Cardiology Annual Report 2005

                 Executive Summary- Prepared by Dr. Wayne Tymchak

Introduction            ...

This report highlights the successes of the University of Alberta’s Division of Cardiology
in Clinical care...
New Volumes: In 2005 the inpatient services (wards 5G2&4 and the CCU-5G3) cared
for 1944 ward and 940 CCU patients, which ...
• Dr. Justin Ezekowitz, clinician/investigator-Heart Failure. Dr. Ezekowitz received his
internal medicine training in Tex...
The Chest Pain Program, co-directed by Drs. Welsh and Holroyd (Emergency Medicine),
is a virtual chest pain clinic designe...
2) We will enhance UAH’s focus on primary and secondary prevention by establishing a
full-service cardiac rehabilitation f...
disciplines (nursing, pharmacy, epidemiology, medicine, basic science). It exemplifies
North-South collaboration.

2) Cont...
research funding. Over the fiscal period April 1, 2000-March 31, 2005,the Division has
brought in $35,074,352 in research ...
Infrastructure 2004

Mazankowski Alberta Heart Institute (AHI):
Construction of this 300,000 ft2, 4-floor heart hospital w...
Scientist Dr. Gary Lopaschuk, a world leader in the area of
                         energy metabolism and control of fatt...
1) Imaging and Intervention Core: This core includes a biplane flat panel angiography
suite with a magnetic navigation sys...
2) Stabilization of Innovative Programs at the end of their grants: Cardiac EASE, the
Chest Pain Program, the PHT clinic a...
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  1. 1. Cardiology Annual Report 2005 Executive Summary- Prepared by Dr. Wayne Tymchak Introduction Page 2 Clinical Pages 2-6 • New Programs and Practitioners: • Cardiac Rehabilitation, Cardiac Magnetic Resonance, Advanced Nurse Practitioner Program • New and Future Cardiology Faculty • Innovative Multidisciplinary Clinics • Cardiac EASE, Anticoagulation Management Service, Chest Pain Program • Alternate Funding Plan (AFP) • Five New Clinical Programs • Magnetically guided cath lab, Cardiac Rehabilitation, Atrial Fibrillation Ablation, Gene Therapy, TeleCardiology Training and Continuing Education Pages 6-7 • National CIHR Research Training Program-TORCH • Growth in Residency and Fellowship Programs • Continuing Medical Education o Weekly Cardiology Rounds o 4th annual Cardiology CME Event for General Practitioners o Roche Distinguished Speakers Series and Dvorkin Memorial Lectureship o DMED 600-Cardiovascular Clinical Trials and Epidemiology Course Research Pages 7-8 • Cardiology Faculty Research Funding approaches $7 million • 8th Annual Cardiac Sciences Day • A Plethora of Prizes Celebrations Page 8 Infrastructure Pages 9-11 Mazankowski Alberta Heart Institute (AHI) Alberta Cardiovascular & Stroke Research Centre (ABACUS) Challenges Pages 11-12 For more information: please consult the complete annual report or visit our website: WMC 2C2.36, 8440 112th Street, Edmonton, Alberta; Contact: Telephone 780 407 6353, Fax: 780 407 6452 Cardiology Annual Report 2005
  2. 2. Introduction: This report highlights the successes of the University of Alberta’s Division of Cardiology in Clinical care, Research (knowledge creation and dissemination) and Medical Education for 2005. The future of the Division is within the Department of Medicine where the Alternative Funding Plan (AFP) has allowed us to develop innovative, multidisciplinary programs and to provide equitable support for distinct Faculty career tracks in clinical care, research, and education. Clinically, Cardiology has grown and prospered with addition of new Faculty, support staff, and new programs (such as the cardiac magnetic resonance imaging program and Cardiac EASE). In terms of education, we have one of Canada’s largest cardiac training programs (both clinical and research). In research, the levels of funding and both the quantity and impact of publication have been substantial. The research excellence has been acknowledged by trainees and Faculty receiving several national awards. The opening of the Mazankowski Alberta Heart Institute (MAHI) in October of 2007 and ABACUS, the Alberta Cardiovascular and Stroke Research Centre, a $20 million, “Molecules to Populations” research centre in fall 2006 will enhance our program. Thanks to Our Supporters The success of the Division would not have been possible without our talented secretaries, nurses, pharmacists and advanced