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Cardiac Sciences Annual Report

2017-2018

Department of Cardiac Sciences

Table of Contents1.0 Executive Summary 1 Department Structure and Organization 1 Accomplishments and Highlights 1 Challenges and Opportunities 4 Quality Assurance and Improvement 52.0 Department and Institute Organization Partnerships 52.1 Libin Cardiovascular Institute of Alberta 72.2 Clinical Department of Cardiac Sciences 82.3 Academic Department of Cardiac Sciences 92.4 Strategic Cardiac and Stroke Clinical Network (SCN) 93.0 Clinical Services 93.1 Sites and Personal Care Units (PCUs) 93.1.1 Foothills Medical Centre 93.1.2 Peter Lougheed Centre 133.1.3 Rockyview General Hospital 143.1.4 South Health Campus 153.2 Cardiology Division Overview 173.3 Cardiac Surgery Division Overview 193.3.1 Advanced Heart Failure and Mechanical Circulatory Support 213.4 Cardiac Critical Care Division Overview 223.5 Cardiac Anesthesia Division Overview 223.6 Diagnostic and Treatment Areas 253.6.1 Coronary Artery Disease 253.6.2 Electrophysiology 263.6.3 Cardiac Imaging 293.6.4 Patient Care 313.6.5 APPROACH 333.6.6 Valvular Heart Disease 343.6.7 Endovascular 354.0 Education 364.1 Cardiology Core Training Program 364.2 Cardiac Surgery Core Training Program 404.4 Post Graduate Medical Education 404.5 Cardiac Sciences Grand Rounds 415.0 Research 446.0 Community Engagement 457.0 Quality Assurance and Quality Improvement 468.0 Highlights and Awards 488.1 Clinical Highlights 488.2 2016 – 2017 Libin Award Recipients 488.3 Clinical Interaction and Awards 489.0 Challenges and Opportunities 499.1 Space and Resources 499.2 Leadership and Organizational Structure 509.3 Alberta Innovates – Health Solutions 519.4 Peer Reviewed Funding 51


9.5 Introduction of New Technology 5110.0 Workforce Planning 5211.0 Goals from 2016 – 2017 and Future Priorities for 2017 – 2018 5212.0 Appendices 5412.1 Libin Cardiovascular Institute of Alberta Organizational Chart 5412.2 Clinical Services Council Membership 5412.3 Alberta Health Services – Calgary Zone, Clinical Department of Cardiac Sciences 55 Division of Cardiac Surgery 58 Division of Cardiac Anesthesia 59 Division of Cardiac Critical Care 5912.4 APPROACH 6012.5 Calgary Zone Organizational Charts 6512.6 Experiences from the Cardio-Oncology Clinic at SHC 6712.7 Publications 6812.8 Libin Annual Report - Research, Space, Teaching, and Grants 10313.0 Tables 10813.1 Research Activity Calendar Year 2015 – 2016 10813.2 Libin Research Revenue for Fiscal Year End March 2016 10913.3 Facilities and Services by Site 11013.4 Division of Cardiac Surgery Workload 11413.5 Cardiac Cath lab Workload 11613.6 Arrhythmia Workload 11713.7 Cardiovascular Diagnostics Zonal Workload 11813.8 Specialized Ambulatory Clinic Visits by Site 126


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1.0 Executive SummaryDepartment Structure and Organization

As a partnership between Alberta Health Services and the University of Calgary, the Libin Cardiovascular Institute (175 members) is responsible for the management and co-ordination of cardiovascular wellness, care, research, and education in Calgary. The Libin Cardiovascular Institute is a wide-ranging program of cardiovascular integration that includes four University of Calgary faculties, ten Faculty of Medicine departments, four Alberta Health Services clinical departments, and five AHS hospitals that are working together to advance the cardiovascular health of Albertans. The Department of Cardiac Sciences includes two primary sections: Cardi-ology (78 members) and Cardiac Surgery (10 members) along with individuals cross-appointed from Cardiac Intensive Care (10 members) and Cardiac Anesthesia (six members).

Accomplishments and Highlights

The Department continues to provide excellent cardiovascular care, research and education. There were a number of developments to highlight including:

• Quality improvement and assurance work including Choosing Wisely reduction in ECGs ordered, expansion of this to other areas• Clinical Informatics work on Bioscope – data reporting and analysis• Establishment of the Cardiac Sciences Intranet• Successful bedside physician and NP program – nearly 100% evening and weekend coverage• Enhanced community and partnership engagement within the Institute – third annual Libin gala and family zoo events• Continued philanthropic support for research priorities• Increased funds for graduate science education• Success of clinical trainees in cardiology and cardiac surgery• Increase in research productivity • Stephenson Cardiac Imaging Centre –research registry (CIROC with > 5,000 patients enrolled)• Completion of the research strategic plan• Numerous individual awards for Department and Institute members• Successful Libin Research Day• Successful recruitment (>10 recruitments in past year)

The Libin Institute, and hence Department, continue to be proud of and excited about their achievements in all spheres of cardiovascular influence. The Institute’s strength is in its people and their unified, integrated, and multidisciplinary approach to meeting goals and objectives. We would like to thank all of the Institute’s physicians, nurses, technical personnel, staff, support-ers, friends, administrative leads and colleagues for their continued interest and contributions to the Department’s and Institute’s work and dreams. Augmenting engagement at all levels remains a key priority for leadership.


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Much work has been done in the clinical domain. Wait times for urgent assessment are gener-ally less than 10 days – through Rapid Access Chest (RAC) Pain and Cardiology clinics run by TotalCardiology as well as cardiology navigation (orchestrated from FMC). Consultations are also seen quickly by C-ERA clinic, which is an entity outside of the Department and Institute structure. New clinic development at the SHC has eased space issues for some referrals and the creation of a Fabry’s disease clinic is a new addition in the last year. It had been our hope to begin a satellite clinic of the RAC clinic at the SHC but this has been delayed until later this fall.

The growth in clinical volume was nicely looked after by the members. Clinic visit volumes have in general increased by up to 10% over the past year. Happily, the growth in testing has been less than this through awareness. For example the number of coronary angiograms increased by about 2.5% but PCI growth was flat. Ablation procedures and pacemaker numbers were decreased by a small amount. Echocardiography volume was stable (21,200 to 21,400). Hospital volume is somewhat fixed due to technologist and room capacity. Volume of all testing con-tinues to be on our radar and appropriateness will be evaluated by ongoing Choosing Wisely type initiatives. ECG growth will be the first pilot project with expansion to other areas during the next year. We are happy to report that ECG numbers did not grow in the past year (stable at 239,000 for the past two years). Several projects are now underway to evaluate cardiac imaging appropriateness in some key areas including acute coronary syndromes.

Wait times for cardiac catheterization has been closely tracked with central triage and Bioscope reporting. The wait for inpatient procedures is in the 2-3 day range and 2-3 weeks for outpatient procedures. The wait times are longer for the minority of members who have not been using central triage for outpatient catheterization bookings. The wait times for some electrophysiology procedures including AFib ablations has increased and will be reviewed this year by Dr. Morillo.

Keynote speaker Milica Radisic, PhD, poses with Eldon Smith, MD, namesake of the Dr. E.R. Smith Lectureship at the Libin Institute’s Tine Haworth Cardiovascular Research Day 2017, held on April 6, 2017 at the University of Calgary’s Foothills Campus.


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The problem area in the past year has been cardiac surgery and structural interventional procedures. As outlined in the report the number of patients on the cardiac surgery wait-list has increased from a low of about 110 (June 2016) to 285 a year later. This has been due to an increase in referral volume leading to longer than usual wait-list in the hospital (25-40 inpa-tients). This created an overall significant increase in our wait times in all categories of cardiac surgery. There has been some adverse events on the wait-list for subjects waiting. Work has been done with senior management to address this concern.

Similarly the TAVR program has been very successful. Procedures are now being done less invasively without the need for full cardio-pulmonary bypass support. Some procedures will be performed in the catheterization laboratory to help deal with inpatients who have urgent TAVR needs. The number of referrals, wait-list and waiting times (mean wait time increased from 20 to 36 weeks) have all increased significantly in the past year. An increase in volume has been requested in both Calgary and Edmonton and partial approval for this fiscal year has occurred.

Expansion of our same day discharge policy for coronary angioplasty and EP device implants has also moved forward. This is expected to save us a large number of bed days within the cardiology bed map, particularly at the FMC site.

Many members of the Department are actively involved in the Cardiovascular Health and Stroke Strategic Clincial Network. The SCN has finished up work on the priority projects in vascular risk reduction. There is ongoing work in acute coronary syndromes, heart failure, chest pain assessment and electrophysiology. There is also much work on quality indicators with some dashboards (Tableau) being developed. Dr. James Stone has taken on the medical director role of the SCN.

Thirty members of the Section of Cardiology (28.75 FTE) were participating physicians in the Department of Medicine’s Academic Alternate Relationship Plan. The Division of Cardiac Surgery has a total membership which was increased to 10.7 FTEs at the end of the fiscal year. This allowed for new recruitment into the section. The group now has a full compliment.

The Division of Cardiology continues to support 12-13 core residents in cardiology and numer-ous subspecialty fellows (10-12). The Cardiac Surgery Program is highly successful and in high demand by potential applicants. It was successful in its most recent accreditation review and now has six residents enrolled in a six year program. All of our cardiology and cardiac surgery trainees were successful in completing their Royal College examinations in the past year.

Through the Faculty of Graduate Studies, there are about 50 graduate students working with Libin members. These individuals are predominantly in the Cardio-Respiratory Program that is headed by Dr. Andrew Braun as well as Community Health Sciences. We have begun a process to review GSE course delivery and organizational structure.

The Department is actively involved in research activities. Libin members brought in about $21M in funding in the past year ($9M for Department members). The amount of funding and number of research papers per FTE is about 50% higher than the CSM average. The total number of manuscripts for members of the Cardiac Sciences department was 236. In total, Libin Institute members published 607 manuscripts.


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We have completed our 2017-2022 strategic plan. The planning process involved widespread consultation. We will align fund raising, allocation of money and space and recruitment decisions around the plan. The research priorities will focus on EP/autonomic dysfunction and

vascular health. The enabling platforms will include APPROACH and the Stephenson Cardiac Imaging Centre. Many of the research groups have had successful retreats to date and several more are planned in the next 6 months. The Institute will have an International Expert Adviso-ry Committee meeting in late Sept 2017 to review the strategic plan and its implementation.

Challenges and Opportunities

Many of the challenges are similar to previous years. Budgets are tight in all areas. We have been trying to focus on using this as an opportunity to improve efficiency and evaluate every-thing that we do with respect to appropriateness. Recruitment remains our biggest need and priority in both the Department and for PhD scientists within the Institute. We have had a very successful year in this regard and look forward to completing our scientist recruits in the next cycle. Aggressive recruitment is required to keep pace with the number of impending retire-ments we have had and will have in the next year.

Research funding remains very difficult to obtain, but there are many opportunities at Alberta Innovates-Health Solutions, CIHR, and the HSF. An increase in bridge funding for scientists who are not successful at CIHR will continue to be helpful. We are excited by the recruitment of 4 PhD scientists to date with two more scheduled in the next year.

Capacity issues remain a large problem across the region and is not novel in our area. The major concern as discussed above remains the wait list for individuals awaiting cardiac surgery and interventions for aortic valve disease (TAVR).


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Quality Assurance and Improvement

Quality improvement projects have allowed us to move towards central triage and wait-list management in a number of areas including outpatient referrals, cardiac surgery, cardiac cath-eterization laboratory, and electrophysiology studies to name a few. The implementation of the Bioscope reporting system within Tableau allows us to track a number of metrics on a monthly basis. Great work has been done by the bioinformatics team to track procedure volumes and wait times. We have expanded this work to track outcomes starting with cardiac surgery procedures. We are also evaluating all of our order sets to minimize redundant diagnostic and laboratory testing. Care pathway development will be orchestrated through the SCNs and CHF has been identified as a priority for the newly developed provincial Care Pathway group.

Important process improvements have been implemented through case review in the cardi-ac sciences QAC. These have mainly been related to adverse events related to undo delay in evaluation or procedures. Our members have had a very successful year and we look forward to great things in the future. Personally, I appreciate the dedicated team within the Department and Institute that I have the pleasure of working with on a daily basis.

2.0 Department and Institute Organization Partnerships2016/17 was a year of reinvigoration and rejuvenation for the Libin Cardiovascular Institute of Alberta, marked by a new strategic research plan led by Deputy Director Dr. Anne Gillis, and by a number of exceptional recruits across our two research priorities: vascular health and


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disease and cardiac electrophysiology and autonomic dysfunction. The plan provides a vision and frame for the next five years and was the culmination of extensive engagement within and outside of the Institute.

At the executive level, the addition of syncope clinician-scientist Dr. Carlos Morillo as the new cardiology section chief adds to what was already an internationally formidable autonom-ic dysfunction research team. Discovery science research in cardiac electrophysiology was reinforced with the addition of Robert Rose at the Associate Professor level, and the addition of Assistant Professors Vaibhav Patel and Jennifer Thompson is equally exciting for vascular biology. Further recruitments continue, with Assistant Professor Aaron Philips slated to arrive in the third quarter of 2017 and ongoing work to attract and secure big data and advanced imaging researchers in the coming year.

Libin Institute researchers continue to perform extremely well among their national and international peers, with doctors Robert Sheldon and L. Brent Mitchell receiving the Canadian Cardiovascular Society Annual Achievement Award and the Canadian Heart Rhythm Society

Annual Achievement Award, respectively, and Dr. Carlos Morillo recognized with the Golden Caliper Award from the Latin American Pacing/EP Society & Brazilian Society of Cardiac Arrhythmias. Nephrology stalwarts doctors Brenda Hemmelgarn and Braden Manns were awarded the Kidney Foundation of Canada Medal for Research Excellence rounding out only a sample of external recognition of Institute members.

Unique among recognition received by Libin Institute members was the invitation to Dr. D. George Wyse to deliver the University of Cal-gary’s Lecture of a Lifetime, not only highlight-ing a remarkable career as a clinician-scientist, but also as a mentor and as someone who con-veys wisdom. The event drew a live audience of more than 500 members of the Calgary commu-

nity, including current and past members of the University’s executive, board of governors and senate, as well as chancellors from the University of Alberta and University of Lethbridge. A video of the lecture has been viewed several hundred times and been highlighted by a number of national entities within the cardiovascular arena and internationally by the Heart Rhythm Society of which Dr. Wyse is a Distinguished Scientist.

Looking forward, the Institute will catalyze our strategic research plan with the development and execution of an implementation plan, and the synthesis of a case for support being led by the Cumming School of Medicine’s fund development team with added support from other theme-affiliated faculties within the University of Calgary and the Calgary Health Trust. The Institute’s role remains to enable and enhance exceptional cardiovascular education, research and care delivery innovation, integrating these pillars where possible. This task, as with all lofty endeavours, is and will remain built on partnership and hard work within a context of overlapping mandates.

Dr. Todd AndersonLibin Institute Director


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2.1 Libin Cardiovascular Institute of Alberta

The Libin Cardiovascu-lar Institute of Alberta (LCIA) is an entity of the University of Calgary and Alberta Health Services. As defined in the Mem-orandum of Under-standing (MOU), the Institute coordinates all cardiovascular health care, education, and research throughout the University of Cal-gary and the Calgary Zone of Alberta Health

Services. The MOU also stipulates that the Head of the Clinical and Academic Departments of Cardiac Sciences shall be the Director of the LCIA (currently Dr. Todd J. Anderson), and as such the Clinical and Academic Departments of Cardiac Sciences in entirety are sub-elements of the Institute.

Professor Emeritus and world-renowned cardiologist Dr. George Wyse delivers the 10th annual Lecture of a Lifetime in front of a sold-out crowd at the University of Calgary’s MacEwan Hall on May 16, 2017. Photo by A. Shellard.


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The Institute celebrated its 14th Anniversary on January 27, 2017 and its membership remains strong at more than 175 multidisciplinary members including physicians, basic science re-searchers, nurses, engineers, technicians, veterinarians, and others with interests in cardiovas-cular health, care, research, and education representing five faculties and nine different Faculty of Medicine Departments.

The Institute is guided by a Strategic Advisory Board (chair Dr. Eldon Smith), and is directed by an Executive committee chaired by the Director. In addition to the Director, the Executive comprises the respective chairs of the Institute’s Clinical, Research and Education Committees, along with department and division heads, and a selection of senior Institute members. There is also a Research Committee (chaired by Dr. Anne Gillis – Deputy Director Libin) and an Education Committee (chaired by Dr. Sophia Ahmed). Terms of reference exist for each of these groups. The remainder of the Libin leadership team includes Al-Karim Walli, Associate Director and Myrna Linder, Fund Development CSM.

The Libin Institute staff includes Judy Siu – research, Melanie Yar Khan – community engage-ment and Dawn Smith – communications. Over the past year we have had administrative support from Vaska Saydina, Leslie Campbell and currently Shamima Chowdhury.

2.2 Clinical Department of Cardiac Sciences

The Clinical Department of Cardiac Sciences is 14 years old and is dedicated to the pursuit of integrated, coordinat-ed, and quality patient care for cardiac patients in concert with the Libin Institute. The Department is led by the dyad of Caroline Hatcher, Executive Di-rector and Todd Anderson, Department Head. The attached organizational chart (Appendix 12.4) reflects the Clin-ical Department of Cardiac Sciences from the physician perspective only. The Department Head reports to the Calgary Zone dyad leadership of Dr. Sid Viner and Brenda Hubband. During the

2016-2017 year, the Department was guided by a) Clinical Services Council (appendix 12.2) that met five times per year to discuss zonal operational Departmental issues and b) Depart-ment Executive – that consist of Department Head, Executive Directors (four), section chiefs (four), cardiology site leaders (three) and the Department Manager. This group will be tasked with long term strategic planning and two way communication from AHS and AH to various stakeholders within the Department and will meet every two months.

The budget for physician academic salaries, sessional fees for bedside physicians, administra-tive honouraria, and operating support is just over $5 million per annum. The overall budget for cardiac services in the Calgary Zone is in excess of $90 million.

Caroline Hatcher, Executive Director, Foothills Medical Centre


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2.3 Academic Department of Cardiac Sciences

The University of Calgary, Cumming School of Medicine, academic Department of Cardiac Sciences is comprised of the Division of Cardiac Surgery and the Division of Cardiology. The Academic Department is made up of 20 Geographic Full-Time members (16 Cardiology, three Cardiac Surgery, one basic sciences), 15 Major Clinical members (Cardiology), 48 Clinical members (41 Cardiology, seven Cardiac Surgery) and one non-university affiliated member (Cardiology). The structure of the Academic Department of Cardiac Sciences is included in Appendix 12.4.

