cardiac sciences annual report 1 department of cardiac

1CARDIAC SCIENCES ANNUAL REPORT

2019-2020

Department of Cardiac Sciences Annual Report

CARDIAC SCIENCES ANNUAL REPORT

Table of Contents

Executive Summary

Leadership Personal Message

Departmental Structure & Organization

Departmental CommitteesDepartment of Cardiac Sciences Physician WellnessCommittee

Divisions, Sections and ProgramsCardiologyCardiac SurgeryCardiac AnesthesiologyCardiacCriticalCare

Membership

Accomplishments and HighlightsA. Cardiology• Advanced Heart Failure• Arrhythmia & Autonomics• Nuclear• Adult Congenital Heart Disease (ACHD)• CardiacMagneticResonance(CMR)• Echocardiography• FoothillsInterventional�ardiology ServiceB. Cardiac Surgery• Minimally Invasive Valve Surgery (MIVS)• C.MultidisciplinaryDepartmentalPrograms• Mechanical Circulatory Support• D. Cardiac AnesthesiaE.CardiacCriticalCare

SitesFoothills Medical CentrePeter Lougheed CentreRockyviewGeneralHospitalSouth Health CampusTotalCardiologyTM

EducationPostgraduateMedicalEducationFellowshipPrograms

ResearchGrants/ResearchRevenueAwardsandRecognitions

Challenges

Opportunities

Workforce PlanningCardiologyCardiac Anesthesia

Quality Assurance, Quality Improvement and InnovationGeneralFutureDirectionandInitiatives

Appendix A

Appendix BCardiacSciencesGrandRoundsSpeakers

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ProgramCalgarySuccess Stories

Clinical AnalyticsTranscatheter Aortic Valve InterventionsResearch Analytics

Aortic


Theyear2019-2020wasmarkedbygrowth,unexpected challenges and the need for agile adaptationfortheDepartmentofCardiacSciences.Despitetheturbulentyear,thereweresignificantsuccesses,mostnotablytheresponsetotheCOVID-19pandemic.Themembersmaintainedoutstanding quality and access to cardiovascular caredespitecontinualuncertaintyduetorapidlyevolvingpublichealthdirectives.Thepandemicresponse resulted in an increased use of virtual careplatformsandofferednewstrategiesforamoreagileandintegratedoperationalteam.

Beyondthepandemic,wetooksignificantstepstoimprovetheexperienceofworkinginandreceivingcare at the Department. We established a physician wellnesscommitteetobeginaddressingthestressofincreasedworkloadsinavolatile,uncertain,andsophisticatedhealth-careecosystem.In2019-2020,the createdaformalEDIcommitteetoproactivelyconsiderhowequity,

Formalreviewsofthetwocoretrainingprogramswerepositive,androutineevaluationsof this nature ensure a quality experience for learners.Morethan260graduatestudents,40undergraduatestudentsand37postdoctoralfellowsundertookadvancedresearchtrainingwiththeDepartmentandInstitutein2019-2020.Our students received numerous scholarships and awardsovertheyear.

Thissuccesscameaboutduringayearofsignificantleadershiptransitions.Dr.ToddAnderson,formerDepartmentHeadandDirectoroftheLCI,andCarolineHatcher,long-standingExecutiveDirectorofCardiacSciences,bothmigratedtonewadministrativeroles.

Inadditiontothesechanges,increaseddemandfor clinical care delivery and the corresponding growthofclinicalvolumesinanenvironmentoffiscalrestraintcontinuedtostretchourcapacity.Suchgrowthstrainsphysicianworkloads,andwehaveexperiencedaresultantdecreaseinstaffwellness.Consequently,theDepartmentremainschallengedtoprovideandeffectivelycoordinatethe human health resources necessary to safely covertheneedsoftheZone.Movingforwardwewillrequirestrongleadershipeffortstoreorganizeand realign our human health resources to address these challenges.

Wewillcontinuetorecruitphysiciansandrestructure care models to support clinical care whileprotectingphysicianwellness.Opportunitiesexistforharnessingourrichdataplatformsandinformaticscapabilities.