nurse practitioners. Cardiology has also benefited from the support of newly-appointed Chief of Medicine, Dr. Jon Meddings and Dean of the Faculty of Medicine and Dentistry, Dr. Tom Marrie. In addition, we thank the COO of the University Hospital, Ms. Debbie Gordon and Capital Health, Michele Lahey and Sheila Weatherill. Clinical Care We envision UAH-Mazankowski Alberta Heart Institute (AHI) Cardiology as a Referral Program of Choice for Western Canada with innovative new programs on site, as well as telecardiology, for remote access, Cardiac EASE, and new patient navigation strategies to ensure rapid-access for all types of cardiovascular care from a single point of entry. Our special areas of expertise include: • Adult Congenital Heart Disease • Cardiac Magnetic Resonance Imaging • Consultative Cardiology-Traditional and via Telehealth • Cardiac Transplantation • Heart Failure • Interventional Cardiology • Pulmonary Hypertension New programs recently introduced include: A cardiac magnetic resonance imaging (CMR) program, shared with Diagnostic Imaging and Biomedical Engineering, Atrial Fibrillation Ablation Program (utilizing CARTOS and Stereotaxis in the future) and an expanded Cardiac Rehabilitation Program. Cardiology Annual Report 2005
  3. 3. New Volumes: In 2005 the inpatient services (wards 5G2&4 and the CCU-5G3) cared for 1944 ward and 940 CCU patients, which was a considerable increase from the 2004 calendar year. By October 2007, with the opening of the Mazankowski Alberta Heart Institute (AHI), we anticipate having a 50-100% increase in all clinical capacities and an associated reduction in length of stay. We also anticipate that the Vital Heart Program for STEMI and new patient navigation programs will help facilitate a single point of entry system. Our Anticoagulation Management Clinic saw well over 13,500 patients which is a considerable increase over the 2004 visits. The Pulmonary Hypertension Clinic follows over 275 patients at his time. We performed 3031 adult diagnostic angiograms and 1020 percutaneous interventions, in addition to 360 adult biopsies. A total of 467 adult and pediatric EPS procedures were performed in our one EPS laboratory. This does not include device implants in the hospital OR suites nor EP laboratory. 2005 was yet another year of significant growth for the echo lab. Clinical volume increased by another 15%, with combined transthoracic, transesophageal, stress and adult congenital echo volume approaching 7,000 studies. This is despite no increase in sonographer staffing, which has remained at 4.6 FTE’s since 2004. Our heart function team consists of 2.2 FTE RNs , 1.0 Secretarial, 0.7 Dietician (added this year), and 6 physicians including the addition of Drs Ian Paterson 2004, David Johnstone 2006, and Justin Ezekowitz 2006. We have 450 active patients, 1166 out patient visits last year, 117 new patients seen. This upward trend in clinical activity is expected to continue given the expanding patient population, and novel treatment options. Future directions for this clinic include a further expansion of resources to increase our patient base and access to heart failure care. Resynchronization therapy is now increasing and has implications for both heart function and EPS clinics. The clinic continues to provide a rich learning experience for a variety of health professional trainees. We performed a total of 51 heart transplants for the 2005 year, which continues to be the largest clinical program in the country. New Means of Delivering Care: 2005 saw an ever increasing number of Cardiac EASE referrals and success of EASE Telehealth. These multidisciplinary, single-point-of-entry programs have over a 100 new consults/month by bringing in new referrals while shortening waits for consultation from 50 to 20 days. Our ANP program continues to be successful with retention being a challenge as our ANPs have left for work where more autonomy is present. At the present time we have ANPs working in the stress lab, Program and Chest Pain Program, wards, and Pulmonary Hypertension. New Faculty and Staff: We are currently one of Canada’s largest Academic Cardiology Divisions with 26 GFT members at the UAH site. Three new Faculty members were added in 2004. Three new Faculty have already been recruited for 2006-07 Cardiology Annual Report 2005