The Department Head reports to the Dean’s office including Senior Associate Deans in the Research, Education and Clinical Affairs portfolio. Dr. Anderson is currently a member of the University of Calgary Medical Group Executive (Clinical Affairs) and the Planning and Priorities Committee (PPC). He is also a member of the provincial operations committee of the Academic Medicine Framework. Dr. Anne Gillis represents the Libin Institute on the Strategic Research Committee (SRC). Drs. Morillo, Anderson and Dr. Howarth are involved in Univer-sity committees related to the Academic ARP. Dr. Derek Exner was appointed as the Associate Dean of Clinical Trials in 2014. Dr. Lisa Welikovitch was appointed as the Associate Dean of PGME (July 2017) and Dr. Sarah Weeks as the Director of CME (July 2017). This the Depart-ment is well represented within the Cumming School of Medicine leadership structure.

2.4 Strategic Cardiac and Stroke Clinical Network (SCN)

The Cardiovascular Health and Stroke Strategic Clinical Network is headed by Dr. Jim Stone (cardiology, Calgary) and Shelly Valaire. The SCN will be tasked with addressing numerous questions relevant to the province. A key performance indicator framework has been a priority over the last year. Caroline Hatcher represents operations from the Calgary zone and brings her expertise in quality outcomes to this group. New priorities are being developed by the core committee. A number of working groups are working on projects related to heart failure J Howlett), acute chest pain syndromes (A Howarth), acute coronary syndromes (M Traboulsi).

3.0 Clinical Services3.1 Sites and Patient Care Units (PCUs)

3.1.1 Foothills Medical CentreCardiovascular Intensive Care UnitUnit 94 CVICU continues to support the intensive care recovery of post cardiac surgery pa-tients and patients requiring ECMO. The ECLS committee is establishing policy and practice to support ECMO patients for the coming years. Twenty-three ECMO patients were cared for in 2016 and currently eight for 2017. The CVICU has been able to accommodate, without restriction or cancellation, the clinical flow of cardiac surgery patients despite the growing demands required of the Cardiac Surgery program. The CVICU continues to improve the care of post-operative patients. Delirium practices are evolving with the collaborative efforts of the strategic clinical networks.


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In March of 2017 the CVICU adopted an early chest opening (ECO program). This project first consisted of developing a clinical algorithm for the management of the rare instance where a patient suffers a cardiac arrest post open cardiac surgery. 120 medical staff including 84 Nurses, 18 Respiratory Therapists and 26 Physicians were formally introduced and trained specifically for this program. The training was facilitated by newly developed and local simulation exercises (eSIM).

A multidisciplinary review and reconstruction of a CVICU admission orders allowed us to operationalize new treatment strategies and improve other existing ones. In keeping with the )Pan-Canadian choosing wisely campaign we were able to streamline many of our routine bed-side care, testing and monitoring. We are currently studying the impact of those changes. We are embarking in a new project related to the development of decubitus ulcer post-op. We are truly excited as it will consist of collaborative work done by OR, CVICU and unit 91 staff.

Units 81 and 82 Medical Cardiology• Successfully completed the implementation phase of ACP/GCD initiative and cur-rently working on sustaining phase. • Integrated a referral system in collaboration with PCN to ensure that patients with-out family GPs are not being discharged without follow up.• Planning stages to introduce Dubutamine infusion to better support care of advanced heart failure patients. Order set is currently being created and will be followed by staff training. • Optimized master rotations for all level of staffing completed and roll out date will be mid-October to meet OBP targets.• CCC 2016 abstract presentation in Montreal “Highlighting the Importance of Early Recognition of an Aortic Valve Rupture.”• Initiated Journal Club with NP and CNEs to support staff development. • Incorporated E-sim to new hire process to better support hands on approach to learning.

Unit 91 - Cardiac SurgeryUnit 91 continues to be a busy and productive post-operative 38-bed cardiovascular surgical ward. The 12-bed telemetry unit receives patients from the CVICU 24 to 48 hours post-op-erative and continues to monitor them through their recovery process. The staffing model on Unit 91 is a mix of RNs and LPNs with Nurse Practitioners managing and overseeing the care of the CV surgery patients. The unit is supported by the nine CV surgeons. The staff on Unit 91 have a high level of skill in advanced competencies such as pacemaker management, dysrhythmia interpretation, managing chest tubes, and pulling of pacer wires. Critical thinking of each staff member is an important component for managing patients on Unit 91. Some major QI initiatives include development of a CV surgery handover tool (CVICU to PCU 91) and completion of a provincial CV surgery patient education booklet in collaboration with the Mazenkowski Heart Institute in Edmonton.

Cardiovascular Intensive Care Unit (CICU) Unit 103A• Enrollment into the 3M trial (TAVI next day discharge with Edwards balloon ex-pandable valve) has officially closed as of April 14/17 with a total of 423 patients. We enrolled 10 subjects (meeting our prospective commitment).


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Here is a brief summary of our results, including number of patients with next day discharge and ER/hospitalization rates within 30 days of TAVI:-9/10 patients went home next day-1/10 patients went home Day 2 post TAVI: Hospital stay prolonged due to new LBBB within

24 hours of TAVI – resolved by day 2 and sent home with outpatient holter.-4 /10 had ER visit and/or hospitalization within first 30 days post TAVI: fractured fibula, com-plete heart block requiring pacemaker • CICU is in the planning stages for a new initiative with the Southern Alberta Organ and Tissue Donation program. This initiative, Donation after Cardiac Death, has already been introduced in the ICU at the FMC. CICU hopes to be ready by November of this year.• CICU continues to work with the 8th floor to improve patient flow and is working on improving the process for elective procedures for example cardioversions.

Cardiac Specialty Clinics • Rightfax implemented which is a paperless fax system to manage referrals and charts.After over a year of training and preparation, CIED implant procedures were trialed in the EP lab successfully.CIED remote monitoring expanded to the Medicine Hat Regional Hospital. This will allow emergent/urgent device interrogations to be done rurally and reviewed by on-call nurse clini-cians at FMC.Millennium scheduler implemented to manage wait lists. Short Stay Cardiology • Same day discharge post angioplasty and repatriation back to rural sites implemented.In alignment with choosing wisely, post angioplasty blood work has been reduced.Millenium optimization to track workflow through 103B.

Cardiac Cath lab at Foothills Medical Centre


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Cardiac Catheterization LabWait time management and reporting commence for inpatient to align with outpatient central referral model. Triage and unit clerk desk construction on unit to assist with central referral processes. Cross training of Registered nurses and Physiological laboratory technicians allows flexibility in workflow and staffing to optimize patient care.

STEMI program• Catchment area increased to include all STEMI patients being treated in Southern Alber-

ta.• Automation of data retrieval to be commenced in fall STEMI feedback letters provided to

all sites to help improve STEMI care• Rotation Optimization to be commenced over the next year.• Fractional Flow Reserve technology implemented in cath lab to help identify lesions that

require stenting.

Calgary Zone Clinical Informatics The Clinical Informatics group is continuously working to build and lay the essential infor-matics foundation to bring forward the Department’s Clinical Informatics agenda to trans-form clinical data to actionable knowledge while keeping the Departmental Clinical Systems functional and up-to-date. The group is currently governed by the Cardiac Sciences Clinical Informatics Committee which is composed of two working sub groups - Clinical Informat-ics Advisory Group and the Clinical Informatics Team. To be able to expand the role and responsibility of a lean Clinical Informatics group, system support models of the major clinical applications were reviewed and re-modeled to involve other enterprise IT Support groups in the maintenance and administration of our clinical application IT infrastructures.

This year, the Business Intelligence System for Clinical Operation and Process Enhancement

which is designed to be a clinical operations information hub and reporting plat-form, expanded its functionality by implementing a few applications:

• to enhance the operational processes in the domain of clinic referral and service wait time• surgery OR scheduling management and notification• DI interpretation billing• clinical data quality and administrative reporting• system management and resource monitoring

It will continuously expand its functionalities by adding new data sources and addressing the

clinical operation and informational needs for the Department. is built on an Ora-cle web-based industry standard rapid application development (RAD) platform which enables us to have a shorter development time and rapid benefit realization. It is also being prepared to be integrated with Tableau System to address the dash boarding and analytics functional requirements of the platform.

Also, this year we have upgraded a couple of our clinical systems to address system stability, scalability and implementation of new system capabilities. The Cardiac Device Clinic Paceart System was upgraded to the Optima version, was scaled to Red Deer and Lethbridge Cardiac


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Device Clinics, and is known as the Southern Alberta Paceart Optima Instance. The ECG MUSE Application had its major upgrade which includes publication of ECG tracings and reports in PDF format in both SCM and Netcare. Echocardiology Xcelera was upgraded for stability and is being tested to integrate Neonatal’s TNE in GE EchoPacs, Lethbridge Paediatric Echo, and Meditech ADT system. We have also implemented a new hemodynamic system in the new hybrid OR and configured it for scalability.

The Clinical Informatics Group will continue to expand its role and responsibility to address the clinical informatics aspects for the Department operations.

3.1.2 Peter Lougheed Centre Unit 48 – Coronary Care UnitIs the sole stand-alone CCU involved in the provincial Critical Care SCN delirium initiative. The goal is to promote delirium prevention, as-sessment and management strategies, and to decrease the overall occurrence of delirium on the unit. Cur-rent strategies include a focus on non-cardiac pain assessment and manage-

ment, as well as regular daily mobility for all appropriate patients.

CV Labs The Cardiac Function Clinic has been focusing on waitlist management strategies, in alignment with Path to Care, in an effort to deal with continued increases in referral volumes.

Staff from the Cardiac Function Clinic presented at the Canadian Cardiac Council of Nurses conference, on their Report Card Surveillance Program. This program is designed to promote patient self-care and coordinated timely discharge from the clinic.

The Congenital Heart Clinic continues to see growth in clinic size. Over the last year aortop-athy referrals in particular have grown significantly in both number and complexity, related to improvements in genetic testing.

The Hypertrophic Clinic at PLC moved to the South Health Campus in the spring of 2017. This clinic move helps accommodate ongoing growth in other congenital populations at the PLC.

The Congenital Heart Clinic welcomed Dr. Michelle Keir to the team in the spring of 2017. Dr. Stephen Reynolds will also be joining the clinic this winter.


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Unit 49 – Medical CardiologyThe average peak occupancy rate for Unit 49 over the last 12 months has been 130%. The unit has had six unfunded beds consistently open to assist with site capacity challenges. Another four overcapacity beds are utilized as needed.

Implementation of CoACT processes continue on the unit, driven by a strong Quality Council. The Unit 49 Quality Council is very fortunate to have a Patient and Family Advisor in its mem-bership.

All staff received PCA pump certification this year, allowing patients needing PCAs to come to the unit.

Unit 71In the past year, Unit 71 has completed the implementation of Phase 1 CoACT elements, which includes doing bedside shift reports. All of the CoACT elements have been integrated into normal operations and have been well received by both patients and staff.

Heart Failure work is being revitalized through engagement with the Heart Failure Outcomes Improvement Team (OIT). This is an initiative to improve clinical outcomes for the Heart Fail-ure population at RGH, as a pilot site, with the goal of developing tools, care interventions and processes that can be adopted across the province in the future.

RGH Cardiac Func-tion ClinicThe addition of a part time Nurse Clinician has resulted in increased capacity in the clinic, which now manages 296 patients – a significant increase over the previous year. The Clinic team is moving to a single office adjacent to their current space, with will enable greater operational efficiencies and seamless communication among team members. The Clinic

team’s ongoing engagement with the Unit 71 Heart Failure education, the Outcome Improve-ment Team, and Unit Council work are indicators of the contribution this small team makes to the entire site, in addition to their exceptional work supporting Clinic patients.

3.1.3 Rockyview General Hospital


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RGH CV Labs• The General Cardiology Clinics continue to experience significant growth with the addition of Dr. Kristen Lyons joining the team in the Fall of 2016.• We also recently welcomed our new RGH Echocardiography Supervisor, Henryka Stachyra.• RGH is participating in a research study with Dr. Fine: “Real-time Myocardial Perfusion Stress Echocardiography for the Evaluation of Cardiac Allograft Vasculopathy”.• There is a new workflow in place for the inpatient Dobutamine Stress Echo within the RGH CCU. This new process began on April 1, 2017 and as of late July, three studies were completed within CCU.• Under the guidance of the zone’s Echocardiography Clinical Instructor, a zone-wide Quality Improvement initiative is underway involving the Diagnostic Medical Sonographers. The goal is to implement more regular (ie, bi-annual) skill assessments.• A zone-wide working group continues to focus on unifying protocols, process, and standards throughout the zone.

3.1.4 South Health Campus

South Health Campus continues to grow and mature as the newest site for cardiac care in Calgary Zone. The Seton community is quickly becoming a hub for SE Calgary with many commercial and residential sites under development. South Health Campus staff are able to promote innovation and community partnership through several activities, including com-munity gardens, the use of peregrine falcons for pest control, partnership work with nearby seniors facilities along with unique attempts at inpatient capacity management.

The site welcomes Dr. Patrick Champagne as our Cardiac Sciences physician lead beginning in September, and would like to thank Dr. Jonathan Howlett for his support and advocacy over the past several years.

South Health Campus


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Each February, Heart Health Month has grown to be an eagerly anticipated site activity, pro-viding a welcome opportunity to educate staff and public on the importance of wellness, heart health and prevention. Three major events occur. The Stair Challenge invites teams of staff to compete in climbing the most flights of stairs in a two-week period. Competition was stiff again this year with over 100,000 flights of stairs climbed. Every year organizers are remembered and thanked months later for changing personal habits and promoting wellness and a healthy lifestyle.

The Race to the Top, which features elite athletes competing to see who can run up 12 flights of stairs the fastest, became a formal event. The winner this year accomplished this feat in one minute and 11 seconds. We are aware of at least a couple of individuals training for this event already. Public are welcomed to Heart Healthy Family Day, where families are introduces to wellness related activities, educational booths and tips and tricks for leading a healthy lifestyle in a busy family.

Acute CareAcute Care Unit (ACU) 66 is a combined Internal Medicine, Medical Teaching and Cardiolo-gy Unit. The Unit has a Quality Council that meets regularly. Falls reduction, transfer of care and hand hygiene have been major QI focuses for the past year, with significant improvements in each area. The unit is also working on a project to reduce the use of Foley catheters within medical patients. Patient and Family Centred Care is a pillar for South Health Campus. The unit continues to embed PFCC principles in every aspect of their care along with evolved practices in dealing with complex patient and family situations. CoACT continues to evolve resulting in changes to how staff provide care with patients. The unit is focusing on a collabo-rative care model for staff care assignments. A new rotation was implemented to provide the structure needed to work in Care Hubs as well as meet new Operational Best Practice guide-lines.

CCU is a two-bed area embedded with the ICU at South Health Campus. Both beds are rou-tinely full. Staff in the area are cross trained between both ICU and CCU.

Cardiac DiagnosticsEchocardiographyEcho has refined scheduling in order to provide the ability to perform urgent stress echocardio-grams.

Electrocardiography• The ECG department has been working with rural and South Zone partners to electron-

ically transmit Holter data, rather than sending physical SD cards to the site. Progress is being made to review Holter processes for South Zone sites that send data to SHC for reading and interpretation.

• QI projects to review proper lead placement for Holters in remote sites has been effective at reducing the amount of difficult to read data coming to SHC.

• A new rotation has been implemented in order to enhance the number of staff on day shifts and align with similar sites for after-hours staffing.


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Nuclear CardiologyMUGA studies have been introduced providing staff the ability to enhance patient care on site.Work continues to enhance workflows within the area. Staffing will be reduced over the coming year, with the departure of a full time technologist. This person will be replaced two days per week in order to more closely align with the workload for the area.

Cardiac ClinicsCardiac Clinics are anticipating further change in the future with new Operational Best Prac-tice comparisons. Staffing will be adjusted accordingly as people leave or seek reassignment. Vacancies in both Cardiac Function and Cardiac Arrhythmia will not be filled. Activity data collection is a significant improvement project in all clinics, involving several corporate partners in order to ensure that activity data is captured accurately and comparisons made to other areas are equivalent.

SHC welcomed the transfer of the Hypertrophic Cardiomyopathy Clinic from the PLC. This has enabled the clinic to expand and alleviate some of the wait list encountered by patients. Structural Heart expanded with the introduction of a bicuspid valve component, for several patients being considered for surgical intervention.

Fabry’s Cardiomyopathy Clinic was also introduced, providing a place for patients experienc-ing cardiac symptoms to be assessed and seen.

Maria Anwar, Clinic Lead Pharmacist for the Cardio-Oncology Clinic will be presenting a poster at the Global Cardio-Oncology Summit in London, England. This poster presentation summarizes the achievements of the SHC Cardio-Oncology Clinic since inception in 2013 including a data analysis of serial cardiac magnetic resonance imaging to enhance understand-ing of the effect of single agent versus combination chemotherapy on myocardial function and tissue inflammation. Additionally, the findings for cardiotoxicity prevention will also be presented.

Dr. Carlos Morillo, the chief of cardiology, speaks to staff at the Foothills Medical Centre during a meet and greet event on April 4, 2017.


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3.2 Cardiology Division OverviewClinical CardiologyAll four hospital sites experienced high clinical volumes and in-patient capacities this year. In addition, most hospital based clinics were very busy. A few notable findings for the12-month period of April 2016 – March 2017 include: • Growth of the Cardio-Oncology Clinic by 61% (total visits: 1,375). • Growth of the PLC ACHD Clinic by 15% (total visits: 2,369). • Growth of the PLC/SHC Hypertrophic CM Clinic by 30% (total visits: 389). • Growth of the PLC Connective Tissue Clinic by 84% (total visits: 323). •Growth of the RGH and SHC Cardiac Function Clinics by 26% and 23%respectively (total visits: 1,968 and 3,937; respectively) with only minor reductions in the patient volumes at the FMC and PLC sites. I don’t have the updated stats we need these to update this section. Most other clinics, as well as procedures (e.g., Cath, PCI, Ablations, Pacemakers, Devices) had clinical volumes similar to the previous year. Short and Long Term Clinical Activities continued to be overseen by the following divisional committees: (a) The Clinical Advisory Council that is made up of six senior clinical leaders and chaired by the Section Chief. This council met three times for strategic planning exercises – particular-ly relating to issues pertaining to resource allocation and recruitment. A Strategic Planning recruitment DOC retreat is scheduled to take place November 3-4. (b) The “Foothills Allied Service Teams and Extended Region” or (“FASTER”) committee, which consists of clinical leaders from each of the in-patient services at all four hospital sites; as well as leaders of relevant portfolios (e.g., unit manag ers,pharmacy, the training program). This committee met three times to discuss and take action on a variety of important zonal cardiology operational issues. (c) Clinical Coverage Council: On a bi-weekly basis the Clinical Coverage Council representatives (led by Andrew Jenkins, Department Manager - Cardiac Sciences) meet to critically review clinical coverage plans across the zone. Typical functions include organizing the Extender schedule for overnight coverage at all hospital sites, overseeing and expanding the cadre of Clinical Assistants (currently a total of seven, including three physicians previously classified as Ward Physicians). Dr. Andrew Grant plays an important role in managing the recruitment, training curriculum, and coverage schedule for the Clinical Assistants. Administrative Governance: Dr. Sandeep Aggarwal who was appointed the Interim Deputy Section Chief of Cardiology in 2014 was affirmed as the Deputy Section Chief of Cardiology. This is an important and busy position within the Division that involves various functions including: developing clinical guidelines for critical lab value alerts, chairing a clinical working group with cardiac surgery,re-


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view of affinity group leaders, sharing the task of completing reviews that are initiated because of patient concerns, participating in the overview of clinical coverage issues at all four hospi-tals,chairing monthly Division meetings when the Chief is unavailable, etc.