Wewillinvestinourdataresourcesandtransformourdataintoactionableinformationtoimprovepatientoutcomesanddrivevalue(improvedqualitywithlesscost)toensureourlegacyofoutstanding cardiovascular care is sustainable.

Department,and2019-2020washighlysuccessfulintermsofbothresearchimpactandproductivity.TheDepartment’sresearchproductivity,5.7publicationsperfull-timeequivalent,exceededaveragefortheCummingSchoolofMedicine(4.1publicationsperfull-timeequivalent).Likewise,theresearchimpact,asmeasuredthroughannual citationsperfulltimeequivalent,significantlyoutpacedtheCSMaverage(439vs.267).

TheLibinCardiovascularInstitute(LCI)membershippublishedmorethan500papersinthelastyearandreceivedover$30millionintotalresearchrevenue.Likewise,educationisacornerstoneoftheDepartment.Specialtyfellowshipprogramsinelectrophysiology,heartfailure,interventionalcardiologyandechocardiology,aswellasstrongcoreclinicaleducationprogramsincardiologyandcardiacsurgery,wereessentialtotheoverallsuccess of the department.

Department

both patients andprofessionalsandensurethatweareresponsiveandtimelyinmeetingtheuniqueneedsofall ofour patientsandstaff.

Clinical research is a crucial strength of the

impact(EDI)inclusiondiversity

Executive Summary

and

4 CARDIAC SCIENCES ANNUAL REPORT

Leadership Personal Message

theInstitute.Wesawthetransitionofinfluentialleaders: Dr. Todd Anderson (former Department HeadandInstituteDirector)becametheViceDeanofMedicine,CummingSchoolofMedicine;andthelong-standingExecutiveDirectorofCardiacSciences,CarolineHatcher,migratedtoanewleadershipportfoliowithinAlbertaHealthServices.

TheirtirelesseffortscreatedastrongfoundationfortheDepartmentandtheInstitute,andwewillbuildupontheirlegacytoexpandourambitiousclinical and academic mission. We are incredibly gratefulfortheircollectiveimpactoverthepastdecade.

Underournewleadership,theDepartmentandtheLCIinvestedinajointstrategicplantocrystallizean integrated vision for the future and develop an end-to-end road map for achieving it. Early in the processanInternationalExternalAdvisoryPanelperformedareviewoftheInstituteandofferedvaluableinsightsforgrowthopportunities.

TheycalleduponustofocusonbetterharnessingtheresearchandhealthcaremodifyingpotentialaffordedbyimprovedintegrationbetweentheDepartment and the LCI. Subsequent member engagementsessionsleadtoarefinedoverarchingvision - to lead and transform health care using precisioncardiovascularhealthplatforms.

ThisiswellalignedwiththeCummingSchoolofMedicinepriorityfocusonprecisionmedicine,and the Alberta Health Services principle of ensuringthatAlbertansreceivetherightcare,attherighttimefromtherightprovider.Ouruniqueorganizationalstructure-afullyintegratedmulti-disciplinary clinical department and cardiovascular researchinstitute-allowsforacomprehensiveapproach to precision medicine. We intend to leverageouruniquecapabilitiestoadvancepatient-centred,valued-basedpracticesthatwillenhancepatient-reportedoutcomes,increaseaccesstocare,andimprovequalitywhilereducingcost.Inbrief,wehopetopromotea“bettermodelforbettercare.”

Overthepastyear,theCOVID-19pandemicofferedan unexpected challenge. I am very proud of our membership in stepping up and maintaining outstandingcareforourpatientsandcontributingto leading edge research in this area. The members showedenormousresiliencyunderaperiodofhighstress.

The2019–2020yearhasbeenoneoftransformationforboththeDepartmentand

It is my privilege to serve as the Head of the Department of Cardiac Sciences and the Director oftheLibinCardiovascularInstitute(LCI).Theunionofthesetwoentitiesunderasingleleaderensuresthatwecanprovideexcellenceinthepreventionandtreatmentofcardiovasculardiseases,conductworld-classresearchandscholarship,andtrainthenextgenerationofleadersincardiovascularhealth.

Paul W.M. Fedak, MD, PhDHead, Department of Cardiac SciencesDirector, Libin Cardiovascular Institute


Leadership Personal Message ...