  4. 4. • Dr. Justin Ezekowitz, clinician/investigator-Heart Failure. Dr. Ezekowitz received his internal medicine training in Texas and cardiology training in Edmonton. Justin also successfully completed our TORCH research traing program. He will eventually assume leadership in our Heart Function Clinic. • Dr. Tom Hruczkowski, clinical electrophysiologist, has an Engineering degree and completed his IM training in Hamilton, Cardiology training ion Edmonton and advanceds training in EPS in Boston, working with Dr. Bill Stevenson • Dr. Sean McMurty, clinician/investigator-Vascular Medicine), received his IM and Cardiology training in Edmonton and training in Vascular Biology in Boston. Sean also successfully completed our TORCH program. Seven to twelve more recruitments are planned to 2012: These positions include Directors for the catheterization and electrophysiology laboratories. These positions have already been formally approved by the Cardiac Sciences Program, Capital Health, and the AFP. They will support new clinical programs (Vascular Medicine, Women’s Heart Health) and new research programs (ABACUS). Other areas of recruitment include clinical EPS, Cardiac CT, Vascular Biology (stem cells, gene therapy). Sabbatical: Dr. Steven Archer anounced that as of April of 2006, he will be on sabbatical for 9-12 months, writing a book on Medical Nobel Laureates. Dr. Wayne Tymchak will resume the duties of acting director. Promotions: Dr. Brian Sonnenberg and Dr. Robert Welsh were both promoted to Associate Professor, University of Alberta A Diverse Faculty: Increasingly, our new members have a second advanced degree (PhD or Masters) and many come from different disciplines. Our Faculty includes 3 PharmD, 1 PhD and we have cross-appointments in Physical Medicine & Rehabilitation, Nursing and Biomedical Engineering. This enriches our program and has equipped us to fully build on the CIHR’s “4 pillars” approach to research. Innovative Multidisciplinary Clinics Shorten Waits and Improve Care: Our many specialized clinics offer outpatients both tertiary and quaternary cardiac care. These clinics have taken a programmatic approach, using alternative providers to deliver care more efficiently or rapidly. In the Innovation Clinics, algorithms, approved by the Division, are used to guide care and testing. None of these clinics would have been possible without the AFP. The AFP offered investigators the chance to apply for MSDIF grants to create the innovative programs that they envisioned. The efficient operation of the Doctorates of Pharmacy (PharmD)-run Anticoagulation Management Service, directed by Dr. Bungard, permits us to assume responsibility for anticoagulation of patients post valve surgery. In addition, satellite clinics were created, thereby disseminating this program throughout Northern Alberta. Cardiology Annual Report 2005
  5. 5. The Chest Pain Program, co-directed by Drs. Welsh and Holroyd (Emergency Medicine), is a virtual chest pain clinic designed to provide evidence-based, consistent, investigation and intervention for patients presenting to the UAH ED with non-traumatic complaints of chest pain in a timely, yet cost effective manner. A protocol driven system, standardizing the assessment and risk stratification of potential cardiac patients and providing a systematic approach to patient management achieves this objective. The ANP-MD team sees over 700 Cardiology consults in the Emergency room/year. The Cardiac EASE (Ensuring Access and Speedy Evaluation) clinic was established based on a Medical Services Innovation Grant held by the Division of Cardiology and Dr. Bungard as a multidisciplinary, rapid response consultative service. EASE consists of a team of general cardiologists, Advanced Nurse Practitioners (ANP), Doctorates of Pharmacy (PharmD), and support staff. EASE is a single point of entry, rapid consultation service. The ANPs, guided by algorithms, solicit information to permit triage and appropriate diagnostic testing prior to the appointment. EASE assesses over a 100 new patients/month. In the past year EASE has cut the waiting time to Cardiology consultation delay from >50 to 20 days. The Pulmonary Hypertension Program, directed by Dr. Michelakis is also funded by an MSDIF grant. This clinic has continued to expand and uses a multidisciplinary team, including physicians from other Divisions, notably Dr. Lien (pulmonary) to care for patients with a rare and serious disease that afflicts the blood vessels