3.3 Cardiac Surgery Division Overview

Rapid changes in the development of PCI and a decrease in overall revascu-larization rates have led to uncertainty in projecting future demand for cor-onary artery bypass surgery. The total number of cardiac surgical procedures performed by the Section of Cardiac Surgery for fiscal year 2016- 2017 was 1293. This represents a 6.6% percent increase in total cardiac surgical case volume relative to the previous fiscal year (1,213 cases). Isolated CABG represented 56.7% (734/1293) of these cases, an increase from 53.8 percent in the previous fiscal year. This increase may be partially explained by the fact that more diabetic patients preferentially are undergoing CABG as opposed to PCI according to

evidence-based guidelines. The number of complex cases involving combined CABG/valve, multiple valves, redos, and aortic surgery continued to increase.

As of March 2017, there are nine clinically active Cardiac Surgeons and two Device Implant Surgeons in the Section of Cardiac Surgery. Dr. Ganesh Shanmugam, a fully trained congenital and adult cardiac surgeon was hired last year to take the surgical lead in the Libin Institute’s electrophysiology program and also to initiate the delivery of basic congenital cardiac surgical services. Since his arrival, our service has managed all patent ductus arteriosis (PDA) cases in Southern Alberta (14), including all neonatal cases. There is now a surgeon on-call for PDA’s on a daily basis. In addition, he has begun performing adult congenital cardiac cases and our intention is to slowly expand these services.

With respect to the surgical electrophysiology program, Dr. Shanmugam, in conjunction with our EP cardiologists has initiated an epicardial LV/RV lead and device implantation program. So far, six procedures have been done with great success. With Dr. Shanmugam’s expertise in congenital cardiac surgery, the EP service has also expanded their pediatric and adult congen-ital cases with 17 procedures being performed and an active waitlist created. In addition, we now have active outpatient clinics at the ACH for non-neonatal PDAs and clinics at the FMC/ACH for adult and pediatric congenital EP cases. Lastly, and again in conjunction with our EP cardiologists, we are hopeful to initiate a formal surgical atrial fibrillation (AF) ablation pro-gram pending approval of funding.

Dr. Imtiaz Ali, Section Chief, Cardiac Surgery


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Twice-weekly multidisciplinary Triage rounds continue to facilitate the discussion of all pa-tients being considered for cardiac surgery. This “Heart Team” approach has been instrumental in making clinically sound decisions for patients being accepted for surgery with respect to the timing of surgery and has also facilitated wise decisions not to operate on those patients deemed to be too high risk. Patients accepted for surgery are assigned a surgeon and queued appropriately according to the clinical scenario. A properly structured Section of Cardiac Sur-gery database has been established and in September 2014 we moved to the web based version of the APPROACH Surgical Module database. Data is now entered prospectively in real time from all cardiac surgery cases by dedicated staff. We now have risk-adjusted outcomes for our group. It is envisioned that as the database matures, CQI projects, and outcomes research will expand.

The Section of Cardiac Surgery has been expanding its services to include surgical approaches to the treatment of heart failure. Dr. William Kent remains the lead of the Surgical Approaches to Heart Failure Program. Ten patients were implanted with long-term LVADs in the last fiscal year. Although not a large volume, our results continue to be exceptional. Dr. Kent is now implanting long-term LVADs with a minimally invasive approach which has facilitated an ex-pedited recovery for our patients and made the eventual transplant procedure in these patients technically less challenging. In addition to the long-term LVADs, we continue to be active with short-term support devices, mainly the C-Mag Levitronix and ECMO.

Dr. Kent, in conjunction with the Heart Failure Team (cardiology, cardiac surgery, intensive care, anesthesia, perfusion), has developed an institutional algorithm for the selection of pa-tients for short-term mechanical circulatory support. The ultimate goal is to select the patients most likely to benefit from this costly technology and maximize survival rates.

ECMO cases decreased slightly to 23 (from 30 in the previous year) and all such cases continue to be vetted through a multidisciplinary team before a decision to proceed is made, in keeping with our Section’s Heart Team approach to patient care. Dr. Kent and Dr. Parhar from the Dept. of Critical Care are in the process of analyzing our Institutional results with all ECMO cases and we look forward to their analysis.

Dr. Fedak leads an active basic science laboratory and has developed a large animal model of systolic heart failure that is being used to study the role of the cardiac extra-cellular matrix (ECM) in the pathogenesis of ventricular remodelling. The results established a proof of con-cept with the ECM and Dr. Fedak has now completed a Phase I clinical trial of an ECM patch as an adjunct to CABG in patients with severe ischemic cardiomyopathy. The results should be available in the near future.

Dr. Fedak is also an International expert in bicuspid aortic valve disease and bicuspid aortopathy. Our Section was delighted to hear that he was the recipient of a nearly $3.5 million NIH research award (in conjunction with colleagues from Northwestern University in Chi-cago) to further his studies with 4-D MRI imaging of patients with bicuspid aortic valve and aortopathy. It is anticipated that this work will further refine the indications for surgery in these patients and allow “patient specific” operations to be performed.

Cardiac Surgery is supported by eight perfusionists, eight cardiac surgical assistants, and sever-al anesthesiology technicians.


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3.3.1 Advanced Heart Failure and Mechanical Circulatory Support

Patients with advanced heart failure represent a growing population. The Mechanical Circula-tory Support Program, led by cardiologist Dr. Deborah Isaac and cardiac surgeon Dr. William Kent, provides both medical and surgical therapy for these critically ill patients. Using devices for temporary and long-term support, heart failure patients are stabilized until they can recover or receive a heart transplant. Our program uses the HVAD, a third generation durable left ventricular assist device, which is implanted in a minimally invasive fashion through a ster-num-sparing left thoracotomy incision. There is evidence that this approach decreases the risk of operative mortality, decreases the risk of blood transfusion and promotes quicker recovery with earlier discharge from hospital.

The program also uses ECMO and the Impella device to support the circulation of patients who present acutely in cardiogenic shock and the Centri-Mag device, which is a centrifugal pump, is implanted in patients in acute, decompensated heart failure who require support for weeks or months until a durable VAD can be implanted or a donor heart can be procured for transplant. The Mechanical Circulatory Support Program applies a team-based multi-disci-plinary approach to the care of heart failure patients.

Recently joining the group from her fellowship at UCLA is cardiologist Dr. Kristin Lyons, who specializes in echocardiograpy and advanced heart failure therapy. The group is presently involved in many clinical trials and cardiac surgeon and scientist, Dr. Paul Fedak, directs a translational research laboratory with a goal to develop innovative therapies, such as epicar-dial infarct repair, which may eventually restore function to the myocardium of heart failure patients.

Minimally Invasive Valve Surgery Program The Minimally Invasive Valve Surgery Program has expanded significantly over the last year. Drs. Andrew Maitland and William Kent provide innovative, leading edge surgical techniques for valve patients in the Calgary region. As the program has grown, minimally invasive aortic valve replacement and mitral valve repair is now offered to the majority of valve patients in Calgary. The minimally invasive technique, which uses sternum-sparing small incisions and thoracoscopic instrumentation, is also used to repair atrial septal defects. With these minimally invasive techniques, patients gain the benefits of less pain, less transfusion, shorter hospital stay and a quicker return to normal activity.

Recent advancements in valve technology have produced rapid deployment, sutureless, bio-prosthetic valves, which facilitate minimally invasive surgery and provide patients the benefit of an aortic valve replacement thorough a right anterior mini-thoracotomy rather than con-ventional sternotomy. The establishment of a dedicated Valve Clinic has also been a significant achievement for the group. Based at the South Health Campus, this multi-disciplinary clinic follows valve patients with echocardiographic and clinical follow-up to minimize the risk of valve-related complications. The clinic also offers an opportunity for research endeavors and, through participation in valve registries and clinical outcome studies, is making a significant contribution to the growing valve literature.


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3.4 Cardiac Critical Care Division Overview

The Cardiovascular Intensive Care Unit (CVICU), Patient Care Unit 94 continues to strive for excellence. The recent unit expansion has been put to good use as the number of cardiac surgeries has increased again this year.

Our dynamic CVICU team has worked very successfully at developing improved clinical path-ways, specifically we have completed the following projects:

• Multidisciplinary transfer tool for CVICU discharge• Mechanical ventilator weaning pathway• Pain and sedation protocol• Identification and management of delirium post op

Next year, quality improvement projects will include the standardization of the management of life threatening ventricular arrhythmia and cardiac arrest post sternotomy. We also wish to work collaboratively with our Edmonton colleagues and develop a programmatic approach to extracorporeal life support (ECMO).

3.5 Cardiac Anesthesia Division Overview

Overview and Administrative Structure The Cardiac Anesthesia Group (CAG) strives for excellence in clinical care, education, and research. Cardiac anesthesiologists hold primary appointments in the Department of Anes-thesiology (Foothills Medical Centre Section) with joint appointments in the Department of Cardiac Sciences. Additionally, all CAG members hold clinical appointments with the Uni-versity of Calgary. The current Director of Cardiac Anesthesia is Dr. Chris Prusinkiewicz. Dr. Prusinkiewicz sits on the Executive Committees of both the Department of Anesthesia and the Department of Cardiac Sciences. Dr. Duc Ha, the Foothills Medical Centre Section Chief, is a member of the CAG. Dr. Alex Gregory serves as both the Director of Cardiac Anesthesia Re-search and the Cardiac Anesthesia Fellowship Program Director. Dr. Doug Seal is the Cardiac Anesthesia Lead for perioperative blood conservation.

All cardiac anesthesiologists are trained in transesophageal echocardiography, have success-fully completed the National Board of Echocardiography Perioperative Examination and have received certification in perioperative TEE as level II echocardiographers from the College of Physicians and Surgeons of Alberta.

There are currently eight active cardiac anesthesiologists, but the CAG is pleased to welcome two additional members in the new academic year. Dr. Nicole Webb is completing her cardiac anesthesia fellowship at the University of Alberta and will be joining the CAG in July 2017. Dr. Chris Noss is completing his cardiac anesthesia fellowship at the University of Calgary and will be joining the CAG in October 2017.

Clinical Practice Members of the CAG work in a multidisciplinary environment to provide anesthetic care for a complex variety of cases in an increasingly elderly population of patients. Anesthesia services


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are provided for procedures such as open-heart surgery, off-pump coronary artery bypass graft-ing, aortic reconstruction with deep hypothermic circulatory arrest, mechanical assist device support, total endovascular aortic repair, tanscatheter aortic valve implantation (TAVI), mini-mally invasive valve surgery and complex pacemaker/implantable defibrillator lead extractions.

Outside the cardiac operating rooms, the CAG provides anesthetics for percutaneous cardiac laboratory procedures such as atrial septal defect closures, perivalvular leak closures, valvu-loplasties, left atrial occlusion device insertion, and complex electrophysiology cases, as well as for select procedures in interventional radiology, such as procedures involving the AngioVac cannula and circuit for the removal of large thrombi from the central venous circulation. Upon request, the CAG also provides care to patients with complex cardiac disease undergoing non-cardiac surgery.

Anesthesiology Workload The CAG provides services for over 1,300 cardiac surgical cases per year and provides addi-tional support for percutaneous cardiac procedures. Three open-heart operating rooms run Monday to Thursday and two open-heart rooms run on Fridays. The CAG covers the Pre-ad-mission Clinic on Tuesdays and is available for inpatient consultations every day. Anesthetic support for complex lead extractions is provided on Wednesdays and Fridays. TAVI cases are done two days per month. Cardiac anesthesiologists provide care for complex electrophysiol-ogy cases, while general anesthesiologists provide services for non-complex electrophysiology cases. Over the last year, the demand for anesthesia services in the electrophysiology laborato-ry has grown.

Education and Cardiac Anesthesia Fellowship The CAG provides a high standard of clinical education. Anesthesia residents rotate through the cardiac operating room in their PYG four-year for two blocks. Off-service trainees rotating with the CAG include fellows from critical care medicine and cardiology. In the past academic year, CAG members have also been responsible for didactic teaching during the anesthesia residency cardiovascular core program. Of note, Dr. Doug Seal was a recipient of an Excellence in Postgraduate Education Award for the 2016-17 academic year from the anesthesia residency program.

The TEE Simulator by Heartworks is located at the Peter Lougheed Centre and is being used to teach anesthesia residents basic TEE prior to their CV Anesthesia and Vascular Anesthesia rotations. An additional educational opportunity in available through the TeachingMedicine.com website, which includes modules on transthoracic and transesophageal echocardiography designed by CAG member Dr. Jason Waecther.

The Cardiac Anesthesia Fellowship Program continues to enjoy success. Following the comple-tion their respective fellowships, Dr. Maxime Thibault will join the Anesthesia Department at the Montreal Heart Institute and Dr. Chris Noss will join the CAG in Calgary. In August 2017, we will welcome Dr. Nadeem Jadavji as the new cardiac anesthesia fellow.

Research • Dr. Alex Gregory is a recipient of the 2017 Dr. Earl Wynands Research Award in Cardio-

vascular Anesthesia from the Canadian Anesthesiologists’ Society. He has also received multiple local grants.


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• Dr. Doug Seal is the project holder of the Foothills Medical Centre Staff Anesthesia Re-search Fund. The fund was established through the generosity of Dr. Tim Tang, a former CAG member. It was developed to promote research in the areas of Cardiac Anesthesia, Patient Outcomes and Quality Improvement.

• The Transfusion Requirements in Cardiac Surgery (TRICS III) trial, a large randomized international study has been completed. With the help of research nurse Karen Meier, Calgary was among the top recruitment sites in the world.

• The CAG will be involved with the Canadian Mitral Research Alliance Trial, a multi-cen-tre, randomized controlled trial designed to compare mitral valve leaflet resection versus leaflet preservation with regards to the development of functional mitral stenosis follow-ing surgical repair of mitral valve prolapse. Members of the CAG also continue to pursue multiple local research projects.

Recent abstracts and publications by members of the CAG include the following:• Campbell E, Miller RJ, Gregory A, Weeks SG. Cardiogenic shock as a complication of Ta-kotsubo cardiomyopathy in a patient with incarcerated bowel. Journal of Cardiothoracic and Vascular Anesthesia. 2017 Feb 1;31(1):243-7.• Guo M, Smith H, Ouzounian M, Boodhwani M, Gregory AJ, Herget EJ, Saczkowski R, Appoo J. How robust are the natural history data of ascending aortic aneurysm? A systematic review and failed meta-analysis. Canadian Journal of Cardiology. 2016 Oct 1;32(10):S270.• Waechter J. Competency by design: when opportunity stops knocking. Canadian Journal of Anesthesia/Journal canadien d’anesthésie. 2017 Mar 1;64(3):325-6.• Smith HN, Boodhwani M, Ouzounian M, Saczkowski R, Gregory AJ, Herget EJ, Appoo JJ. Classification and outcomes of extended arch repair for acute Type A aortic dissection: a systematic review and meta-analysis. Interactive cardiovascular and thoracic surgery. 2017 Mar 1;24(3):450-9.

MIVSAfter starting in January 2012, the Minimally Invasive Valve Surgery (MIVS) program contin-ues to grow. The MIVS cases are done by Drs. Maitland and Kent. Calgary is the first centre in western Canada to have a Cardiac Surgery MIVS program.

CV Anesthesia continues to provide dedicated coverage for an ever increasing number of complex lead extractions. These cases are covered by a multidisciplinary team consisting of CV Anesthesia, EP Cardiology, CV Surgery, perfusion, CV OR nursing, EP nursing, an Anesthesia technologist, and a DI technologist. Anesthesiology Workload In April 2014, an extra 162 cases per year were added. This resulted in three CV ORs Monday to Thursday and two CV ORs on Fridays. TAVI cases were moved to Thursday and lead ex-tractions were moved to Wednesdays and Fridays starting in April 2014. CV Anesthesia covers the Preadmission Clinic on Tuesdays. After completing a series of simulations, the Cardiac Surgery Hybrid OR opened in October 2014. This now facilitates TAVI, TEVAR, CRT, and complex lead extraction cases.

Education / CV Anesthesia Fellowship The Anesthesia residents rotate through the CV OR in their PYG4 year for two blocks. We also have residents and fellows from Critical Care Medicine and Cardiology. The TEE Simulator by


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HEARTWORKSTM is located at the PLC and is being used to teach the Anesthesia residents basic TEE prior to their CV Anesthesia and Vascular Anesthesia rotations. A Cardiac Anesthe-siology Journal Club is held three to four times per year.

ResearchDr. Tang generously created the Foothills Medical Centre Staff Anesthesia Research Fund. This was established through the University of Calgary. It was developed to promote research in the areas of Cardiac Anesthesia, patient outcomes and quality improvement. Dr. Seal is the project holder for the fund. Dr. Alex Gregory was the first recipient of fund in 2015 for a project on the use of Speckle tracking imaging for assessment of aortic stiffness.

Transfusion Requirements in Cardiac Surgery (TRICS III): A Randomized Controlled Trial: Site Investigators: Dr. Charlie MacAdams, Co-Investigator: Dr. Douglas Seal, Dr. Alex Gregory: This is a multicentre trial investigating transfusion strategies in Cardiac Surgery.

Registry for Off-Label Use of Recombinant Factor VIIa – Chart review: Principle Investigator: Dr. C. MacAdams, Co-Investigator: Dr. D. Seal; Research Nurse: K. Maier

TACS Study – Transfusion Algorithm in Cardiac Surgery Study: A prospective trial using a transfusion algorithm in conjunction with viscoelastic testing for perioperative bleeding. Prin-ciple Investigator: Dr. C.

3.6 Diagnostic and Treatment Areas

3.6.1 Coronary Artery Disease

ACSA provincial order set was completed and disseminated under the direction of the ACS Expert Working group. Overall, site feedback has been positive with plans to adopt or adapt, includ-ing by the Covenant sites. A number of outdated ordersets have been replaced with the new evidence based Provincial ACS admission orderset and RSMG form. An Insite article about this work and FAQ’s from the Telehealth sessions are pending and the FAQ’s will be posted along with an ACS webinar on the Cardiovascular Health and Stroke webpage.

The ACS working group has submitted a proposal to the CvHS SCN Core Committee for ongo-ing support of ACS and STEMI. 30-day in-hospital mortality is a priority measure in AHS, and though the target is currently being met there is variability across the province. The proposed scope of the project is to assess current state, re-engage stakeholders, build on previous work with Vital Heart and STEMI and develop strategies to improve time to treatment, timely trans-fer, communication and repatriation, and standardize care in the province; while maintaining or improving AMI mortality and reducing variability. In addition, the goal is to monitor and report on Key Performance Indicators (KPIs) related to STEMI and patient outcomes. This proposal is currently pending CORE committee review and approval.


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PCIDevelopment and implementation of a “Same Day Post PCI Discharge Model” is in place to facilitate the same day discharge of elective PCI patients into the community.