Thecommitmenttobothexceptionalpatientcareandtheacademicmissionneverwavered.Thepandemicresponsewascoordinatedandnimble,andtheDepartmentseizedtheopportunitytomobilizeexistingdataassetstoenhancereal-timeclinicaldecisionmaking.ItalsohighlightedhowourDepartmentcanbeagilewhenneededandrapidlyadapttochange.Weweresuccessfulinpromptlyandeffectivelyrestructuringourcardiovascularservices throughout the Zone to ensure a seamless provision of quality cardiac care throughout the pandemic.Thelessonslearnedwillhelpusshapefuturecaremodelstowardimprovedefficiency,value,accessandappropriateness.

WebelievethatcollaborationbetweentheLCIandtheDepartmentofCardiacSciencesoffersimmense value to the community by using our robustdataenterprisetofindandaddressgapsincare,reducevariabilityanddevelopthetoolsnecessarytomakeabroaderimpact.

Accordingly,ourstrategymovingforwardinvolvessignificantinvestmentsinclinicaldataandfurtherintegratingourdataresourcestoinformbestpractices;cultivatingarobustapproachtosexandgenderconsiderationsinbothresearchandclinicalcare(CV&Me);andreducingdemandonthesystemthroughinnovationsincardiovasculardiseasepreventionandhealthpromotion(P2).

Weareinastrongpositiontorespondtotheenormous pressures and changes that threaten publichealth,andourbroaderhealthsystem.TheInstitute’sintegratedleadershipstructure,ouroutstandingandcommittedmembers,ourrobustenablingplatforms,andourresiliencyensureourability to face ongoing and future challenges and continuetomeetexpectationsaswehavedoneover the past year.


Assuch,wehaveaffiliatedmembershipwithcardiacanesthesiaandcardiacintensivecare colleagues. Our cardiovascular service line delivery model’s integrated nature represents afundamentalvaluepropositionofourorganizationalleadership.

We deliver clinical services to our health region asambulatorycare,cardiacdiagnosticsandlife-savinginterventionalproceduressuchasopen-heartsurgery,structuralheartinterventions(TAVI)andprimarycoronaryinterventions(PCI)foracutemyocardialinfarctionsandcoronaryrevascularization.TheDepartmentprovidesthemajority of cardiovascular care throughout our vasthealthregion.Twocommunityprivatepracticeoutpatientambulatorycardiacclinicsalsoplayanessentialroleindeliveringoutpatientambulatoryanddiagnosticcareinpartnershipwithourmembers. Many of these community physicians arealsoaffiliatedmembersofourDepartment.

The Libin Cardiovascular Institute (LCI) is a joint entityoftheUniversityofCalgaryandAlbertaHealthServices.TheInstitutecoordinatesallcardiovascularhealthcare,educationandresearchthroughout the University of Calgary and the Calgary Zone of Alberta Health Services. The LCIisawide-rangingprogramofcardiovascularintegrationthatincludesfourlargeUniversityofCalgaryfaculties,10facultyofMedicinedepartments,fourAlbertaHealthServicesclinicaldepartmentsandfiveAlbertaHealthServiceshospitalsthatworkasasynergisticteamtohelpallAlbertans.Thislargescale,highlyintegratedenterpriserepresentsanexcitingopportunitytoaddress the changing needs of cardiovascular care withinourcommunities.Webelievethatlessonslearned could be useful for health-care systems aroundtheworld.

OrganizationThe Department of Cardiac Sciences is the arm of theLibinCardiovascularInstitute(LCI)responsibleforthedeliveryofclinicalcare.TheInstituteisajointentityofAlbertaHealthServicesandtheUniversityofCalgary,withamandatethatalsoincludesresearchandeducation.

Alberta Health Services is the most extensive integrated provincial health care system in Canada.Careisdividedbygeographiclocation,and the Calgary Zone is the largest in Alberta. TheCalgaryZoneservesmorethan1.6millionpeoplewithina40,000-kilometersquaredarea.ThisgeographicareaisoverfivetimesthesizeofPrinceEdwardIsland.TheDepartmentofCardiacSciences coordinates cardiovascular care delivery fortheCalgaryZone,whichislargelyadministeredthroughfouracutecarehospitalswithinthecityofCalgary.