in the lung called pulmonary arterial hypertension, which has high morbidity and mortality. The management of these very ill patients is complex and their drug therapies expensive. This program also conducts cutting edge clinical research. Cardiac Transplantation: Our program is the largest program in the country with up to 45 heart transplants per year. Our results, as being better than published ISHLT values are attributable to our hard working team. Adult Congenital Heart Program: This multidisciplinary program is the largest west of Toronto with full capabilities with respect to clinical expertise, imaging and intervention. Heart Function Clinic: One of the first established in Canada, provides superb care to a multitude of extremely ill and complex patients, with proven reduction in hospitalization and improved quality of life. Five Innovative Clinical Programs: 1) We will soon open a flat panel, biplane, magnetically guided Cardiac, Cerebral Catheterization and Electrophysiology Laboratory in ABACUS. This research lab for patients with heart, stroke and vascular disease will be the first of its kind in Canada. Remote, computerized stereotactic, manipulation of catheters in the body enhances the safety, speed and accuracy of electrophysiology, neuro-intervention and angioplasty while also reducing radiation and orthopedic problems in the physician operators. Cardiology Annual Report 2005
  6. 6. 2) We will enhance UAH’s focus on primary and secondary prevention by establishing a full-service cardiac rehabilitation facility and program, under the leadership of Dr. Bill Dafoe. AHI will have its own cardiac rehabilitation centre. 3) Dr. Pantano and colleagues have successfully launched an atrial fibrillation ablation program, supported by a CARTOS mapping system. 4) We have started a human gene therapy program aimed at Therapeutic Angiogenesis- growing new blood vessels in the hearts of patients with coronary disease (Figure). Drs. Tymchak, Burton and Archer are engaged in or have completed three trials in this area, supported by a NOGA mapping system. 5) We continue to focus on shortening waiting times for diagnostic testing, delivery of interventional and device therapies and consultation through programs such as Cardiac EASE and EASE Telehealth. We have obtained funding to create a tele-stethoscopy program in 2005, permitting remote physical examination. Coupled with traditional Telehealth this may reduce the need for visits by patients from remote sites. Alternate Funding Plan (AFP): The AFP has provided the means to realign incentives so that we equally reward all three parts of our mission (clinical care, teaching and research). It has allowed us to honor job descriptions and show that teaching, and research are valued similarly to patient care. In research, it has protected researchers time and allowed us to benefit from many Canada Foundation for Innovation (CFI) grants. In education, formal undergraduate and post-graduate teaching commitments are now a part of each faculty members’ contract. This has allowed us to deal with the greatly expanded teaching responsibilities associated with the expanded medical school size and growing Cardiology residency-fellowship program. The AFP is universally well received and has seen the growth of innovation programs. These programs often rely on physician extenders and are time-intensive but have low billing return and thus are often not feasible in conventional remuneration plans (e.g. Chest Pain Program, Anticoagulation Service, Cardiac EASE, PHT program). In addition, the MSDIF fund, made available as part of the AFP, allowed investigators to realize their dreams and create new means of caring for their patients. Under the AFP, our clinical service levels have continued to grow and waiting list have shortened. The Division thanks Dr. Marrie for his vision and leadership in establishing this plan and Dr. Meddings for his early efforts to renegotiate the plan and achieve parity with the new Calgary plan. Without the AFP physician recruitment and retention would be extremely difficult. Training and Continuing Education 1) TORCH (Tomorrow’s Research Cardiovascular Health Professionals) is one of Canada’s premier research training programs, under the able leadership of Paul Armstrong and his Calgary colleague, Dr. Bob Sheldon. The TORCH curriculum, created by Drs. Michelakis (Edmonton) and Anderson (Calgary), is delivered by weekly Edmonton-Calgary Teleconferences. TORCH has over a dozen trainees from various Cardiology Annual Report 2005