The Interventional cardiology group consists of 10 interventional cardiologists, one research director, one data-analyst, 3 research coordinators and 2 clinical support nurses. PCI volume has remained stable over the last 5 years despite population growth. The group has increased the percentage of drug-eluting stents utilized in response to best practice. The TAVI program has been capped at 42 cases/yr with a long-waiting list at the present time, but very good outcomes have been maintained. The opening of the new Hybrid OR in the McCaig tower has facilitated novel procedures. A limited number of CTO procedures were done in the past year. The IVUS of diagnostic manoeuvres such as IVUS, OCT and FFR have been stable and are utilized in about five per cent of cases.

We are proud of the robust training program, well structured academic program and research opportunities for the trainees. Clinical research is strong with about 10 ongoing trials in the area of stent evaluation, pharmacological therapy, and chronic management of cardiovascular risk. Acute STEMI trials are also ongoing and are done in collaboration with the Stephenson Centre. APPROACH based research and clinical QI remains a core platform within the group and the Department /Institute. The group is proud of the new central triage system that will begin in May 2015. This will enable a better understanding of wait-times and access issues.

3.6.2 Electrophysiology

Arrhythmia Clinic

Dr. Yorgo Veenhuyzen


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Arrhythmia/Autonomic• Over 1,200 cardiac implantable electrical devices (CIED; pacemakers & defibrilla-tors) were implanted at FMC last year• We had a very low device infection rate of 0.4%, compared with national and interna-tional benchmarks of 1-1.5%• We offer a full-suite of tertiary care level devices, including leadless pacemakers, subcutaneous implantable defibrillators, and laser lead extractions• Our new Arrhythmia Surgeon, Dr. Ganesh Shanmugam, has Pediatric Cardiac Surgery experience. We have started performing some simple device procedures in children in Calgary, with collaboration from Alberta Children’s Hospital and Foothills Medical Center. These procedures previously had to be sent to other centers.• We hosted an ICD Patient Celebration led by Dr. Samuel F Sears, Professor of Clinical Psychology at East Carolina University in the USA. He is the world’s expert on issues surrounding “Living with an ICD”. We had almost 300 patients and caregivers attend the event in Calgary, with people watching via Telehealth in Red Deer, Lethbridge, Medicine Hat, Ed-monton, and Saskatoon. It was well received by our patients.• We have trained the EP Lab nurses and staff to being to perform device implants in the EP Lab to help us to deal with short-periods of increased demand for device implants. This should help us to decrease wait times and hospital stays.• We are leading a provincial effort to standardize the CIED peri-operative implanta-tion orders and implement best practices across AHS.

Dr. Derek Exner, Cardiologist and Heart Rhythm Specialist


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Autonomic Investigation & Management Clinic• The Autonomic Investigation & Management Clinic is based out of South Health Campus. It provides consultation services and cardiovascular autonomic testing.• Referrals come broadly from Western Canada and occasionally further. In the last year, patients have come to the clinic from across the country. • The Syncope & Autonomic expertise of Dr. Robert Sheldon and Satish Raj has been augmented with the recruitment of Dr. Carlos Morillo to create one of the strongest programs in the world.

EP Lab• Over 520 procedures were performed in the Sam and Beverly Mozell Heart Rhythm Treatment Research and Education Laboratories sat FMC last year for the full panoply of cardi-ac arrhythmias amenable to this therapy.• Two Fellows completed their training in Electrophysiology and catheter ablation and have gone on to obtain academic jobs in Canada and abroad.• We are now the only site in the province to offer left atrial occlusion therapy for atrial fibrillation patients at risk of stroke who are unable to tolerate anticoagulant therapy.• As above, the EP labs will now accommodate pacemaker and ICD implantation to streamline patient access to these therapies.• Both labs have been updated with the latest three-dimensional mapping systems for complex catheter ablation systems.• We were the leading Canadian recruitment site for the CABANA Trial, which is the largest ever clinical trial of catheter ablation versus drug therapy for atrial fibrillation. Follow up will soon be complete and results are expected to be presented this spring at the Heart Rhythm Society Annual Scientific Sessions. • The VANISH trial of catheter ablation versus antiarrhythmic drug therapy for ICD patients with ventricular tachycardia was published in the New England Journal of Medicine.• Drs. Morillo and Rizkallah joined the catheter ablation group at the Libin Institute bringing unique expertise in complex ablation procedures and research.

Arrhythmia & Autonomic Research• Dr. Derek Exner is leading the REFINE-ICD trial, an international study to assess novel risk stratification tools to find patients who may benefit from implantable defibrillators.• Dr. Robert Sheldon is leading a series of Prevention of Syncope Trials (POST) studies that will inform doctors on the best way to treat different types of syncope. The SPRITELY (POST3) study results will become known this year, and will inform doctors about whether a pacemaker or an implantable loop recorder is a better first option in patients who faint with evidence of electrical disease on their electrocardiogram.• Dr. Stephen Wilton has been funded by the Cardiac Arrhythmia Network of Canada (CANet) to try to get more centers to evaluate left ventricular ejection fraction after a heart at-tack. This would lead to more compliance with national and international guidelines and would identify patients that may benefit from a life-saving implantable defibrillator.• Dr. Satish Raj is funded by the Canadian Institutes of Health Research (CIHR) to look into the role of antibodies that target adrenaline receptors in the heart and vasculature in patients with Postural Tachycardia Syndrome (POTS).


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Atrial Fibrillation Clinic The General AFC Manual and the Nurse Orientation Manual are both in the draft phase and are awaiting review before final copies will be ready.

Medication Reconciliation is taking place in the clinic with the Audit portion to begin in April 2015. The AFC is participating in the Nationwide AF Models of Care across Canada and they continue work in collaboration with the Research Nurse at the clinic to support ongoing AF studies.

The Atrial Fibrillation Clinic has continued to provide an integrated system of care for patients with this dysrhythmia in Calgary, with patients being seen at Foothills Medical Centre and the South Health Campus. We provide highly-rated education sessions for patients and are a single point of contact to coordinate many aspects of their care. We are updating our current protocols and algorithms to rationalize aspects of clinical testing and streamline patient flow through the clinic. We have continued to work on the AP-PROACH AF Clinic module and hope to be able to transition to this database in the coming year. The clinic continues to play an active role in research, with all patients being screened for their suitability to enter clinical trials.

3.6.3 Cardiac Imaging

CMRThe Stephenson Cardiac Imaging Centre has become one of the largest clinical research programs in North America studying the role of MRI in patients with cardiovascular disease. As an academic pillar of the Libin Cardiovascular Institute this program supports a large and growing team of clinicians, researchers, students and staff. Performing approximately 4,000 cardiac MRI studies per year using two dedicated facilities at the Foothills Medical Centre and

For more information on the Stephenson Cardiac Imaging Centre, and to learn about the research studies they are performing, please visit their website at www.stephensoncentre.ca.


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South Health Campus, the Stephenson Centre has developed its strong reputation for clinical and academic excellence through focused efforts to standardize cardiovascular imaging for the purposes of individualized risk prediction. Through established and expanding expertise in 4-dimensional (4D) cardiac modelling for cardiac structures and the blood flow within these structures the Centre is rapidly advancing the field of precision medicine through application of machine learning (i.e.: Big Data) analytics. Additionally, the Centre is studying new pulse sequences aimed to assess the health of heart muscle without the need of intravenous contrast, a major recent advance in the field. Overall, this work is attracting the attention of talented students and researchers from across Canada and the globe.

One of the most unique aspects of the Stephenson Centre is its commitment to patient-centred research, this facilitated through the Cardiovascular Imaging Registry of Calgary (CIROC). This Registry, established in 2015 by Director - Dr James White, is aimed at providing patients with the opportunity to volunteer their cardiac images and medical history to establish the largest single repository of standardized disease-specific data. With over 7,000 MRI studies captured to date from 5500 patients this has rapidly become one of the richest sources of data for many cardiovascular diseases, combining MRI-based modelling with anonymized admin-istrative data made available through the Centre’s partnership with Alberta Health Services (AHS) and the University of Calgary. This work is allowing for disease models to be developed that may assist in automated disease diagnosis and for the prediction of major cardiovascular events, such as sudden cardiac death (SCD) or heart failure (HF). The Centre has recently expanded the CIROC architecture to support and catalyze similar work in Cardiac CT (Co-leads: Dr Carmen Lydell and Dr Ilias Mylonas) and Echocardiography (Lead: Dr Nowell Fine). Overall, the CIROC Registry aims to recruit 50,000 patients over the next five years, a target that would establish it as the largest prospective repository of disease-classified cardiac images in the world.

In addition to its focus on large scale disease modelling, the Centre is conducting a number of disease-focussed studies in the fields of SCD risk prediction, procedural guidance for pace-maker therapy in heart failure, early detection of cardiotoxicity (drop in heart function related to chemotherapy) and 4D strain analysis for patients with genetic heart diseases (such as Hypertrophic Cardiomyopathy). Rapid development in 4D Flow imaging has catalyzed work of investigators, such as Dr. Paul Fedak and Dr. Michael Bristow, allowing for the analysis of complex blood flow patterns in patients with valvular and vascular disease. Novel techniques for myocardial blood flow analysis are also being investigated by Dr. Bobby Heydari and Dr. Naeem Merchant in hopes of improving the early detection of coronary artery disease.

The Centre’s large clinical operation is led by Clinical Co-directors from the departments of Cardiac Sciences (Dr. Andrew Howarth) and Diagnostic Imaging (Dr. Carmen Lydell), this partnership highlighting the unique and admired collaboration established between Cardiac Sciences and Diagnostic Imaging through the Stephenson Centre. With talented clinicians and clinician scientists from both departments working in concert with collaborative basic sciences researchers, post-doctoral fellows and graduate students; advancements in novel imaging tech-niques are rapidly translated into the clinical service to improve patient care.


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Nuclear Cardiology, and Cardiac CT, Electrocardiography, EchocardiographyNuclear Cardiology and Cardiac CT• Volumes for both Myocardial Perfusion Imaging and MUGA tests remain consistent and at capacity for the site. MPI procedures performed = 999 while MUGA tests = 302 for 2016-2017.• Increase in 8.2% in Cardiac CT procedures compared to previous year. Total studies per-formed at FMC = 358.• The Calgary Zone Cardiac CT program has begun discussions and planning in regards to a unified reporting system which will be supported by the Cardium platform currently in use in Cardiac MRI.

Electrocardiography• Consistent volumes throughout the last fiscal year for Holter Monitoring and Event Record-ers. Total Holter Monitors =2,457. Total Event Recorders = 112.• Excellent work been done to support the Choosing Wisely campaign with efforts to reduce unnecessary ECG testing. Measures put in place to reduce routing ECGs in Cardiac Clinics and the CVICU. Further opportunities to reduce unnecessary ECG testing are currently being investigated in several areas. Total ECG volume decrease of 4.4% in compared to previous fiscal year at FMC. Total ECGs performed = 102,828

Echocardiography • Slight decrease of 6.6% in combined (complete and limited) Transthoracic Echocardiograms in 2016-2017. Total procedures performed = 6856• Transesophageal Echocardiograms decreased slightly 5%. Total procedures = 591• Finalized new Calgary Zone Acute Care Echo protocols, including Comprehensive Adult TTE, Impella and LVAD Echo protocols. Continued efforts to standardize all protocols are actively underway.• FMC has begun providing allocated testing times for Outpatient Dobutamine Stress Echo-cardiograms. Resources are currently limited but future growth is anticipated as referral base grows.

3.6.4 Patient Care

Cardiac Navigation In December 2014, in addition to its regular activities, Cardiac Navigation took over the out-patient Cardiac Catheterization referrals to optimize triaging and to ensure they are executed against the established standards for urgent, semi-urgent, and routine outpatient referrals.

Rapid Access Cardiology Clinic (RACCTM) The Rapid Access Cardiology Clinic (RACCTM) was originally established in 2008 as the Rapid Access Chest Pain Clinic to assess patients with chest pain syndromes. Since then, we have expanded our criteria and now accept referrals for patients with known or suspected heart disease. We provide timely cardiac consultation and arrange appropriate testing if required. Consultation services are provided at our Sunridge location or in our Clinical Care Centre at our Bridgeland location.


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RACCTM provides high quality cardiac care that directly benefits patients and also benefits the health care system by alleviating pressure in hospital emergency rooms and urgent care centres. Guided by the Advanced Access model of patient-centred care, our goal is to see the patient for a clinical consultation within ten business days. Referrals to RACCTM are accepted from community clinics, physician offices, emergency departments, and urgent care centres. Our central referral process begins with the triaging of patients by an experienced cardiac nurse followed by timely access to one of our cardiologists for consultation and if necessary further clinically-appropriate testing.

Since 2013, RACCTM clinical consultation letters are uploaded into the Alberta Netcare system making them readily available to a larger pool of health care providers. This allows for better continuity of care and avoids redundant testing.

Referring physicians and health care workers can use our secure online booking to make ap-pointments for cardio-diagnostic testing and will soon be able to book Rapid Access Cardiolo-gy Clinic (RACCTM) consultations as well.

More information on RACCTM or TotalCardiology is available on our website: www. totalcar-diology.ca.

TotalCardiologyTM Rehabilitation and Risk ReductionTotalCardiologyTM Rehabilitation and Risk Reduction has been providing secondary pre-vention of cardiovascular disease services through its rehabilitation program to residents of Alberta Health Services Calgary Zone for over 21 years. The program also offers screening and primary prevention services for those who either self refer or are referred by their family phy-sician. The foundation of the program continues to be early access, quality patient education, health coaching, and timely medical intervention. We continue to strive for the highest quality integrated cardiovascular wellness, clinical care, education and research as evidenced below. We continue to have great success with the Early Cardiac Access Clinic (ECAC). All STEMI, NSTEMI, and ACS patients continue to be assessed within four to ten days of hospital discharge. The success of this program has contributed to timely program participation and an increased number of separations, defined as those who complete the traditional 12 week program or satisfactorily graduated from an individualized program. In the period of January 1, 2016-December 31, 2016 we had 1781 patient separations, which represents an 8% increase from the previous year.

We continue to streamline our patient education program with a focus on ensuring that all pa-tients receive the core information needed to support them in their lifestyle change. Over 80% of new patients attend our introductory education series “Taking Charge of Your Heart Health”. Additional education is offered through our patient resource manual, the education and re-source centre, and optional workshops related to nutrition, exercise, and stress management. Over the past year our staff have participated in continuing education related to health coach-ing and motivational communication. Based on this training the supervised exercise program has been updated to provide each patient with weekly health coaching from our team of nurses, exercise physiologists, kinesiologists, and a dietitian. To support the health coaching sessions, we have also developed a health behavior tracking booklet to facilitate self-management through awareness and accountability.


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Promotion of heart healthy living in the community has remained a priority over the past year. Program staff helped to prepare 40 patients for the Calgary Marathon 5km event in May 2017 through a partnership with Astra Zeneca. We also participated in various health fairs through-out the year offering basic risk screening and heart health education.

TotalCardiologyTM Rehabilitation and Risk Reduction has been actively involved in a number of provincial initiatives including the Cardiovascular Health and Stroke Strategic Clinical Net-work. We continue to foster medical education within our clinic and coordinated rotations for those physician residents specializing in internal medicine, family medicine, cardiology, sport medicine, physiatry as well as allied health undergraduate and graduate students.

The Research Committee continues to be very productive and has been successful in publish-ing program outcomes in the Journal of Cardiopulmonary Rehabilitation and Prevention, the Canadian Journal of Cardiology, Circulation, Sleep Medicine, Disability and Rehabilitation, and the Journal of Behavioural Medicine. In April 2017 our program dataset was merged with APPROACH which will allow for future research opportunities.

3.6.5 APPROACH

APPROACH is a practical, effective, and patient-focused initiative with the stated mission of collecting and processing information to improve cardiac care. Over its 20 year history APPROACH has maintained and administered an inception-cohort database of all patients undergoing diagnostic cardiac catheterization, percutaneous coronary intervention (PCI), and cardiac surgery In Alberta. This rich database currently includes clinical information on over 200,000 patients. This pioneering work opened the door to multi-region accountability in cardiovascular medicine and the initiative has since been adopted by many other regions in Canada. Through this collaborative work, its extensive publication record in the health services research and the organization of an annual national meeting on outcome and health quality work, APPROACH has emerged as a national and international leader in outcome assessment and process-of-care improvement.


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The APPROACH registry includes hospital admissions at participating centres in Southern Alberta with the diagnosis of Acute Coronary Syndromes (ACS). There are currently over 60,000 admissions in the registry. This information is critical in obtaining population-level insight into regional incident coronary events, patient selection for invasive procedures, physi-cian adherence to published treatment guidelines and quality indicator measures over a broad spectrum of patients with coronary artery disease.

In addition, the APPROACH registry includes information on patients undergoing cardiac imaging tests such as nuclear scans (17,000) and cardiac CT (3,000).

The APPROACH software has had impact on many levels and has proven its utility to individ-ual practitioners (in the form of patient data and coronary anatomy graphical summaries), to research teams (in the form of clinically rich and reliable data for analysis), to local administra-tors (in the form of utilization and outcome reports), and to provincial administrators (in the form of reports regarding wait times and outcomes). This initiative has led the way in stream-lining reporting processes and integrating clinical information into daily health care processes.

3.6.6 Valvular Heart Disease

TAVI The Transcatheter Aortic Valve Implantation (TAVI) Program has continued to deliver an alternate, noninvasive to minimally invasive approach in the treatment of severe aortic stenosis for high risk surgical patients. The program is a joint initiative between the sections of Cardi-ology and Cardaic Surgery. This method of aortic valve replacement decreases recovery time, length of hospital stay and rehabilitation time for patients. The TAVI program also formalized their intake clinic, known as the Structural Heart Disease clinic, at the South Health Campus. The clinic facilitates a consistent post procedure follow-up model; as well as, a more efficient referral intake process. In the last year the group celebrated their 250th case.

Minimally Invasive Valve Surgery Program The minimally invasive valve surgery program has grown significantly over the last year. Ini-tially spearheaded by Dr. Andrew Maitland to provide innovative, leading edge surgical tech-niques for valve patients in Calgary, the team has now been joined by Dr. William Kent. After training in Chicago, Dr. Kent brings new minimally invasive techniques to the Libin Institute. As the collective experience of the program has grown, minimally invasive aortic and mitral valve surgery has now become routine in Calgary. Many more patients now realize the benefits of less pain, shorter hospital stay, and quicker return to normal activity. In the coming year, the sutureless valve will be introduced and will provide patients the benefit of an aortic valve replacement that is done in a more efficient fashion thorough a small incision between the ribs rather than the conventional sternotomy approach.


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3.6.7 Thoracic Aortic Surgery

Dr. Jehangir Appoo continues to lead the multidisciplinary Calgary Thoracic Aortic Program (http://www.aorta.ca) with ongoing focus on clinical excellence, innovation, teaching and re-search. In 2016, the FMC was one of four centres in North America to use software to facilitate fusion of preoperative CT imaging onto the OR table in the state of the art Hybrid OR. With leadership from the program co-director, Eric Herget, and interventional radiologist, Vamshi Kotha, the last year also saw introduction of new endovascular techniques in aneurysm and dissection repair and an expansion of indications for minimally invasive surgery that helped facilitate improved patient outcomes.