The Department delivers life-saving cardiovascular procedures,suchasopen-heartsurgeryandpercutaneouscoronaryinterventions,topopulationofmorethantwomillionresidentslivinginthreeadjacentzonesinSouthernAlberta.

The membership of the Department of Cardiac Sciences is primarily composed of cardiologists and cardiac surgeons. We are home for more than75cardiologistswithamixofclinical,research,education,andleadership/administrativeresponsibilities.

Weareproudtohaveagrowingteamof12clinicalcardiacsurgeons,whoalsoholdamixofacademicresponsibilitiesandclinicalinterests.While cardiology and cardiac surgery represent theDepartment’sprimarysections,weareafullyintegrated team providing a cardiovascular service line.

Departmental Structure and


LIBIN CARDIOVASCULAR INSTITUTE

DIRECTORLibin Cardiovascular Institute

Dr. Paul Fedak

Director of ResearchDr. Rob Rose

Operations DirectorDr. Lisa Petermann

Education DirectorDr. Jennifer Thompson

COMMUNICATIONSDawn Smith

CV & Me CoordinatorAlexa Desjarlais

P2 CoordinatorCamilia Thieba

Clinical DirectorDr. Nowell Fine

Executive AssistantChristina Faulkner

RESEARCH OFFICERJudy Siu

EVENTS MANAGERMegan Smith

OPERATIONS COORDINATORBarsha Rimal

DATA INITIATIVE LEADMelanie Rosario

CLINICAL ENGAGEMENT SPECIALIST

IT COORDINATORJohn Nystrom


CORE LEADERSHIPDEPARTMENT OF CARDIAC SCIENCES

ZONE CLINICAL DEPARTMENT HEAD

Dr. Paul Fedak

Zone Clinical Department Manager Andrew Jenkins

Administrative Services Manager Amber Arsneau

SITE LEADERSHIP SECTION CHIEFS EDUCATION

PHYSICIAN WELLNESS AFFINITY GROUP LEADS

EDICOMMITTEE

INFORMATICS

ASSOCIATE ZONE MEDICAL DIRECTOR

Dr. Peter Jamieson

VICE DEANDr. Todd Anderson

SENIOR OPERATING OFFICER Shawna Syverson

EXECUTIVE DIRECTOR Cardiac Sciences Amanda Weiss *

*Executive Director Cardiac SciencesMs. Caroline Hatcher

2009 ‐ 2020


SITE LEADERSHIPDEPARTMENT OF CARDIAC SCIENCES


Dr. Paul Fedak

Foothills Medical Centre Facility Site Chief: Dr. Carlos Morillo Executive Director: Amanda Weiss

CICU, PCU 81, PCU 82Daniel Salcedo

Executive Director CCU Teresa Thurber

Cardiac Diagnostics, Informatics, APPROACH

Barb Jones

PCU91, PCU 94, Perfusion, MCS Program

Kari France, Diane Silvestri

ICU and CCUMelissa Redich

Short Stay Cardiology, Cardiac Cath Lab, Specialty

ClinicsDiane Schmidt

Director Cardiac Critical CareDr. Andre Ferland

Director Cardiac AnesthesiaDr. Chris Prusinkiewicz

Section Chief Cardiac SurgeryDr. Imtiaz Ali

Section Chief CardiologyDr. Carlos Morillo

Deputy Section Chief Cardiology

Dr. Sandeep Aggarwal

Rockyview General Hospital Facility Site Chief: Dr. Nakul Sharma Executive Director: Virginia Meyer

Cardiac Clinics and CV LabsMartine Fell

PCU71Robert Berney

South Health CampusFacility Site Chief: Dr. Patrick Champagne Executive Director: Paul Stewart

PCU 66, Cardiac Clinics, CV Labs

Lori Forand

Peter Lougheed Centre Facility Site Chief: Dr. Michael Connelly Executive Director: Emma Folz