  7. 7. disciplines (nursing, pharmacy, epidemiology, medicine, basic science). It exemplifies North-South collaboration. 2) Continuing Medical Education: The Division provides weekly CME events and has created and hosts several Distinguished Lectureships. These include: • Cardiology Rounds: The Cardiology rounds remain vibrant and well attended (>60 individuals/week). Rounds are eligible for MOCOMP credits. Dr. Michelle Graham continues to do a superb job as Rounds Coordinator. Weekly rounds can now be viewed by teleconference at hospitals in Edmonton (Grey Nuns, Misericordia, Glenrose, Sturgeon) and beyond (Whitecourt, Grande Prairie, Ft McMurray). • Annual CME Event: A successful annual CME event is held at Telus Centre for GPs, ANPs and internists with >100 attendees. 2005 saw our 5th annual event. • Visiting Speaker Series: These lectures are delivered as part of our Cardiac Sciences Research Day: • Roche Distinguished Speakers Series: This program was initiated in 2000 by Dr Paul Armstrong based on an unrestricted grant from Hoffman-La Roche Ltd. Internationally renowned faculty spends 2 days visiting faculty and lecturing. The visitor also conducts teaching rounds with Cardiology and Medicine residents, meets with individual faculty members, and presents an additional research seminar. • Dvorkin Lectureship: The Dvorkin memorial lecture honors one of Alberta’s most beloved clinical cardiologists, Dr. Joseph Dvorkin. 3) Cardiology Residency and Fellowship Training Programs: It is our intention to make the 3-year training program at the University of Alberta the preferred training site for Cardiology residents and fellows in Western Canada. The residency program, led by Dr. Rob Welsh has expanded to ~4 core positions/year (including 1 trainee/year in our 2- year, TORCH research training program). The fellowship program, coordinated by Dr. Michelle Graham, has 3-5 trainees/year (echo, EP and interventional). Currently the U of A is one of Canada’s largest Cardiology training programs. Plans exist to expand our fellowship programs and add a Cardiac Rehabilitation, Adult Congenital Heart and Non- invasive Cardiac Imaging fellowship. 4) Med 600: Dr. Tsuyuki teaches and coordinates this Cardiovascular Clinical Trials and Epidemiology Course for the Departments of Medicine and Public Health. Med 600 has been instrumental in formalizing the training of clinician investigators and population researchers. 5) DMED 514: Dr. Cujec has done a wonderful job in coordinating the cardiology component of this course which includes the small group sessions, lectures and PBL components. Research The Division is home to growing research excellence and avibrant, cardiovascular research-training program. This is reflected in an impressive growth in peer-reviewed, Cardiology Annual Report 2005
  8. 8. research funding. Over the fiscal period April 1, 2000-March 31, 2005,the Division has brought in $35,074,352 in research funding. We believe that we are one of Canada’s top three Cardiology Divisions, as measured by funding, publications, and citations. Additional recruits and the opening of ABACUS arecenterpieces of future research expansion. Our expertise includes the following areas: Acute Ischemic Trials, Cardiovascular Outcomes Research and Epidemiology, Vascular Biology (Oxygen sensing, Pulmonary Hypertension), Heart Failure. , Translational Research, and Cellular Electrophysiology. We will continue to build on the existing excellence of our research groups: VIGOUR (Dr. Armstrong), EPICORE (Dr. Tsuyuki), Vascular Biology-(Dr. Michelakis) 9th Annual Cardiac Sciences Day: Our annual Cardiac Sciences Research Day, organized by Dr. Ross Tsuyuki, is one of Canada’s largest and most comprehensive local Cardiac Sciences meetings. Over 60 abstracts are presented each year and we use a state of the art, on-line abstract grading system. MDs, Ph.D.s, nurses, scientists and trainees from all hospitals in the region participate. Past speakers are listed in the complete report. This year our speakers were: Roche Distinguished Speaker-Russel Leupker (Minnesota) on out of hospital sudden cardiac death and Dvorkin Memorial Lecturer-Dr. Methias Friedrich (University of Calgary) on Cardiac MRI 2005 Where Are We? Research Awards: Faculty have received several awards reflecting their national standing. Our trainees have also been very successful in research competitions. Vascular Biology Group Trainees have won the Cournand-Comroe YIA at the American Heart Association’s National Meeting in 4 of the 6 past years. Celebrations: The Division hosts several celebrations to foster collegiality and thank our support staff. 