In addition to the clinical advances, research collaborations continue with Biomedical Engi-neering and Pathology. With leadership from Dr. Alex Gregory, Cardiac Anaesthesia, a strong new research relationship has been formed with the renowned Stroke Neurology group in Calgary that has resulted in several studies underway to better understand interactions be-tween the aorta and the brain. Through a funding partnership between Libin, EFW Radiology, Cumming School of Medicine and the University of Ottawa, $90,000 has been the raised in the last year to facilitate a nation wide randomized clinical trial on ascending aortic aneurysms. Going forward, the focus for the group will be to build on existing expertise to establish an Aortic Dissection program that is world class and unique in its depth.

Dr. Jehangir Appoo, Cardiac Surgeon


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4.0 Education 4.1 Cardiology Core Training Program

The highlight of this year is really how well our Cardiology Training program has been doing. Our three Royal College candidates were all successful in complet-ing their Royal College exam last fall. We were successful at recruiting our four top picks in the CARMS match in October. We did have a 2 hour meet and greet session on the Thursday evening of the CARMS match. This was new for us and about 20-25 of the CARMS candidates came by to find out more about our pro-gram and Calgary. All 13 of our trainees presented their research projects at the Libin Research day. Drs. Miller, Oqab and Ramlal were selected for Rapid Fire Talks. Dr Sheila Klassen was selected for a TOD Talk.

AwardsDr. Derek Chew: Clinical trainee award for his research at the Libin Research day

One of the finalists in the ACC 2017 Young Investigator Competition and, although he did not win, he did received an honorable mention for his presentation: Economic Evaluation of Left Ventricular Assist Devices for Destination Therapy in Patients with End Stage Heart Failure.

Rob Miller: Resident Research Prize at ACC Rockies 2017. Co-winner of the LB Mitchell Research Award.

Dr. Saman Rezazadeh:- Libin Clinical Research Development Award ($25,500) 2016- Rare Disease Catalyst Network Award ($25,000) 2016- CANet CHAT Discovery Competition Finalist ($15,000) 2016- Dean’s Teaching Excellence Award 2016- Invited to be a Cardiology Fellow in training member of the Canadian Journal of Cardiology editorial board.- 2017 George Mines Travelling Fellowship ($57, 000)

Dr. Zardasht Oqab:CANet CHAT Discovery Proposal Grant Winner 2016Junior C-SPIN Investigator Research Award 2016Best Research Proposal at Canadian Stroke Prevention Intervention 2016

Dr. Sheila Klassen


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Dr. Jeff Shaw:Canadian Critical Care Conference 2016 (2nd prize for poster): A poor prognosis at presenta-tion with out of hospital cardiac arrest is strongly associated with no cardiac catheterization in post ROSC care. University of Calgary Cardiology Fellows tied with UBC for the top spot at WECREEP Jeopar-dy held in Edmonton March 2017

National / International PresentationsDrs. Miller, Klassen, Chew and Oqab presentations/ posters at ACC Washington Dr. Oqab also had a posters at the Heart Rhythm meeting in Chicago 2017 and CCC in Mon-treal 2016Dr. Chew also presented at CCC in Montreal 2016Dr Shaw presented at Chest Conference 2016 and Canadian Critical Care Conference 2016

Publications1. Chew DS, Shaw BH, Isaac D, Howlett J, Raj SR. Autonomic Failure Triggered by Continu-ous-Flow Left Ventricular Assist Device Implantation. Can J Cardiol (in press). doi: 10.1016/j.cjca.2016.10.025 2. Chew DS, Raj SR, Sheldon RS. (2016) Vasovagal Syncope in 2016: The Current State of the Faint. Interventional Cardiology 8(4):661-665. doi: 10.4172/ica.1000661

1. Rezazadeh S and Duff H. Genetic determinants of congenital bradyarrhythmias. Canadian Journal of Cardiology. 2016. Invited Review. In press.2. Rezazadeh S, Guo J, Duff H, Ferrier RA and Gerull B. Reversible dilated cardiomyopathy due to high-burden of ventricular arrhythmias in Andersen-Tawil syndrome. Canadian Journal of Cardiology. 2016. 32:1576.3. Rezazadeh S and Duff H. Dissociative states: hERG channel (Kv11.1) modulators that enhance dissociation of drugs from their blocking receptor: potential new therapeutic drugs.Circulation: Arrhythmia and Electrophysiology. 2016. 9:e4003.

Klassen S, Emery J, Patel A, Kraeker C. Utility of Telemetry Monitoring in the Inpatient Man-agement of CongestiveHeart Failure. Internal Medicine Review. 2016: 2

1. Manuscript-Oqab Z, McIntyre WF, Hopman WM, Baranchuk A. Which Factors Influence Resident Physicians to Prescribe NOACs to Patients with Non-Valvular Atrial Fibrillation? Journal of Atrial Fibrillation 2016;9-22. Manuscript-Patzer J, Oqab Z, McIntyre WF, Hopman WM, Baranchuk A. Cardiology resi-dents’ anticoagulation preferences for stroke prophylaxis in atrial fibrillation patients. Interna-tional Journal of Cardiology. (In Press)3. Manuscript- McIntyre WF, Oqab Z, Seaborn GE, Hopman WM, Hammad N, Baranchuk A. Changes in Plasma Hormones and Heart Rate Variability in Patients Receiving the Cardiotoxic Anti-Cancer Agent Bevacizumab. Int J Cardiol 2016;219:25–26.

June 13 2013 we held our annual RTC retreat at Heritage Park. The special speaker this year was Dr. Denyse Richardson. She is the author of the Royal College White paper on Feedback and Coaching for success. She conducted a workshop on coaching for success.


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Electrophysiology Fellowship Program The electrophysiology (EP) training program offers a research and clinical experience in adult heart rhythm disor-ders. Clinical training includes standard and complex ablations, device procedures, and lead extraction along with inpatient and outpatient management. The over 1.5 million catchment area provides the trainees with a wide range and volume of electrophysiology problems and procedures. The EP staff are world renowned researchers and have ongoing projects ranging from benchside research in electrophysiology to multicentre, international clinical trials. At present, our program, along

with three other programs in Ontario, are the sole Royal College accredited Area of Focused Competence (Diploma) programs in EP. This enables our trainees who meet the requirements at the end of their EP Fellowship to be able to obtain a DRCPC from the Royal College of Phy-sicians and Surgeons of Canada.

Currently there are four fellows: Drs. Mohamed (Mukhtar) Ahmed, Mohamed AlShehri, Sam Wang, and Ali Kharazi. Three of the four will be finishing at the end of June 2017 and moving to EP positions in the Middle East and New Brunswick. In July 2017, we were joined by two local cardiology fellows, Dr. Derek Chew and Dr. Saman Rezazadeh, along with Dr. Dustin Johnson from Texas. Our fellows have research projects, as well as grants, and some are submit-ting abstracts to upcoming international conferences, as well as manuscripts for publication in peer-reviewed journals.

Interventional Training Program In 2016, we had three fellows, two of which were Canadian applicants (Dr. Ashim Verma and Dr. Allison Hall) and commpleted their two years of fellowship at the end of June 2017. Dr. Nouf Alanazi from Saudi started with us in July 2016. In 2017, we will have two Canadian applicants joining our FICS team/Fellowship program. Dr. Anthony Main, and Dr. Danny Mal-ebranche. Dr. Alanazi will continue on with her second year and complete in June 2018.

For the most part, the Fellows are responsible for both the pre- and post-procedure care of the patient and have to deal with access site complications, acute kidney injury, transient ischemic attacks and other rare procedural complications. For the majority of these cases, Fellows are the primary operator, and, during their second year, they are the sole Interventionalist during the case, obtaining advice as needed from the staff cardiologists.

Dr. Derek Chew, Clinical Fellow, Cardiac Electrophysiology


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The group is responsible for weekly academic presentations which included core subject pre-sentations every three months and regular journal club reviews. In addition, quality assurance rounds are presented by the trainees.

Dr. Merril Knudtson has retired from the FICS team but still continues to do clinical duties. We wish him all the best in future. Dr. Jim Hansen has retired from Interventional Cardiology after over 35 years of service. We wish him all the best of retirement with his family. Thank you for all those that attended the farewell dinner at Heritage Park. Both Dr. Knudtson and Dr. Hansen will always be missed here at FMC.

Echocardiography Fellowship Program The Echocardiography Fellowship program was established by the Department of Cardiac Sciences at the University of Calgary in 2013. It provides the educational curriculum, physical resources, and learning environment necessary to ensure that the trainees will acquire out-standing knowledge and skills in cardiac non-invasive imaging.General Principles

• Subspecialty training in echocardiography will be offered to candidates who have successfully completed training in a Royal College accredited core Cardiology pro-gram in Canada, or equivalent international program of study.• Eligible trainees will have already achieved Level II proficiency (performed and inter-preted 150 and 450 transthoracic studies).• Program duration will be a minimum of one year (13 blocks of training)• Echo Fellows will be expected to: I. Achieve Level III training II. Develop and maintain a portfolio which will satisfy the criteria for a Diploma in Echocardiography as set forth by the Royal College of Physicians and Surgeons of Canada III. Participate in a clinical research project• Fellows will be expected to attend at least one international scientific meeting with a focus on cardiac imaging (i.e. annual meeting of either American or European Society of Echocardiography)• Fellows will be encouraged to spend three or more blocks of training in a recognized lab outside of Calgary in order to acquire experience in specific skills (i.e. strain-rate imaging, 3D imaging etc.)• Be prepared to complete the ASCeXAM® (Examination of Special Competence in Adult Echocardiography)• The Fellowship program in echocardiography will enhance and support learning needs of core trainees• There is no dedicated funding to support this fellowship. Candidates will be expect-ed to apply for scholarships or research funding as appropriate.

Trainees:Outgoing Fellow: Dr. Khalil Jivraj (2016-2017) - joining the Echo lab at RCS Diagnostics.Incoming Fellow: Dr. Michelle Keir - specialist in Adult Congenital Heart.


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4.2 Cardiac Surgery Core Training Program

Under the leadership of Dr. William Kent as Program Director and Christina Faulkner as Program Administrator, the Cardiac Surgery training program successfully achieved full accreditation this year after undergoing a Royal College external review. Chief resident Dr. Daniel Holloway completed his training and then began an advanced fellowship program in percutaneous valve interventions and heart transplantation/mechanical circulatory support at Northwestern University in Chicago. The program presently has six residents enrolled and is supported by 9 full-time dedicated adult cardiac surgeons and two surgeons that specialize in arrhythmia and device implantation. All members of the division are committed to residency education and work to provide an excellent training environment.

The academic curriculum consists of academic half days focused on didactic teaching, journal clubs, thoracic aortic rounds, M and M rounds, and cardiovascular triage rounds. The academ-ic schedule is well partnered with the Department of Surgery curriculum, including critical thinking, surgical skills, principles of surgery and CanMEDs. Our junior residents also attend a teacher training retreat, where they are prepared for a role as teachers and leaders in their community. There is an increased amount of simulation and hands-on skills offered by the program, including labs for cadaveric dissection and minimally invasive valve surgery. This year saw the first swine heart transplant simulation lab, which was a tremendous success for the program.

In the operating room, residents are trained in complex open-heart procedures, device implan-tation, mechanical circulatory support, endovascular aortic surgery and transcatheter valves. Opportunities in clinical outcomes, basic science and translational research are also supported and this year saw residents successfully present their work at both national and international meetings. Dr. Holly Mewhort won the CIP Excellence in Published Research Award as well as the Vivien Thomas Research Award from the American Heart Association. Dr. Daniel Hollo-way won the annual John Burgess Resident Research Award for his work on surgical simula-tion. This success achieved by our residents has further established the University of Calgary as one of the top residency training programs in the country.

4.3 Undergraduate Medical Education 2016– 2017

The combined cardiac and respiratory course for the medical students – Course III – ran from Jan. 3 to March 17, 2017. This year’s program was extremely successful due to the ongoing efforts of our academic and fee-for-service cardiologists, cardiac surgeons and anesthetists. There were also major contributions from cardiology and cardiac surgery residents and subspe-cialty trainees.

This year we brought in further integration of basic science and clinical teaching with the help of our anatomy team headed by Dr. Jamniczky, as well as Dr. Fewell from the Department of Physiology and Pharmacology.

Student feedback continues to identify our faculty, bedside teaching, and small group sessions as the strengths of the course. The overall rating of the cardiology component was 3.98 / 5.0. This represents an increase from last year, and is one of the highest ratings of the numbered courses in the first two years of the medical curriculum. We are incredibly proud of our under-


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graduate teaching, and want to thank everyone who contributed this year!

4.4 Post Graduate Medical Education

In June 2017, we said goodbye to our four senior Cardiology residents: Dr. Derek Chew, Dr. Saman Rezazadeh, Dr. Sheila Klassen and Dr. Robert Miller. Dr. Miller was awarded the Dr. Peter Russell award for clinical excellence. He is presently doing a Heart Failure & Transplant Fellowship at Stanford. Dr. Chew was awarded the LB Mitchell Award for Clinical Research and has continued onto his subspecialty training in Electrophysiology here at the University of Cal-gary’s faculty of medicine. Dr. Rezazadeh has also continued onto his subspecialty fellowship in Electrophysiology at the University of Calgary. Dr. Klassen is completing her Echo Fellowship in Boston.

4.5 Cardiac Sciences Grand Rounds

Cardiac Sciences Grand Rounds run from September until June. The Grand Rounds committee is Chaired by Dr. Carlos Morillo Section Chief and consists of Drs. Jehangir Appoo, Angela Kealey, Vikas Kuriachan and Steve Wilton. In this academic term, we had 33 Grand Rounds presentations with a further seven to come, including the PI of the COMPASS trial a landmark Secondary Prevention trial in patients with established CAD.

The attendance at our Grand Rounds is excellent and continues to grow with over 50 attendees weekly between physicians, trainees, researchers, and nursing staff from all Calgary Zone sites. In addition, the rounds are telecast to the major teaching hospitals: the Peter Lougheed Hospi-tal, the Rockyview General Hospital, and the South Health Campus. Both National and International speakers from all subspecialties in Cardiology and Cardiac Surgery have presented at our Grand Rounds sessions which are the flagship educational activ-ity at LCVIA. Complete list of speakers is summarized below:Sept. 2016 - June 2017

Grand Rounds Speaker Origin Title

Ratika Parkash Nova Scotia “The Seeds of Atrial Fibrilla-tion: A Root Cause Analysis”

Marc Jolicoeur Montreal “Refractory Angina”

Michael Farkouh Toronto “Evolving Management Strategies in Diabetic Pa-tients with Coronary Artery Disease”

David Kass Baltimore “Can Cardiac Dyssynchrony be Turned into a Therapy?”

Libin: Research Strategic Plan Update Todd/Anne

Raffaello Furlan London UK “Cardiovascular Rhythms in Human Physiology and Pathophysiology”


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Mike Slawnych Calgary “Cardiac Palliative Care – Are We There Yet?”

Dr. Jan Beyer-Westendorf Germany “Concepts and Misconcep-tions in Oral Anticoagula-tion 2016”

Dr. Sean Virani Vancouver “Get with the Guidelines: A Cardio-Oncology Primer”

Greg Schnell Calgary “Why do I have to fill out this form? Metavision: What it is and What can it do”

Dr. Hisham Dokainish Hamilton “INTER-CHF: A Global Heart Failure Registry”

Dr. Kevin Bainey Edmonton “Use of Oral Anticoagula-tion in ACS: A Complicated Question?”

Fellows Rounds Cardiac Fellows Holiday Rounds & Staff Cardiology Merit Awards Presentation

Dr. G. Guaraldi (also speak-ing in Edmonton / Paolo Raggi)

Italy “Cardiovascular Disease in Human Immunodeficiency Virus Infected Patients: A True or Perceived Risk?”

Dr. J. Thomas Heywood California “The Role of Hemodynamic Monitoring in Heart Failure: Who, What, Why, When and Where…”

Libin/AHFMR Prize winner - Dr. Erin Olson

Texas “Correction of Muscle Dis-ease by Genomic Editing”

Carlos Morillo UK “Detecting Sub-Clinical Atri-al Fibrillation (SCAF): Noise or Muzak”

Nowell Fine Calgary “Cardiac Amyloidosis: A New Paradigm in Diagnosis and Management?”

Carlos Morillo Calgary Best of ACC


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Dr. Joseph Hill New York “Heart Failure: The Path Ahead”

Dr. JP Casas Romero Belgium “Large-Scale Genomics & Health Informatics: Applica-tions To Drug Discovery in Cardiovacular Disease”

Dr. Todd Anderson Calgary “Update on New Lipid Low-ering Trials - Implications for Practice”

Dr. Debra Isaac Calgary “Born Blue - The Guyana Project”

Dr. Pedro Moreno New York “Atherosclerosis in 2017: From Inflammation and Neovascularization to Plaque Regression”

Dr. Karin Sipido Belgium “Identifying Anti-Arrhyth-mic Targets in Hypertrophy and Cardiomyopathy”

Dr. Norman Wong Calgary “SGLT2i and Epigenetics in Battling an Old Foe (CHF)”

Dr. Jason Afilalo Montreal “Frailty Assessment in Car-diovascular Disease: What Have We Learned Over The Past 5 Years”

Dr. Jason Roberts San Francisco “Arrhythmia Genetics: Clinical Implications for Common and Rare Diseases”

Dr. Bruce Smaill New Zealand “Inverse Cardiac Electrical Mapping: A Systematic Assessment of Body Surface and Intracardiac Approaches”


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5.0 ResearchA significant achievement of the Department of Cardiac Sciences and Libin Cardiovascular Institute is its tradition of facilitating the initiation and conduct of high quality basic, clinical, and translational research. All three components are required to improve the understanding of cardiovascular health and to manage cardiovascular disease. Members of the Department of Cardiac Sciences had another successful year in the research arena, as reflected by their pro-ductivity as outlined in Table 12.3, there are 20 GFT members within the Department.

Libin Research Highlights

The Libin Cardiovascular Institute of Alberta had a strong year in research, with 48 of the 607 peer-reviewed publications written by Institute members in journals with impact factors above 10.