PCU 48, CCU, Cardiac Clinics, CV LabsGlenda Durupt


PROGRAM LEADERSHIPDEPARTMENT OF CARDIAC SCIENCES


Dr. Paul Fedak

Advanced Heart FailureMedical Leader: Dr. Brian Clarke


Director Cardiac AnesthesiaDr. Chris Prusinkiewicz


Director Cardiac Critical CareDr. Andre Ferland



Arrhythmia ServicesMedical Leader: Dr. Satish Raj

Cardiac Critical CareMedical Leader: Dr. Greg Schnell

Cardiac Magnetic Resonance (CMR)Medical Leader: Dr. James White

EchocardiographyMedical Leader: Dr. Nowell Fine

Interventional CardiologyMedical Leader: Dr. Michael Curtis

Nuclear CardiologyMedical Leader: Dr. Ilias Mylonas

Minimally Invasive Valve Surgery Surgical Leader: Dr. William Kent

Aortic ProgramSurgical Leader: Dr. Scott McClure

MULTIDISCIPLINARY DEPARTMENT PROGRAMS

Mechanical Circulatory Support Program

Surgical Leader: Dr. William KentMedical Leader: Dr. Brian Clarke

Structural Heart ProgramMedical Leader: Dr. Anna Bizios

Adult Congenital Heart Disease Medical Leader: Dr. Michelle Kier


SCIENCES CARDIAC OF DEPARTMENTEDUCATION


Dr. Paul Fedak

EDUCATION ‐ CARDIOLOGY





CARDIOLOGY RESIDENCY PROGRAM

Program Director Dr. Katherine Kavanagh

ElectrophysiologyProgram Lead: Dr. George

Veenhuyzen

Clinical Clerk CoordinatorDr. Angela Kealey

Undergraduate Medical DirectorDr. Andrew Grant

Interventional CardiologyProgram Lead: Dr. Francois

Charbonneau

Echocardiography Program Leader: Dr. Sarah Weeks

FELLOWSHIP PROGRAMS

Advanced Heart FailureProgram Leader: Dr. Brian Clarke

EDUCATION – CARDIAC SURGERY

CARDIAC SURGERY RESIDENCY PROGRAM

Program Director Dr. William Kent

SURGICAL FOUNDATIONS PROGRAM

Cardiac Surgery Director Dr. William Kent


Departmental Committees

Department of Cardiac Sciences Physician Wellness Committee

Lead – Vikas KuriachanOurnewlyformedCardiacSciencesPhysicianWellnessCommitteeconsistsofrepresentativesacross all four facets of our department: Chris Prusinkiewicz(CardiacAnesthesia),KenParhar(CardiacCriticalCare),AndrewMaitland(CardiacSurgery)andJillColbert,GrantPetersandVikasKuriachan(Cardiology).ThecommitteeaddressesorganizationwellnessconcernsthatariseandworkswithWellDocAlberta.AlsoanyofthecommitteememberorleadershipcanbeapproachedtodiscussanywellnessandburnoutissuesthatariseforanystaffphysicianintheDepartment of Cardiac Sciences.

Ifanyconcernsarisethatcannotbesatisfactorilyaddressed internally in our department then our ombudspersonforWellnessisDr.JeffSchaeffer,ZoneClinicalSectionChief,SectionofGeneralInternalMedicine.OurcommitteeensuresthatallstaffphysicianshaveaccesstonecessaryresourcessuchastheAlbertaMedicalAssociationPhysicianandFamilySupportProgram(PFSP)andtheOfficeofProfessionalism,EquityandDiversity.Thecommitteeisalsoavailabletoliaiseandsupporttraineewellnessandworkscloselywithourclinicaltraining programs.

Physician and Family Support Program (PFSP) and theOfficeofProfessionalism,EquityandDiversity.Thecommitteeisalsoavailabletoliaiseandsupporttraineewellnessandworkscloselywithour clinical training programs.

Sections and ProgramsThe Department of Cardiac Sciences has four

cardiology,cardiacsurgery,cardiacanesthesiology,andcardiaccriticalcare.