7th Annual Cardiology Picnic: Over 150 people including spouses, friends and children attended this family event at Fort Edmonton. Christmas Party and Fundraiser for Edmonton Food Bank: The Division hosted a gala Christmas party for ~260 faculty, nurses, technicians, and friends at the Royal Glenora Club. The 2 005party was organized by Cindy Watt. Dr. Jonathan Tang played the piano beautifully and performed a selection of carols. A good time was had by all. $2500 and food were collected for the Edmonton Food Bank. Heart and Stroke Volunteer (H&SF) Appreciation Day: The Vascular biology Group and Cardiology Division, sponsored and organized the annual tour of the clinical and research facilities at the University of Alberta for 250 H&SF canvassers. The tour highlights the work done by clinicians and investigators at the U ofA and energizes these fundraisers. Twenty volunteers from the University of Alberta demonstrated basic science labs, CCU, Cardiac MR suite, cath lab, stress lab, and ECHO lab. Cardiology Resident and Fellow Celebration: An annual thank you and recognition party is held for our trainees and was successfully hosted by the Welsh’s. Cardiology Annual Report 2005
  9. 9. Infrastructure 2004 Mazankowski Alberta Heart Institute (AHI): Construction of this 300,000 ft2, 4-floor heart hospital with an 8-story tower is in the home stretch soon to be complted. We anticipate opening of the facility to patients in October 2007. AHI will consolidate CV surgery and Cardiology.. AHI will increase clinical capacity by 50%. The outpatient capacity will increase significantly with the provision of a 20+ bed holding facility. In addition, the number of electrophysiology and cardiac catheterization labs will increase to two and three, respectively with an additional EP procedure room. A new cardiac MR will be added on Level 2. This is a $250 million project and the Division thanks the lead fundraiser, Mr. Bill Comrie and his colleagues for their support of the project and their masterful engagement of the community both in Edmonton and across Alberta. Under the leadership of Mr. JR Shaw, ~$10 million was raised in Calgary. We thank the Hospital Foundation for their fund raising efforts and acknowledge the Alberta Government, the major funder of this centennial project. The Divisional members also are major donors to AHI. ($320,000) We are proud to announce that just recently the leadership team was named which includes: Dr. David Johnstone, a nationally recognized cardiologist from Eastern Canada, will become the Heart Institute's Clinical Director. His role will be to lead the clinical care team and provide training for the next generation of cardiac specialists. As former Vice President of the InterAmerican Society of Cardiology; past President of the Canadian Cardiovascular Society and former head of the Cardiology Division at Dalhousie University, Halifax, Dr. Johnstone championed the development of national guidelines for all cardiovascular services. Dr. Johnstone will also serve as Clinical Professor in the Faculty of Medicine and Dentistry at the University of Alberta. Dr. Arvind Koshal, Capital Health's chief of cardiovascular surgery and regional director of cardiac sciences, will become the Heart Institute's Director of Development and External Affairs. Dr. Koshal is a surgeon who has led Capital Health's cardiac team for more than a decade. During his tenure as chief of cardiovascular surgery, Capital Health's heart transplant program has become the largest in Canada. In his newly expanded role, he will advance the Heart Institute's reputation across the country and share his experience with students as Director and Clinical Professor of Cardiac Surgery at the University of Alberta. He is also the Heart Institute's connection to the philanthropic community. Cardiology Annual Report 2005