In April 2017, the Libin Cardiovascular Institute of Alberta launched its new strategic research plan, which sets the Institute’s research and research training priorities over the next five years (2017-2022). After numerous consultation sessions with stakeholders that began in November 2015, the plan’s bold vision is to reduce the burden of suffering and premature death due to cardiovascular disease through transformative research. Building on our research strengths and new recruitments our new research priorities are:• Vascular Health and Disease• Arrhythmias and Autonomic DysfunctionFaculty renewal, retention and research training and mentorship, as well as the core enabling platforms of the Libin Institute (i.e., Mozell Family Analysis Core Laboratory, Stephenson Car-diac Imaging Centre, numerous clinical research groups, APPROACH, Libin’s Core Pathology Lab) will continue to the keys to the Institute’s success.Out of members of the Department of Cardiac Sciences, Todd Anderson, Henry Duff, Derek Exner, Paul Fedak, Anne Gillis, Merrill Knudtson, L. Brent Mitchell, Richard Novick, Edward O’Brien, Robert Sheldon, Eldon Smith, Ron Sigal, John Tyberg, and George Wyse have an h-index of 30 or more.• 13 GFT (Todd Anderson, Henry Duff, Derek Exner, Paul Fedak, Anne Gillis, Merrill Knudtson, L. Brent Mitchell, Edward O’Brien, Robert Sheldon, Ron Sigal, Eldon Smith, John Tyberg, George Wyse)• 1 Clinical (Richard Novick)

Out of members of the Department of Cardiac Sciences, Drs. Todd Anderson, Henry Duff, Derek Exner, Paul Fedak, Matthias Friedrich, Anne Gillis, Merril Knudtson, L. Brent Mitchell, Ed O’Brien, Robert Sheldon, Ron Sigal, and George Wyse have an h-index of 30 or more.

Peer Reviewed Publications• 236 of 607 Institute peer-reviewed publications were authored by clinical department members (January 1, 2016 to December 31, 2016).• Clinical department members were authors on 25 peer-reviewed publications with an impact factor of 10 or more: six publications had a clinical department member as first author; three publications had a clinical department member as senior author.


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Graduate StudentsAs of September 2017, there are currently 31 active graduate students enrolled in the Cardio-vascular/Respiratory Science Program.• 17 MSc students• 11 PhD students• 3 PhD/MD students

6.0 Community Engagement

To date, donations/commitments of over $50 Million dollars have been made to the Institute via Calgary Health Trust and Faculty of Medicine Fund Development. A further $2M was raised in 2016-2017 for Institute priorities. Highlights included funding for a)$575K raised from the 3rd Libin gala for biomedical engineering and technology and the transition program for the adult congenital heart disease program; b) Mozell Family Analysis Centre, c) AP-PROACH d)$500 K for recruitment e) Stephenson Cardiac Imaging Centre - $200K for joint research between Paul Fedak and imaging group, f) ongoing support for Professorships. The Libin Institute’s Community and Partners Advisory Committee (CPAC) met in November of 2016. Presentations were made by Drs Morillo about the importance of atrial fibrillation detection and treatment. Dr. Debra Isaac reviewed the important work that she leads in Guy-ana. About 75 members of the community were thanked for their ongoing contributions to the Institute. Previous and potential sponsors of the Libin gala were treated to an entertaining evening in May 2017 to promote gala fund-raising. Dr. Fedak reviewed his work in structural heart disease and aortic diseases. This event raised further table sales and sponsorship for the upcoming 4th edition of the gala.

The Institute has developed its fund raising priorities that have been approved by the CHT and University of Calgary respectively. The first is a cardiac innovation fund to develop new programs for the recently funded Hybrid OR. Money raised in the last year allowed us to begin in a limited fashion i) Mitral valve clip program – five cases completed, ii) Left atrial occlusion devices and iii) Sutureless aortic valves. The second project is a joint effort between the CHT and the ACHF. This project will seek funds to coordinate the transition of care between pediat-ric and adulthood for the growing number of patients with congential heart disease. From the gala we have secured about $550K and are seeking matching funds from the ACHF. We will begin this fall with a consultant who will move the project forward to establish the IT struc-ture required to provide a clinical and research database for the adult congenital population. Strong collaboration between ACHRI, Libin and the ACHF has been demonstrated in the past 6 months.

The fundraising priorities for the new ENERGIZE fund-raising program announced from the University are being developed in conjunction with the Strategic plan. We have identified pri-ority groups and fund raising initiatives that will total about $50M over the next 5 years. The case for support document has just been completed.

Engagement events for our members and health care providers included: a) Libin research day (April 2017 – Milica Radisic PhD ER Smith Lecturer), b) AHFMR-Libin Prize in Cardiovas-


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cular Research – Dr. Eric Olsen was the 6th recipient of this prestigious award. He presented public and research lecture on the utility of gene editing to improve muscle disease. c) Libin Gala (Sept, 2016) to promote awareness of cardiovascular excellence in Calgary and engage new community partners. This third annual event brought in 450 people and raised $585K in net revenue. It was co-chaired by Tony Dilawri and Ken King. d) Libin family zoo event – This was a huge success with over 500 people attending the zoo festivities the last Sunday in August 2016. e) Science in the Cinema – Feb 2017. In conjunction with the CSM this cardiac themed movie provided entertainment and a chance to discuss cardiac surgery and transplantation (300 people). f) Libin 101 event February 2017 – atherosclerosis theme with 80 -90 people at the central public library. g) monthly Libin 101 events at libraries around Calgary – 40 people on average to listen to our cardiovascular clinicians and scientists discuss new treatments and research.

The Libin Cardiovascular Institute of Alberta once again had a significant presence at the 2016 Canadian Cardiovascular Congress held in Montreal as a Gold level sponsor. The Institute also had a booth in the exhibition area and hosted a reception on the Congress sidelines for mem-bers, staff, and past trainees. Last year we did a joint reception with our University of Alberta colleagues and had some 200 guests. Several members were featured very prominently at the meeting.

Our members were also heavily involved in Continuing medical education for nursing, prima-ry care physicians, pharmacists and internal medicine specialists in the province. Many of the heart failure cardiologists provide heart failure consultation in Medicine Hat, a great service for their patients. Libin engagement sessions were held at all four adult hospitals during the last fiscal year.

The Institute maintained communications with the cardiovascular community and the public at large with updates to its website, www.libininstitute.org, a monthly electronic newsletter (Libin Buzz), and Libin Life, the Institute’s print bi-annual newsletter. This was orchestrated by Dawn Smith, our new Communications Coordinator. Barb Jones and Andrew Grant have established the Intranet Web presence for Cardiac Sciences that was launched in the past 6 months.

Ongoing global health work included significant expansion of the clinical care and education training in Guyana led by doctors Debra Isaac and Wayne Warnica. Dr. Belenkie, emeritus pro-fessor has remained active in fostering educational opportunities for clinicians from Nicaragua to expand their cardiology skills.

7.0 Quality Assurance and Quality Improvement

1. Cardiac surgery QI: There continues to be increased uptake of the cardiac surgery central triage system. Monthly reports provide input into referrals, wait-times and OR utilization. Inpatient wait list is provided on a daily basis. Since January 2017 there has been an increase in the referral numbers and inpatient volume has increased. We peaked at 40 inpatients in May and have been consistently running above 20. This has created an increase in overall wait times for inpatient and outpatient procedures. The robust metrics have allowed us to keep senior leadership in the loop and request additional OR time. This has occurred and has helped our


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peak periods. The number of patients on the cardiac surgery wait list has increased from a low of about 110 a year ago to around 275. The 90% wait times for CABG and valve surgery have steadily increased over the last year and are now consistently out of target.

2. Catheterization laboratory QI: The central referral and management system for cath lab has been well utilized. This will allow us to track wait-times and schedule patients in a more expedited fashion. While cath lab volumes did not increase substantially this year (2.5%), there is still some heterogeneity of wait times that we wish to address. Initial data has demonstrat-ed that about 2/3 of the physicians are using central triage. For those who do the outpatient catheterization waiting time is < 3 weeks. For those who do not use central referral it is around 6 weeks. This data is tracked along with other wait times on Tableau (Bioscope cardiac sciences program).

3. Cardiac Sciences QA Committee: This has become operational and is co-chaired by Jamie McMeekin and Caroline Hatcher. A limited number of cases have been discussed to date. The cases have focussed on adverse events related to patients waiting for cardiac surgery or structural heart disease procedures. Some important process changes have been implemented including having cardiac surgery performed within 48 hours for patients who present with an ACS where a significant left main stenosis is deemed to be the culprit.

4. ECG Choosing Wisely Project: The ECG project to reduce the number of redundant ECGs performed in the region in the hospital environment has been successful. We have been able to halt the growth in ECG ordering over the past 2 years instead of what had been a 5-8% year over year increase. This project is led by Russell Quinn, and Andrew Jenkins and other team members. The number of ECG did not increase in the last year – stable at 239,000. The work to date has concentrated on cardiology ECG ordering at the FMC site. Reductions of up to 30% have been shown in the FMC CICU. We are now working on knowledge translation at the oth-er sites. Fully half of the ECGs are done in the ED and we have been working with Eddy Lang and his team to address this.

5. Cardiac Science Choosing Wisely Group: In the past 6 months Carlos Morillo and Russell Quinn have co-chaired a group to expand appropriateness criteria to other areas. Russell and team were successful in obtaining an AHS QI grant to look at redundant imaging testing for subjects with low EF following an MI who might be candidates for CIEDs. There are three other projects that will address imaging use in subjects post ACS. The goal is to decrease testing in those with preserved EFs and increase testing in those with low EFs who might qualify for device therapy. These projects are registered with ethics and will create new knowledge. The Stephenson CMR group has data demonstrating EF stability in subjects with breast cancer undergoing chemotherapy. LV function stability will allow a reduction in the number of yearly CMR evaluations.

6. Policy: Regular policy and procedure updates have been led by Barbara Jones. We are up to date with these and in a very strong position. These have been posted on the newly functional Departmental Intranet for daily use by staff.


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8.0 Highlights and Awards 8.1 Clinical Highlights

A few of the clinical highlights (outlined in more detail in section 3) included:• A few of the clinical highlights (outlined in more detail in section 3) included:• Quality improvement work including central triage expansion across the Department leading to reduction in wait times including cardiac surgery• Clinical Informatics work on Bioscope – data reporting and analysis• Stephenson Cardiac Imaging Centre –research registry (CIROC with > 5,000 patients enrolled). Expansion to echo and cardiac CT to begin• Successful bed-side physician and NP program – nearly 100% evening and weekend coverage. New clinical assistants being trained• Heart failure pathway work at SHC• Expansion and addition of new sub-specialty clinics• Appropriateness work resulting in more limited growth in procedure volumes• Impressive recruitment for the Department and Institute

8.2 2016 - 2017 Cardiac Sciences and Libin Award Recipients:

• U of Calgary Senate Lecture of a Lifetime- Dr. D George Wyse• Annual Achievement Award CCS – Dr. Robert Sheldon• Canadian Heart Rhythm Society annual achievement award – Dr. LB Mitchell• Golden Caliper Award – Dr. Carlos Morillo• Kidney Foundation Gold Medal of Excellence – Drs. Brenda Hemmelgarn and Bra-den Manns• Promotion to Full Professor – Drs. Paul Fedak and Satish Raj• FMC long term service awards – Drs. Teresa Kieser, Charles MacAdams and John Rothchild• Killam Award for graduate supervision and mentorship - Dr. Paul Fedak• Telemachus Distinguished Mentorship Award Clinician-Investigator Program, 2017 - Dr. Paul Fedak• Vivien Thomas CV surgery award of the AHA – Dr. Holly Mewhort – CV surgery resident• ACC Young Investigator Award (runner up) – Dr. Derek Chew- cardiology resident • George Mines Travelling Fellowship from the Canadian Heart Rythmn Society– Dr. Saman Rezazadeh – cardiology resident

8.3 Departmental Honours

The Peter Russell Memorial Fund is an award established by the colleagues and family of Dr. Peter F. Russell to honor his life and the exceptional care and compassion he provided for his patients. Dr. Russell was the first graduate of the Clinical Cardiology Training Program at the University of Calgary in 1983. The award is presented annually to the clinical fellow who is considered to best exemplify Dr. Russell’s passion for medicine and patients. The 2016-17 award recipient was Dr. Robert Miller, a senior cardiology trainee.


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The L.B. Mitchell Clinical Research Prize was created in recognition of the significant con-tributions of Dr. L.B. Mitchell to cardiovascular health in Calgary. Dr. Mitchell served as the inaugural Director of the Libin Cardiovascular Institute of Alberta. The purpose of this annual prize is to recognize excellence in clinical research. The winner in 2016-17 was Dr. Derek Chew. Due to the high quality of the applicants this year three runner up awards were present-ed to Drs. Robert Miller, Dr. Saman Rezazadeh and Zardasht Oqab.

The annual teaching award, chosen by the cardiology trainees went to Dr. Frank Spence for his almost three decades of dedicated teaching in the area of coronary angiography and interven-tional cardiology.

We formalized our annual department dinner into an event that recognized our residents and fellows in addition to honoring members of the Department who had retired from active prac-tice. This year we recognized the wonderful careers of a) Wayne Warnica, cardiology, b) Henk ter Keurs, cardiology, c) James Hansen, cardiology and d) John Rothchild, cardiac surgery. These individuals played important roles in shaping cardiac sciences in Calgary over 40 year careers. Speeches and roasts were appreciated by the 90 Department members who attended the event.

9.0 Challenges and Opportunities 9.1 Space and Resources

With multiple recruitments in the last year, our space is now fully occupied. We have complet-ed a recent space plan within the Libin Institute and have allocated all of our dry lab (office space). There is still one wet lab available for a clinician-scientist recruitment. There is not enough space for all graduate students to have office space outside of their labs. Similarly the vast majority of laboratory managers must also occupy space within the labs. A series of office moves has taken place this spring to accommodate new recruits with unique requirements.

Office space is still tight at FMC for clinical hires with little ability for swing space for those visiting from other sites, although one office has been set up on the 8th floor of FMC (C801). New recruits are housed in either the FMC or University of Calgary depending on alignment. We have been able to accommodate space for Dr. Morillo, the new division chief in cardiology on the 8th floor. Clinic space allocation in Area 6a of UCMG is still not ideal in terms of flex-ibility for new hires or people wanting to add clinic time. The ability to have clinic at the SHC has been very helpful. New clinics have been established there for TAVR, valvular heart disease and the cardio-oncology program. The hypertrophic cardiomyopathy and new Fabry’s clinic have been established there in the past year. There is a request to have a satellite general rapid access clinic at the SHC as well. At the PLC, the volume continues to strain capacity for both the general cardiology and congenital clinics. While efficiencies are being evaluated, we are looking for increased resources to help our very busy clinicians at the PLC. The volume of con-genital patients continues to grow by 10% per year. Three cardiologists have been added with offices at the RGH and these individuals have clinic there. Capacity is also an issue at that site.


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Three years ago, we began a cardiac surgical uplift to meet the increasing needs of our patients. The physical plant for cardiac operating rooms and intensive care unit (unit 94) is near capacity with this uplift. Intermediate planning is required to meet growing needs in this area. It is also not ideal that we have operating rooms on the 9th floor, 7th floor and in the McCaig Tower (hybrid OR). CICU capacity planning established a four-bed room in the CICU (room 1021) as the overcapacity space for cardiac surgery.

Over the last year, it has become clear that we have capacity issues within the hospital environ-ment. Most units are running at over 100% capacity. Most of the concerns on the wards have been related to increased capacity across a variety of services that utilize the beds (hospitalist and medicine). The CICU overcapacity plan was established and is in place during times of high CICU use. One of our mitigation strategies is to increase the number of same day dis-charges for procedures. This is already well established for PCI and can be expanded to ablation procedures and CIED procedures.

The physical space for echo at the FMC is inadequate to meet the growing needs (volume increasing yearly). Some expansion of this space will be required. Similarly nuclear cardiology space is not well designed for patient flow and some safety concerns have arisen. One of the nu-clear cameras is at end of life and requires replacement. It remains at the top of the FMC capital equipment replacement list. Some discussions have taken place about whether cardiac imaging can be co-located near the Stephenson Cardiac Imaging Centre in the basement of FMC. More work required on this. Central triage and referral systems have just been implemented for the catheterization laboratory. This will allow us to determine whether there are adequate resources available there.

The CICU/ICU environment at the RGH is antiquated and without windows is a difficult place for patients who need to be there for any length of time. A new physical location for these services is on the radar of the leadership at the RGH. This has remained on the priority list for AHS and is the Departments first priority for capital projects.

The wait times for cardiac surgery have increased dramatically in the last year, we still face very long wait times for structural interventional procedures including TAVR. New briefing notes have been generated for both of these areas. An expansion of the TAVR numbers was approved for this year but the needed 100 cases/yr is still to be re-evaluated. New randomized clinical trial data suggests that a shift from open heart AVR to TAVR will be something to consider, particularly for patients over 80 years of age even if they are good surgical candidates.

9.2 Leadership and Organizational Structure

We were pleased to welcome Dr. Carlos Morillo from McMaster University as the new section chief replacing Dr. O’Brien in October 2016. Dr. Carlos Morillois an outstanding clinician-sci-entist with a research and clinical focus on electrophysiology and autonomic dysfunction. No other leadership positions changed within the Department. At the Faculty level however, Dr. Lisa Welikovitch assumed the role of Associate Dean of PGME (July 01, 2017). Dr. Sarah Weeks also became the Director (Assistant Dean) of the CME program.


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9.3 Cardiology Academic Alternate Relationship Plan (AARP) and Cardiac Surgery Clinical ARP

We feel very fortunate to have ARP positions for both cardiology and cardiac surgery. Many Departments do not have this luxury and there is ongoing work on the Academic Medicine Framework to expand the numbers of Departments within the AARP across the province. Cardiology is part of the Medicine AARP. A new organizational structure has been set up that includes oversight by the GOA. The next level down is a Provincial Strategic Committee, then a Provincial Operations Committee (Dr. Anderson one of three U of C Department Head representatives). Below this is the South Sector steering committee (Dr. Anderson, with back-up from Dr. Howarth). Individual Department committees will continue to exist (Dr. Howarth as our representative) but more decisions will be made at a sector level. The plan going forward will be known as the Academic Medicine – Health Services Plan (AMHSP) and the new Master Agreement and ISA will be signed in the fall of 2017.

The Division of Cardiac Surgery has a clinical ARP. Due to strategic planning by the division expansion to 10.7 FTE has been accomplished. This is in part due to the increased demand from the surgical uplift that has just begun. Dr. Fedak is the ARP manager. The recruitment of two new cardiac surgeons in the last year has completed the complementof clinical ARP positions.

Finally, the cardiac surgical assistants have been successful in beginning an ARP for the important work that they do. This is viewed as a model for other surgical assistant programs within AHS.

9.4 Peer Reviewed Funding

Funding remains very competitive at this point with some shift from fundamental science funding to patient oriented research. New funding opportunities exist with the CIHR Strategic Patient Oriented Research (SPOR) envelope in Alberta. Some core resources funding will help Libin based researchers. Overall, based on our last Faculty report card both the Department and Institute had increases in peer reviewed funding. However, it is noted that both CIHR and the HSF are funding at around the 15% level making for stiff competition. Increased resources within the CSM have helped including mandatory internal peer review for CIHR, bridge fund-ing opportunities along with support for grant applications.

