fibrillation affects approximately

It is estimated that

of all strokes are caused by atrial fibrillation

Hospital admissions for atrialfibrillation have increa-sed by

Clinical Trials Real-life Evidence

How Real-life Evidence Is Making A Difference In Atrial Fibrillation

Objective

Test safety and efficacy of a drug vs. a comparator

Understand patterns of use of a medication in clinical practice

Setting

Controlled clinical trials Real-life clinical practice

Subjects

Highly selected by applying many inclusion/exclusion

criteria

Less selected as there are very few inclusion/exclusion criteria

Uses of data

Determine efficacy and safety of drug before it can be used in clinical practice

Monitor and report on effectiveness and safety of drug after it is approved for use

Treatment

Pre-specified regimen Flexible regimen

Sources: Heart & Stroke Foundation, European Heart Rhythm Association