  10. 10. Scientist Dr. Gary Lopaschuk, a world leader in the area of energy metabolism and control of fatty acid metabolism in the heart, will become the Heart Institute's Scientific Director. He will lead research through the Institute and within a broader cardiovascular research community. Dr. Lopaschuk is pharmacologist who trained as a fellow at the Mayo Clinic and is published in numerous medical journals. He is well known in Alberta and across Canada for his research achievements as Director of the Cardiovascular Research Group at the University of Alberta where he is also a Professor in the Faculty of Medicine and Dentistry. Alberta Cardiovascular and Stroke Research Centre (ABACUS) The Alberta Cardiovascular and Stroke Research Centre (ABACUS) is an investigator- initiated, research centre scheduled to open in September 2006. Directed by Dr. Stephen Archer and administered by Ms Bev Armstrong, this $18 million, translational research centre is funded by several federal and provincial agencies, including the Canada Foundation for Innovation (CFI), the Alberta Government and the University Hospital Foundation. Our major corporate partner in this endeavor is Siemens. ABACUS will serve over 100 investigators and their trainees in Edmonton and Calgary. The 10 lead investigators in ABACUS are each internationally recognized leaders in their research fields (ranging from informatics to cardiac and neuro-intervention). Several hold national Research Chairs and are leaders in their own fields The mission of ABACUS multidisciplinary faculty (from six departments) is to perform outstanding research aimed at the prevention, detection and cure of cardiovascular diseases (CVD), including stroke. The research will be conducted at levels ranging from Molecules to Populations. The focused research mission provides a home for investigator-initiated research, and will also enhance patient care and contribute to the education of scientists and cardiovascular healthcare professionals. ABACUS will occupy 1800m2 on a research floor shared with Dr. Allen’s, CFI-funded in vivo NMR Research Centre. Located in close proximity to a tertiary care Emergency Department and the Alberta Heart Institute, ABACUS has unparalleled capacity to support research on subjects ranging from ambulatory to those with acute and severe cardiovascular illnesses. ABACUS is a ‘Research Hospital Within a Hospital’ that will enable researchers to quickly apply breakthrough therapies and revolutionary biomedical devices to patients participating in studies or clinical trials. This innovative centre will not only help patients, but also enables Canadian scientists to perform groundbreaking research and compete on the international stage. ABACUS is strategically aligned with the Alberta Heart Institute, the University of Alberta Faculty of Medicine and Dentistry and Capital Health. ABACUS now has its own website ( and desktop. ABACUS contains the following 4 cores: Cardiology Annual Report 2005
  11. 11. 1) Imaging and Intervention Core: This core includes a biplane flat panel angiography suite with a magnetic navigation system (suitable for heart and stroke research), electrophysiology, echocardiography, an ultrafast 64-slice CT scan, IVUS, CT-SPECT nuclear imaging, an exercise physiology laboratory, mapping catheters for gene therapy (NOGA) and electrophysiology (CARTO) and a 6-bed recovery/procedure and telemetry unit. 2) Vascular Biology-Gene Therapy Core: This core has sophisticated basic science tools for the evaluation mechanisms of CVD. It will facilitate identification/testing of new therapies (drug and genes) to modulate the interaction between the blood and the vessel wall. It includes core facilities for: vascular function, molecular imaging (Live Imaging confocal), applied proteomics, gene therapy, tissue banking and cellular electrophysiology. The core contains a robotic protein chip facility, funded by Western Economic Diversification that will aid researchers in identifying abnormal protein biomarkers that predict the presence, and correlate with the severity and activity, of several cardiovascular diseases. By studying changes in protein biomarkers, researchers may identify diseases prior to the appearance of physical symptoms, potentially reducing health care costs and patient risk. 3) Trial Design/Data Analysis/Outcomes Core: ABACUS will provide the infrastructure needed to support data analysis and trial implementation by existing research groups such as EPICORE, VIGOUR and APPROACH. APPROACH, the provincial coronary disease outcomes registry led by Dr. Knudtson (U of Calgary), will be based in ABACUS. Break out space for collaborative discussions, flex workspace for scientists, trainees and visitors has been designed for use within this core. In collaboration with Capital Health, space has been designed for Cardiology Clinical Trials and consists of exam rooms, a conference room, secured medication and lab storage and workspace for trial coordinators. 