9.5 Introduction of New Technology

Given the current fiscal realities within the province and health-care budget there are several new technologies that we have not been able to introduce or only to a very limited degree. These would include the following:• Mitraclip program – structural procedure for percutaneous Rx of mitral regurgita-tion• Left atrial occlusion devices – to reduce risk of stroke in patients who cannot take anti-coagulants• Pulmonary pressure monitoring devices – for optimization of CHF treatment• Minimally invasive surgical procedures


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10.0 Workforce Planning 10.1 Cardiology Recruitment 2016– 2017 • Dr. Anna Bizios, University of Calgary – structural heart disease intervention• Dr. Jacques Rizkallah, University of Calgary – electrophysiology• Dr. Carlos Morillo, McMaster University – division chief cardiology• Dr. Kristin Lyons, University of Alberta – advanced heart failure• Dr. Ahmed Abdi Ali, University of Calgary – general cardiology• Dr. Maria Figura, University of Alberta – general cardiology• Dr. Erkan Ilhan, University of Calgary – general cardiology• Dr. Michelle Keir, University of Toronto – congenital heart disease

10.2 Department Retirements 2016-2017• Dr. James Hansen – interventional cardiology• Dr. Wayne Warnica – advanced heart failure• Dr. George Wyse – electrophysiology• Dr. Sonny Belenkie – heart failure• Dr. John Burgess – cardiac surgery• Dr. Frank Spence – interventional cardiology• Dr. Charles MacAdams – cardiac anesthesia (premature death)

10.3 Cardiac Sciences and Libin Research 2016-17• Dr. Robert Rose – Dalhousie University – Basic Science EP• Dr. Vaibhav Patel – University of Alberta – Basic Science vascular biology (Depart-ment of Physiology and Pharmacology)• Dr. Jennifer Thompson – University of Georgia – Basic Science vascular biology (Department of Physiology and Pharmacology)

11.0 Goals and Future Priorities for 2017 – 2018 Priorities for 2016 – 2017From the previous annual report we had set the following as priorities for 2016-2017: 1. Recruitment• Vascular biology scientists – Jennifer Thompson and Vaibhav Patel arrived• Exercise physiologist – Dr. Aaron Philipps – Sept 01,2017• Big data scientist – 2nd search underway• Imaging Scientist for Stephenson Cardiac Imaging Centre – 2nd search underway• three cardiology recruits have started work2. Libin and Department Strategic Plan review for 2017-2022• Completed – implementation underway• Case for support – being finalized with Fund Development3. Clinical• Expansion of the Choosing Wisely appropriateness work• Wait times have lengthened for structural heart disease (TAVR) and cardiac surgery

despite increased number of cases – briefing notes send to expand both of these programs• New clinics set up at SHC – Fabry’s disease clinic4. Education• Expansion of graduate education scholarships


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2017-2018 Departmental Priorities1. Recruitment• Completion of GFT scientist recruitments – 3 additional positions• Clinical recruitment – 3-4 cardiologists2. Libin Strategic Plan• Implementation and fund raising plans completed and initiated• Community engagement and communication plans expanded• International Expert Advisory Committee input – Sept 20173. Clinical• Cardiology and Cardiac Surgery retreats and clinical priorities identified• Access and wait time improvement – for cardiac surgery and TAVR• Testing reductions – expansion of the Choosing Wisely work• Adult congenital heart transition program4. EducationIncrease opportunities for students at all levels


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12.2 Clinical Services Council Membership

Todd Anderson-ChairCarlos Morillo Imitiaz Ali Sandeep AggarwalMichael ConnellyJonathan HowlettAndrew FerlandChris PrusinkiewiczCaroline HatcherJana Ambrogiano

Pam HolbertonVirginia MeyerNowell Fine Derek ExnerGreg SchnellDavid GoodhartIlias Mylonas James WhiteAndrew HowarthJames McMeekin

Andrew Jenkins Diane Schmidt Dan SalcedoKevin OrtonLori ForandGlenda DuruptRobert BerneyMelissa RedlichShirley Glasgow

Cardiac Sciences ExecutiveTodd Anderson - ChairCarlos MorilloImtiaz AliSandeep AggarwalMichael Connelly

Jonathan Howlett Andrew FerlandChris PrusinkiewiczCaroline HatcherJana Ambrogiano

Pam HolbertonVirginia MeyerAndrew Jenkins

12.0 Appendices12.1 Libin Cardiovascular Institute of Alberta Organizational Chart


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Libin Executive

Todd Anderson - ChairAnne GillisSofia AhmedWallace MacNaughton

Bill GhaliJonathan LyttonBob SheldonCarlos Morillo

Nairn Scott-DouglasJustin McDonaldAl-Karim Walli

Abdi Ali, Ahmed Clinical Assistant Cardiac Sciences

Aggarwal, Sandeep Clinical Associate Cardiac Sciences

Al Qoofi, Faisal Clinical Assistant Cardiac Sciences

Alvarez, A.N. MC Associate Cardiac Sciences

Anderson, Todd J. GFT Professor Cardiac Sciences

Banijamali, Hamid Clinical Associate Cardiac Sciences

Basic, Doris Clinical Assistant Cardiac Sciences

Bizios, Anna Clinical Assistant Cardiac Sciences

Boyne, T. Clinical Associate Cardiac Sciences

Champagne, Patrick

Clinical Assistant Cardiac Sciences

Charbonneau, Francois

Clinical Associate Cardiac Sciences

Clarke, Brian MC Assistant Cardiac Sciences

Cohen, J.M. Clinical Assistant Cardiac Sciences

Colbert, Jill MC Assistant Cardiac Sciences

Connelly, M. MC Assistant Cardiac Sciences

Curtis, M. Clinical Associate Cardiac Sciences

Duff, H.J. GFT Professor Cardiac Sciences

Exner, Derek GFT Professor Cardiac Sciences

Figura, Maria Clinical Assistant Cardiac Sciences

Filipchuk N.G Clinical Associate Cardiac Sciences

Fine, Nowell MC Assistant Cardiac Sciences

Giannoccaro, Peter Private No UofC

Gillis, A.M. GFT Professor Cardiac Sciences

12.3 Alberta Health Services – Calgary Zone, Clinical Depart-ment of Cardiac Sciences

Division of Cardiology


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Goodhart, David M.

Clinical Associate Cardiac Sciences

Grant, Andrew MC Assistant Cardiac SciencesHabibi, Hamid Clinical Assistant Cardiac SciencesHansen, J.L. Clinical Associate Cardiac SciencesHar, Bryan Clinical Assistant Cardiac Sciences

Heydari, Bobby MC Assistant Cardiac SciencesHowarth, Andrew GFT Assistant Cardiac SciencesHowlett Jonathan MC Professor Cardiac SciencesHutchison, Stuart Clinical Professor Cardiac SciencesIsaac, D. MC Professor Cardiac SciencesJoshi, Anand Clinical Assistant Cardiac SciencesJung, M.A. Clinical Assistant Cardiac SciencesKanani, Ronak S. Clinical Assistant Cardiac SciencesKavanagh, Kath-erine

GFT Associate Cardiac Sciences

Kazmi, Mustapha Clinical Assistant Cardiac SciencesKealey, Angela MC Assistant Cardiac SciencesKeir, Michelle Clinical Assistant Cardiac Sciences

Knudtson, Merril GFT Professor Cardiac Sciences

Kolman, Louis MC Assistant Cardiac Sciences

Kryski, A. Clinical Associate Cardiac SciencesKuriachan, Vikas MC Assistant Cardiac SciencesLyons, Kristin MC Assistant Cardiac Sciences

Lesoway, R.N. Clinical Associate Cardiac SciencesMa, P.T.S. Clinical Assistant Cardiac SciencesMason, Cindy Clinical Assistant Cardiac SciencesMcMeekin, J. MC Professor Cardiac SciencesMeldrum, D.A.N. Clinical Associate Cardiac SciencesMitchell, L.B. GFT Professor Cardiac SciencesMorillo, Carlos GFT Professor Cardiac SciencesMylonas, Ilias Clinical Assistant Cardiac SciencesO’Brien, Edward GFT Professor Cardiac Sciences


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Peters, Grant Clinical Assistant Cardiac SciencesPrieur, T. Clinical Associate Cardiac SciencesQuinn, Russell MC Assistant Cardiac Sciences

Raj, Satish GFT Professor Cardiac Sciences

Reynolds, Stephen Clinical Assistant Cardiac Sciences

Rizkallah, Jacques MC Assistant Cardiac Sciences

Schnell, Gregory Clinical Assistant Cardiac Sciences

Sharma, Nakul MC Assistant Cardiac Sciences

Sheldon, Robert GFT Professor Cardiac Sciences

Slawnych, Michael MC Assistant Cardiac Sciences

Smith, E.R. Clinical EmeritusProf Cardiac Sciences

Spence, Francis Clinical Assistant Cardiac Sciences

Stone, Jim Clinical Professor Cardiac Sciences

Sumner, Glen MC Assistant Cardiac Sciences

Ter Keurs, Hendrik GFT Professor Cardiac Sciences

Traboulsi, Mouhieddin

Clinical Professor Cardiac Sciences

Veenhuyzen, George

MC Assistant Cardiac Sciences

Warnica, James Clinical EmeritusProf Cardiac Sciences

Weeks, Sarah MC Assistant Cardiac Sciences

Welikovitch, Lisa GFT Associate Cardiac Sciences

Westib, Andreas Clinical Lecturer Cardiac Sciences


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White, Alan Clinical Associate Cardiac Sciences

White, James GFT Associate Cardiac Sciences

Wilton, Stephen GFT Assistant Cardiac SciencesWyse, D.G. MC EmeritusProf Cardiac SciencesYacyshyn, Vincent Clinical Associate Cardiac Sciences

Division of Cardiac Surgery

NAME UofCAppt UofCRank Primary De-partment

Joint UofC Appt

Ali, Imtiaz MC Professor Cardiac Sci-ences

Surgery

Appoo, Jehangir Clinical Associate Cardiac Sci-ences

Surgery

Fedak, Paul GFT Associate Cardiac Sci-ences

Surgery

Kent, William Clinical Assistant Cardiac Sci-ences

Surgery

Kidd, William Clinical Associate Cardiac Sci-ences

Surgery

Kieser, Teresa GFT Associate Cardiac Sci-ences

Surgery

Maitland, An-drew

GFT Associate Cardiac Sci-ences

Surgery

McClure, Robert

Clinical Assistant Cardiac Sci-ences

Surgery

Rothschild, John

Clinical Associate Cardiac Sci-ences

Surgery

Shanmugam, Ganesh

Clinical Assistant Cardiac Sci-ences

Surgery


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Division of Cardiac Anesthesia

NAME UCalgary Appt

UCalgary Rank

Primary Department

Bands, Colin Clinical Assistant Anesthesia

Chun, Rosa Clinical Associate Anesthesia

Gregory, Alex Clinical Assistant AnesthesiaHa, Duc Clinical Assistant Anesthesia

Kowalewski, Ryszard

Clinical Assistant Anesthesia

Prusinkiewitz, Chris

Clinical Assistant Anesthesia

Seal, Douglas D. Clinical Assistant Anesthesia

Division of Cardiac Critical Care Luc Berthiaume MC Associate Critical CarePaul Boucher MC Assistant Critical CareAndre Ferland MC Associate Critical Care

Tomas Godinez Clinical Assistant Critical Care

Calvin Lam Clinical Assistant Critical Care

Richard Novick Clinical Professor Critical Care

Ken Parhar Clinical Assistant Critical Care

Frank Warshawski Clinical Assistant Critical Care

Jason Waechter Clinical Assistant Critical Care / Anes-thesia


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12.4 APPROACHAppendices – APPROACH

The APPROACH team looks to develop creative ways to expand this broad disease-based focus to all areas of the Province. Further, it is increasingly clear that specialty areas in cardiology must work together in this quest to capture the multiple dimensions and phases of ischemic heart disease. These areas include diagnostic catheterization/revascularization, heart failure, electrophysiology and multi-modality imaging.

Achieving the APPROACH mandate requires wide patient recruitment, promotion of clarity in clinical communication and extending observations over time to factor in both the acute events and the chronic realities of coronary artery disease. It also requires the ongoing skill and commitment of key outcome and information technology specialists and an acceptance of this work in a collaborative spirit within each partner healthcare facility. The APPROACH team is up to these challenges with 20 years of research and clinical communication success in Alberta and strong international partnerships in methodological research to ensure that the very latest strategies for care quality promotion and surveillance are made available to Albertans. AP-PROACH© - Patient entry can occur at any module

APPROACH© - Patient entry can occur at any module


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Evolution of APPROACH - the current software has been rewritten on a web platform with a focus on HL7 integration to allow for seamless data flow – this new software was released in September 2014. All data from the legacy system was converted into the new online system so historical data was not lost. The new system is user-friendly and includes a focus on data exchange/integration. Enhancements were made to enable STEMI surveillance and complete cardiac surgery tracking. Three new modules are planned for release this spring: 1) Heart Function Clinic, 2) Heart Rhythm module (including ICD, pacemaker and laser leads), and 3) TAVI.

The APPROACH team is currently working with the Patient and Community Engagement Researchers (PACER) program at the University of Calgary to identify priorities for shared decision-making tools in cardiac care. Through this process patients who have had recent hospitalizations with heart disease will describe their experiences and provide input on content and design of future APPROACH dashboard tools that will be developed to allow them to see their individualized treatment plans and help them understand how proposed treatments might affect their health status.

In addition, the APPROACH team, with engagement from AHS stakeholders, is developing user-specific dashboards for administrators, healthcare workers and physicians.

The APPROACH team sees an important opportunity to bring sophisticated data collection and dissemination strategies to promote consistency in medication, device and treatment choices and to facilitate application of evidence-based treatment and investigation guidelines. In addition to the utility of APPROACH information gathering on an accountability front, a wide range of healthcare workers and administrators have come to depend upon APPROACH communication systems and automated report libraries. As a broader AHS electronic health record (e-HR) strategy evolves, the APPROACH expertise and experience should be integrated into this process thus capitalizing on this knowledge, experience and expertise moving this e-HR process along more effectively.

Ongoing APPROACH Deliverables APPROACH as a Provincial Program: One of the strengths of the APPROACH initiative is the broad geographically-inclusive nature avoiding the selection bias inherent in single centre experience monitoring and to ensure that the right patients are treated with the right therapy, in the right place and at the right time. APPROACH is uniquely positioned to ensure that this happens. Reporting completeness and accuracy• Intuitive and comprehensive data fields that are patient-focused for cardiac ACS admissions, nuclear and CT, catheterization, interventional cardiology, and surgery.• Promote data definition standardization by adoption of CCS definitions and stan dards as well as the ACC-NCDR (American College of Cardiology – National Car diovascular Data Registry) and STS (Society of Thoracic Surgeons) definitions. • Data quality and completeness checks using methods such as multiple-level data element consistency checks and automated “missing data” report strategies.• Avoidance of data entry duplication and registration errors through linkages between APPROACH© software and ADT hospital systems and catheterization laboratory


62

physiologic recorders.• Specialized software development to promote objectivity and consistency of interpre tation for revascularization, invasive and CT angiography, and perfusion imaging.• Record of specialized pharmacotherapy and device use in each catheterization labo ratory (including bare metal stents and drug-eluting stents, clot extraction devices, intravascular ultrasound, pressure and flow wires and IABP use).

Quality care promotion• Patient outcome measures used: repeat procedures, mortality (quarterly merge with Alberta Bureau of Vital statistics); and Health Status Measures (Quality-of-life). APPROACH is the only database initiative in Canada with repeat long-term health s status assessments.• Automated real time cardiac catheterization and PCI procedural reports accessible through APPROACH as well as via Netcare.• Automated real-time patient reports that are part of the patient’s health record for nuclear and CT tests at FMC and SHC. • Waitlist procedure booking systems that extract information, calculate urgency rat ings, track wait times and reason for delays (diagnostic angiography, PCI, surgery, and nuclear testing).• Rich clinical information collected allows for timely risk scoring and appropriate r risk-adjustment in health outcome comparisons.• The ACS admissions module tracks patients through their acute hospital journey promoting data integrity, avoiding data communication errors and facilitating data transfer to rehabilitation programs and to healthcare providers in the community.• Automated monitoring of adherence to important clinical practice guidelines during admission and at discharge.• Development of a patient tracking tool used by Patient Navigators under the Alberta Access to Care initiative.• Continued the work with AHS and DIMR on the open data sharing project.• APPROACH is represented on the Quality management subcommittee of the Strategic Clinical Network.

Patient safety promotion• Monitoring use of non-invasive testing prior to invasive examination and revascular ization• Monitoring critical time-to-treatment intervals in management of ACS patients• Procedural complication reporting• Monitoring treatment consistency and adherence to clinical practice guidelines• Online alerts to identify those patients at high procedural risk (e.g. known allergies, renal disease)Disease prevalence and regional resource use tracking• Age and sex adjusted regional admission and procedure rates to allow assessment of equity of access across the province• Natural history profiling using patient-centered data archiving • Monitoring the adoption of new devices, technology and pharmacotherapy over time and subsequently their impact on patient outcomes• Patient-focused data entry to facilitate reporting of repeat procedures, procedure cross-over and readmission rates.


63

Provincial and National care initiatives• Dr. John Spertus is a world renowned cardiologist who has been named as one of the most influential scientific minds for shaping cardiovascular care was the guest speak\ er at the annual APPROACH workshop held in September at the DELTA Bow Valley. • APPROACH software is in use in St. John’s Newfoundland, Sunnybrook and St. Mi chael’s Hospitals in Toronto, London ON, and Regina SK - these sites will be convert ed to the NEW web platform this year.• APPROACH continues the partnership with PHSA (Provincial Health Services Au thority) and the NEW web-based software is currently in use in all BC tertiary care sites. They have co-branded the software as (Information Solution). • Winnipeg Regional Health Authority and Saint John Regional Hospital will adopt the NEW software this summer. • APPROACH is represented on two subcommittees of the CCS, the pan-Canadian Data definitions Steering Committee and the Canadian quality indicators committee. Website: http://bridge.ccs.ca/index.php/en/ • The Canadian Association of Interventional Cardiology (CAIC) has endorsed the APPROACH © software and recommends it as the cathlab database of choice to facilitate National benchmarking and quality control.

Research• Drs. Steve Wilton and Matt James are in their second year as Co-Directors of Re search• Colleen Norris is an APPROACH Investigator and the Scientific Director of the Strategic Clinical Network• APPROACH has active partnerships with key national and international health services research groups • APPROACH has multi-disciplinary and multi-faculty partnerships with medicine, nursing, economics, computer science and geography • The APPROACH© software provides an proven platform for adherence to CCS data definitions as well as evaluation and adoption of the latest quality indicators • APPROACH has >200 peer-reviewed publications with 15 new manuscripts pub-lished in 2014• NEW Grants funded: o CIHR – A prognostic tool to inform management of ACS in people with kidney disease PI: Matt James o MSI – Refined prognostication in CAD using routine laboratory test data PI: Lawrence deKoning

• Ongoing Grants o CIHR - Effect of acute air pollution exposure on AMI & Stroke – PI: Gil Kaplan o CIHR - Impact of HS-Troponin assay implementation on patient out comes, ED operations and healthcare resource utilization - PI: Andrew McRea o PRIUS - Efficient/effective delivery and follow up of CV Implantable elec-trical devices in AB: Performance Evaluation and Rhythm Follow up Optimization and Remote Monitoring (PERFORM) – PI: Derek Exner


64

Security• Enhanced role-based security and auditing for limiting unauthorized access, tracking and archiving data access activities and protecting the integrity of data at all levels• APPROACH continues to address key privacy issues through a strategy of active en gagement. The Office of the Privacy Commissioner is kept fully informed as to all current and planned programs. The APPROACH software has an approved PIA (PIA OIPC file#H6325)

Integration with eHR• APPROACH team are actively working with clinical informatics and the eHR teams to supplement the health record with procedure and imaging detail from AP PROACH.• CARAT™ (Coronary Artery Reporting and Archiving Tool) – Cathlab and CT re ports are available to caregivers throughout the Province through Netcare.

The APPROACH team is located in the Libin Cardiovascular Clinic on the ground floor of the TRW building facilitating collaboration with clinicians and researchers in nephrology, electro-physiology and hypertension. The APPROACH research team meets weekly in the state-of-the-art Libin conference centre. In addition, IT consultants and managers have a work station in the Libin footprint as they travel from the Mazankowski Institute in Edmonton to Calgary to work and discuss enhancements to the database. The Libin Institute facilitates the collaborative spirit which allows the APPROACH team to pursue the mandate of gathering data that will track the patient journey and provide decision-support through risk-modelling.


65

12.5 AHS – Calgary Zone Organizational Charts


66

Associate ZoneMedical Director,

Calgary ZoneDr. Peter Jamieson

AHS MEDICAL AFFAIRSCALGARY ZONE

CLINICAL DEPARTMENTOF CARDIAC SCIENCES

Section ChiefCardiology

Dr. Carlos Morillo

Zone ClinicalDepartment Head

Director, LibinCardiovascular Institute

Dr. Todd Anderson

Director, Medical AffairsCalgary Zone

Ms. Catherine Keenan

Section ChiefCardiac Surgery

Dr. Imtiaz Ali

Post Graduate MedicalEducation Director

Cardiac SurgeryDr. William Kent

Clinical DepartmentManager

Andrew Jenkins

Post Graduate MedicalEducation Director

CardiologyDr. Katherine Kavanagh

Arrhythmia ServicesMedical LeaderDr. Derek Exner

EchocardiologyMedical LeaderDr. Nowell Fine

Cardiac Critical CareMedical LeaderDr. Greg Schnell

Cardiac MRIMedical Leader

Dr. James White

Interventional CardiologyMedical Leader

Dr. David Goodhart

Nuclear CardiologyMedical LeaderDr. Ilias Mylonas

Site ChiefPeter Lougheed Centre

Dr. Michael Connelly

Site ChiefRockyview General

HospitalDr. Sandeep Aggarwal

Undergraduate MedicalDirector

CardiologyDr. Andrew Grant

Section ChiefCardiac Critical Care

Dr. Andre Ferland

Section ChiefAnesthesia

Dr. Chris Prusinkiewicz

Administrative ServicesManager

Amber Arsneau

Site ChiefSouth Health CampusDr. Jonathan Howlett

Clinical ClerkCoordinator

Dr. Angie Kealey

Vice President and Medical Director,Central and Southern Alberta

Zone Medical Director – Calgary ZoneDr. Sid Viner

Advanced Heart FailureMedical LeadersDr. Debra Isaac

Dr. Jonathan Howlett

Deputy Section ChiefCardiology

Dr. Sandeep Aggarwal

12.5 Alberta Health Service - Calgary Zone Organizational Charts


67

12.6 Experiences from the Cardio-Oncology Clinic at South Health Campus


68

12.7 Publications


69


70


71


72


73


74


75


76


77


78


79


80


81


82


83


84


85


86


87


88


89


90


91


92


93


94


95


96


97


98


99


100


101


102


103

12.8 Libin Annual Report - Research, Space, Teaching, Grants and Research Revenue


104

2012‐13 2013‐14 2014‐15 2015‐161

122 126 136 136

57.7 57.7 62.4 60.7

43 44 48 48

20.3 20.2 22 21.4

18.07 18.61 28.24 20.38

0.15 0.15 0.21 0.15

0.31 0.32 0.45 0.34

3.46 3.95 4.04 4.20

0.03 0.03 0.03 0.03

0.06 0.07 0.06 0.07

1.73 2.36 2.08 3.33

0.01 0.02 0.02 0.02

0.03 0.04 0.03 0.05

Nov 2012 Nov 2013 Nov 2014 Nov 2015

2 4 3 3

0% 25% 33% 33%

Sep 2012 & Mar 2013 Sep 2013 & Mar 2014 Mar 2015

25 24 12

12% 17% 25%

Sep 2014 Sep 2015

2 5

50% 40%

March 2016

21

10%

Success Rate vs CSM

Annual Report 2015‐16 ‐ LibinYear

Members * Full Members Activity Profile#

$ (Millions)

per RE (Full Members)

Prepared by the Office of Faculty Analytics (OFA) ‐ October 2016

per Full Member


# of applications

Success Rate (not including CIHR bridge funding)

CIHR Open Operating Grant

Total # of Publications 8 by Year

Success Rate vs CSM

Success Rate(not including CIHR bridge funding)

Success Rate vs CSM

# of applications

Success Rate vs CSM

# of applications

Success Rate

NSERC Discovery Grant

CIHR Revenue6

per Full Member


Clinical Revenue7

per Full Member

# of Full Members2

CIHR Project Grant

Research Equivalents (RE) 3

Research Revenue

Total Research Revenue5

Research Equivalents (RE) 3

# of Full FT Members4

# of applications

Success Rate

Success Rate

Success Rate

Success Rate

CIHR Foundation Grant

Success Rate

Clinical29.1%

Education10.6%Research

44.6%

Admin15.7%

0% 25% 33% 33%42% 57% 44% 58%

2012‐13 2013‐14 2014‐15 2015‐16

Libin CSM

12% 17% 25%22% 14% 22%

2012‐13 2013‐14 2014‐15 ‐

Libin CSM

50% 40%21% 24%

‐ ‐ 2014‐15 2015‐16

Libin CSM

10% 12%

‐ ‐ ‐ 2015‐16

Libin CSM

2012 2013 2014 2015Libin 222 258 286 288CSM 1247 1373 1434 1533

0

200

400

600

800

1000

1200

1400

1600

1800

0

50

100

150

200

250

300

350

CSM

Libin


105


106


107


108

13.0 Tables

TABLE 13.1 Research Activity Calendar Year 2016 – 2017Libin Institute

Calendar Year

Research Activity

2014 2015 2016

Philanthropy (since 2002)

Over $45 Million

Over $50 million

Over $52 million

Peer Reviewed Publications

432 545 607

Impact Factor > 10

23 (Depart-ment of Cardi-ac Sciences) 32 (Libin Institute)

11 (Depart-ment of Cardi-ac Sciences) 41 (Libin Institute)

25 (Dept. of Cardiac Sci-ences) 48 (Lib-in Institute)

Mean Impact Factor

5.0 (Depart-ment of Cardi-ac Sciences) 4.5 (Libin Institute)

5.7 (Depart-ment of Car-dic Sciences)5.5 (Libin Institute)

4.40 (Dept. of Cardiac Sciences) 4.13 (Libin Insti-tute)


109

TABLE 13.2 Libin Research Revenue for Fiscal Year End March 2016

Source Group Source Name 2013 2014 2016Federal Gov-erment

Tri-Council (CIHR, NSERC, SSHRC)

3,978,002 3,867,180 $3,946,153.36

Canada Founda-tion for Innova-tion (CFI)

516,989 346,098 $59,774.09

Canada Research Chair

700,000 1,110,011 $700,000.00

Other Federal Government

388,675 27,950 $2,278,673.00

Federal Goverment Total

5,583,666 5,351,239 $6,984,600.45

Provincial, Regional or Municipal Governments

Alberta Innovates - Health Solutions

3,706,780 4,203,055 $4,090,338.26

Alberta Provin-cial Research EnvelopsAlberta Enterprise and Advanced Edu-cation

-1,607,202 72,543

Alberta Health Services (in-cludes Alberta Cancer Board)

2,805,970 1,837,976 $3,237,596.83

Other Alberta Provincial Gov-ernment

106,989 404,022 $300,816.18

Other Canadian Provin-cial Governments

8,600 86,476 $35,693.34

Provincial, Regional or Municipal Governments Total

5,021,137 6,604,071 $7,436,328.32


110

TABLE 9.3 Facilities and Services by Site

2016-17

Bed Capacity FMC PLC RGH SHC

Short Stay Cardiology 28

Inpatient Cardiology 76 26 3216 (allocated within GIM Unit)

Inpatient Cardiac Surgery 38

Inpatient CICU / CCU 18 6 7 2

Inpatient CVICU 15

TABLE 13.3 Facilities and Services by Site


111

TABLE 13.3 Facilities and Services by Site (continued)

2016-2017

Investigation/ Treatment Services FMC PLC RGH SHC

ECG / Holter monitoring / exercise testing facilities

1 1 1 1

Cardiac Echocardiography Rooms 5 4 2 4

Non-Invasive Cardiac Electrophysiology Laboratory 1

1 (Special Procedure

Room -Cardioversion

space)

Nuclear Cardiology Camera 2 1

Cardiac CT 1 1

Cardiac MRI 1 1

Cardiac Catheterization / PCI Laboratories

4exclusive, 1 shared

with invasive

EP.

Invasive Cardiac Electrophysiology Laboratory

1exclusive, 1 shared with cath

/pci

1 special procedure

room (implantloop recorders,cardioversion,

etc)


112


2016-2017

Investigation/Treatment Services Cont’d FMC PLC RGH SHC

Open-heart Cardiac Surgery Operating Theatres

2exclusive

+ 2 shared

Pacemaker / ICD Implantation Operating Theatres 3 shared

Specialty Outpatient Clinics

UCMC Cardiology Outpatient Clinic 1 1 1

1 GeneralCardiology Clinic (not UCMC)

UCMC Cardiac Surgery Outpatient Clinic 1

Other Cardiac Surgery Clinic 1

Cardiac Function Clinic 1 1 1 1

Cardiac Arrhythmia Clinic 1 1 1 1

Cardio-Oncology Clinic 1

Cardiac Transplantation Clinic 1

Southern Alberta Adult CongenitalHeart Clinic 1

Connective Tissue Clinic 1

Device Clinic 1 1 1 1


113


2016 - 2017

Specialty Outpatient ClinicsCont’d FMC PLC RGH SHC

Hypertrophic Cardiomyopathy Clinic 1

Atrial Fibrillation Clinic 1 1

Cardiac Navigation / Access Clinic 1 1

Structural Heart Clinic /TAVI 1

Cardiac Genetics Clinic1

(located at ACH)


114

TABLE 13.4 Division of Cardiac Surgery Workload 20

16- 2

017

Spec

ialty

Out

patie

nt C

linic

sCo

nt’d

FMC

PLC

RGH

SHC

Hype

rtrop

hic

Card

iom

yopa

thy

Clin

ic1

Atria

l Fib

rilla

tion

Clin

ic1

1

Card

iac

Navig

atio

n / A

cces

s Cl

inic

11

Stru

ctur

al H

eart

Clin

ic /T

AVI

1

Card

iac

Gen

etics

Clin

ic1

(loca

ted

at

ACH)


115

4

1010

13

34

22

0510152025303540

2011

-201

220

12-2

013

2013

-201

420

14-2

015

2015

-201

620

16-2

017

# of

VAD

Pro

cedu

res


116

TABL

E 13

.5 C

ardi

ac C

ath

lab

Wor

kloa

d

*201

617

tota

ls u

pdat

ed to

refle

ct Q

A to

tals

.

Angi

ogra

phy

PCI

Tota

l

2011

-201

261

2524

2685

51

2012

-201

361

9424

8986

83

2013

-201

463

7825

5489

32

2014

-201

566

2123

2089

41

2015

-201

668

2824

5092

78

*201

6-20

1769

7924

9594

74

010

0020

0030

0040

0050

0060

0070

0080

0090

0010

000

Cath

Lab

Pro

cedu

res


117

TABL

E 13

.6

Arr

ythm

ia W

orkl

oad

*201

516

tota

ls u

pdat

ed to

refle

ct Q

A to

tals

.

Abla

tion

ICD

-New

ICD

-Rep

lace

Pace

mak

er-

New

Pace

mak

er-

Repl

ace

Tota

l

2011

-201

238

624

221

850

624

315

95

2012

-201

342

123

819

949

525

116

04

2013

-201

444

421

515

757

425

016

40

2014

-201

542

920

413

756

525

215

87

*201

5-20

1642

723

515

169

723

717

47

2016

-201

744

421

616

265

321

716

92

020

040

060

080

010

0012

0014

0016

0018

0020

00

Arrh

ythm

ia P

roce

dure

s


118

TABLE 13.7 Cardiovascular Diagnostics Zonal Workload

FMC

PLC

RGH

SHC

Tota

l20

11-2

012

1034

9946

002

4882

70

1983

2820

12-2

013

1069

1148

225

5452

00

2096

5620

13-2

014

1042

7846

657

4668

129

657

2272

7320

14-2

015

1098

5146

028

4839

735

790

2400

6620

15-2

016

1076

0746

822

4928

836

070

2397

8720

16-2

017

1028

2847

629

5077

937

092

2383

28

0

5000

0

1000

00

1500

00

2000

00

2500

00

Elec

troca

rdio

grap

hy


119

Note

: Da

ta c

hang

ed a

s CT

A re

mov

ed fr

omth

is ca

tego

ry.

Inclu

des

MUG

A an

d M

yoca

rdia

l Per

fusio

n.

FMC

SHC

Tota

l20

12-2

013

1969

019

6920

13-2

014

1563

438

2001

2014

-201

515

5373

922

9220

15-2

016

1320

730

2050

2016

-201

713

0271

220

14

0

500

1000

1500

2000

2500

Nucle

ar C

ardi

olog

y


120

FMC

PLC

RGH

SHC

Tota

l20

11-2

012

1034

9946

002

4882

70

1983

2820

12-2

013

1069

1148

225

5452

00

2096

5620

13-2

014

1042

7846

657

4668

129

657

2272

7320

14-2

015

1098

5146

028

4839

735

790

2400

6620

15-2

016

1076

0746

822

4928

836

070

2397

8720

16-2

017

1028

2847

629

5077

937

092

2383

28

0

5000

0

1000

00

1500

00

2000

00

2500

00

Elec

troca

rdio

grap

hy


121

FMC

PLC

RGH

SHC

Tota

l20

11-2

012

1953

3358

3683

089

9420

12-2

013

2261

3211

3839

093

1120

13-2

014

2696

1854

2941

4062

1155

320

14-2

015

2666

1740

3107

3936

1144

920

15-2

016

2344

1573

2830

3492

1023

920

16-2

017

2457

1604

2932

3414

1040

7

0

2000

4000

6000

8000

1000

0

1200

0

Holte

r


122

FMC

RGH

SHC

Tota

l20

11-2

012

263

00

263

2012

-201

325

30

025

320

13-2

014

235

068

303

2014

-201

516

145

121

327

2015

-201

612

875

186

389

2016

-201

711

260

187

359

050100

150

200

250

300

350

400

450

Even

t Rec

orde

r


123

* 201

5-20

16da

ta in

clud

es th

e N

ucle

ar S

tress

Tes

t for

FM

C a

nd S

HC

.

FMC

PLC

RGH

SHC

Tota

l20

11-2

012

496

612

972

020

8020

12-2

013

443

565

937

019

4520

13-2

014

482

522

807

250

2061

2014

-201

541

847

662

858

321

05*2

015-

2016

900

491

605

1088

3084

2016

-201

791

843

954

412

2131

22

0

500

1000

1500

2000

2500

3000

3500

Exer

cise

Test

s


124

Not

e: D

ata

refle

cts

only

thos

e C

ardi

ac C

Ts c

ompl

eted

by

Car

diol

ogy.

FMC

SHC

Tota

l20

12-2

013

356

035

620

13-2

014

310

259

569

2014

-201

535

036

871

820

15-2

016

331

338

669

2016

-201

735

831

267

0

0

100

200

300

400

500

600

700

800

Card

iac C

T


125

FMC

SHC

Tota

l20

12-2

013

1763

387

2150

2013

-201

414

7014

6929

3920

14-2

015

1703

1658

3361

2015

-201

613

7521

7035

4520

16-2

017

2069

1828

3897

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Card

iac M

RI


126

TABLE 13.8 Specialized Ambulatory Clinic Visits by Site

Not

e: A

s of

201

4-20

15 d

ata,

a c

hang

e of

dat

a so

urce

was

mad

e fro

m A

trial

Fib

Dat

abas

e to

OAC

CS.

**Al

l vis

its in

clud

ing

face

-to-fa

ce a

nd p

hone

; phy

sici

an a

nd/o

r RN

/Gen

etic

s C

ouns

ello

r

FMC

SHC

Tota

l20

13-2

014

1105

1831

2936

2014

-201

512

4519

8232

2720

15-2

016

1126

1718

2844

2016

-201

714

3922

3836

77

0

500

1000

1500

2000

2500

3000

3500

4000

Atria

l Fib

rilla

tion

Clin

ic


127

FMC

PLC

RGH

SHC

ACH

Care

link

Tota

l20

11-2

012

3208

059

03

1475

4745

2012

-201

333

990

00

716

4050

4620

13-2

014

3453

3836

843

1696

5274

2014

-201

530

0565

6213

46

1729

5001

2015

-201

627

2382

143

195

717

3148

8120

16-2

017

2626

128

171

346

723

5656

34

050

010

0015

0020

0025

0030

0035

0040

0045

0050

0055

0060

00

ICD

Clin

ic


128

FMC

PLC

RGH

SHC

Tota

l20

11-2

012

2852

889

1172

049

1320

12-2

013

8148

1511

1944

011

603

2013

-201

471

1325

6516

3531

3314

446

2014

-201

566

1828

1115

6431

8914

182

2015

-201

663

9826

0619

6839

3714

909

2016

-201

772

2428

9123

4040

7316

528

020

0040

0060

0080

0010

000

1200

014

000

1600

018

000

Card

iac F

unct

ion

Clin

ic


129

**A

ll vi

sits

incl

udin

g fa

ce-to

-face

and

pho

ne; p

hysi

cian

and

/or R

N/G

enet

ics

Cou

nsel

lor

FMC

PLC

RGH

SHC

ACH

Care

link

Tota

l20

11-2

012

5288

686

1139

070

4072

2320

12-2

013

4872

912

1666

058

8775

9520

13-2

014

4792

1001

1379

524

8872

7856

2014

-201

546

4211

8111

7358

460

7477

1420

15-2

016

4206

780

1279

573

9022

871

5620

16-2

017

4671

702

1228

829

9335

478

77

010

0020

0030

0040

0050

0060

0070

0080

0090

00

Pace

mak

er C

linic


130

Navig

atio

n Cl

inic

PLC

Cong

enita

lCl

inic

PLC

Hype

rtrop

hic

Card

iom

yopa

thy

Clin

ic

PLC

Conn

ectiv

eTi

ssue

Clin

ic

2011

-201

226

8712

0222

623

120

12-2

013

2012

1082

222

207

2013

-201

413

8518

9729

621

520

14-2

015

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cardiac sciences annual report - libin …...department of cardiac sciences 9.5 introduction of new...

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