4) Data Acquisition and Transmission Facility (DAT -PCR): This 100 -150 seat facility is accessible globally via high-speed Internet. It is a wireless networked viewing centre allowing conventional and virtual conferencing. The DAT – PCR will allow data acquisition from scientists and research subjects. The faculty and trainees will be linked in a virtual electronic research community through ViviDesk®, Dr. Hayward’s “made in Alberta” portal or digital desktop environment. Secure software has been developed to facilitate to acquire, move and analyze images and information electronically. Challenges 1) Volumes and Average Length of Stay (ALOS): The ALOS, which had been reduced by ~2 days after 5 years of concentrated effort to enhance efficiency, has again increased, due to delays in obtaining diagnostic testing (notably MIBI stress tests, implantation of pacemakers and defibrillators and angiography/angioplasty). Patient acuity has continued to increase and the UAH CCU, which manages ventilators, balloon pump patients etc, remains very busy and extremely efficient. Further support from CH is required. Cardiology Annual Report 2005
  12. 12. 2) Stabilization of Innovative Programs at the end of their grants: Cardiac EASE, the Chest Pain Program, the PHT clinic and the AMS program (and the associated ANP positions) all require permanent funding when their grants expire. This was the understanding when they were submitted and the first of these programs (AMS) has made the transition from grant support to CH support. The Division of Cardiology is working with Debbie Gordon on this issue. 3) Cardiology Faculty Office Space in AHI: We no longer have any room for physician or secretarial recruitment and yet have several faculty returning to positions before AHI opens (October 2007). While interim solutions are required, this space issue should be resolved by AHI. We have secured reassurance from Dr David Johnstone and Debbie Gordon that the Divisional faculty offices will be in AHI. 4) Research Space in AHI: Dr. Gary Lopaschuk will be responsible for securing research space in MAHI. 5) ) Operational Model for ABACUS and Interinstitutional Agreement between CH and U of A: Work continues with the leadership team of MAHI, Andy Greenshaw (UA) and Debbie Gordon (CH) to establish an interinstitutional agreement to allow the flow of patients and staff through ABACUS. and Michele Lahey on an operational model for the running of ABACUS. The challenge will be to secure incremental staff (i.e. clinical facilities in Cardiology need to run while ABACUS does clinical research-itself provide care for patients). Will ABACUS collect fees and overhead (up to 30 % which now goes to NACTRC) and use this for growth/operational expenses? Alternatively, will funding by CH and U of A support the core operations, with grants supporting the curiosity- driven research aspects of the centre? 6) Electrophysiology: We are conducting a search for Director of EPS services. At the present time Debbie Gordon and Dr. Dylan Taylor are chairing a committee which is implementing the Mario Talajic report. In the future Dr. Wayne Tymchak will replace Dr. Dylan Taylor. 8) Transition to the Electronic Health Record: The Division will make the switch to an electronic health record using the funding provided by the POSP. Under the guidance of Dr. Kimber, we have selected Microquest as a vendor and will be using this program in mid-late 2005. The linkage with CH’s EMR is uncertain, but we have kept the Dept. of Medicine and CH IS (Donna Strating) fully apprised of our plans. 9) Working across specialties-liaison with DI and Neurology: We continue to expand our links with Diagnostic Imaging and have had good support from Dr. Lambert (UAH) and Dr. Anderson (Regional). Our interfaces include the cath lab, the cardiac MR program and, in the future, Vascular Medicine and Cardiac CT. Respectfully submitted by: Wayne Tymchak MD, FRCP, FACC Acting Director of Cardiology Cardiology Annual Report 2005