Cardiology

Sections:

The Section of Cardiology provides a uniqueprogramofstandardizedcity-widecareandcontinuestodevelopinnovativecarepathways.Thesectionprovidesbothprimarycareandspecializedcareinnumerousclinicsaroundthecitywithspecialtiesthatincludearrhythmias,atrialfibrillation,adultcongenitalheartdisease,aorthopathies,cardio-oncology,cardiacimplantableelectronicdevices,hypertrophiccardiomyopathy,cardiacrehabilitation,heartfailureandtransplant,syncopeandautonomicdysfunction,andcardiologyrapidaccessclinics.Our members also provide primary cardiology care anddiagnosticteststhatincludeexercisetesting,echocardiography,myocardialperfusionimaging,CTscan,andCardiacMRI.

Section Chief, CardiologyCarlos A. Morillo, MD


Cardiac Surgery

MultidisciplinaryHeartTeamsarethebasisforevidence-baseddecision-makingforthetreatmentofallcardiacsurgicalpatients.Membershavearobust academic medicine approach and embrace qualityimprovementinnovations.

Forexample,thedivisionrecentlyadoptedtheKeepyourMoveintheTube(KYMITT)concept,replacingthestandardsternalprecautionsapproachforpost-operativepatientswiththegoaloffasterrecoveryforopen-heartsurgerypatients.

Cardiac Anesthesiology

Vision: To improve the quality of life and longevity ofpatientswithsurgicalcardiacdiseasebyoptimizingperioperativemanagement

Mission:Tobeaninternationalleaderintheenhancedrecoveryofcardiacsurgerypatientsandto excel in academic cardiac anesthesia.

Our members perform numerous subspecialty operationsincomplexaorticsurgery,hybridaorticsurgery,minimally-invasivevalvesurgery,completearterialrevascularizationandtranscatheteraorticvalve surgery (TAVI).

TheCardiacAnesthesiaGroup(CAG)consistsofninesub-specialtytrainedanesthesiologistswhohold primary appointments in the Department of Anesthesiology,PerioperativeandPainMedicine(FoothillsMedicalCentreSection)withjointappointments in the Department of Cardiac Sciences.GroupmembersalsoholdclinicalappointmentswiththeUniversityofCalgary.

All group members have successfully completed theNationalBoardofEchocardiographyPerioperativeExaminationandhavereceivedcertificationinperioperativetransesophagealechocardiography from the College of Physicians and Surgeons of Alberta.

The Director of Cardiac Anesthesia is Dr. Chris PrusinkiewiczandherepresentstheCAGonboththeZoneAnesthesiaExecutiveCommitteeandtheCardiacSciencesExecutiveCommittee.MultiplegroupmembersholdleadershippositionsincludingDr.DucHa(FMCSectionofAnesthesiaSiteChief),Dr.AlexGregory(DirectorofCardiacAnesthesiaResearchandDirectoroftheCardiacAnesthesiaFellowshipProgram),andDr.DougSeal(CardiacAnesthesiaLeadforPerioperativeBloodConservation).

The group has recently recruited Dr. Michael Gyselasanewmember.Dr.Gyselwilljointhefacultyin2021,uponcompletinghisfellowshipincardiothoracicanesthesiaatDukeUniversity.Hewilltakealeadershiproleindevelopingqualityassurance and quality improvement programs in cardiac anesthesia.

Cardiac Critical Care

The Cardiovascular Intensive Care (CVICU) provides high quality care for the post cardiac surgery patients.Thiscanonlyhappenwiththeamazingdedication,teamwork,andcollaborationofallthedepartmentsandmultidisciplinaryteamsinvolvedthroughoutthecardiacsurgerypatients’journey.Theunithasatotalof22bedsontwoseparateunits(Unit94and104)with16ofthesebedscurrently funded.

Section Chief, Cardiac Surgery Imtiaz Ali, MD


The Cardiovascular Intensive Care Unit (CVICU) attheFoothillsMedicalCentre,istheonlyCVICUservingSouthernAlbertawithmorethan1,650cardiacsurgerycasesin2019.TheCVICUspecializesinpost-operativeopen-heartsurgerywithCoronaryArteryBypassGraft(CABG)andvalverepairorreplacementmakingupthemajorityof cases.

Otherpost-operativesurgeriescaredforintheCVICUincludecomplexthoracicaorticsurgery,minimally-invasive valve surgery including alternate approachestofemoral-basedTranscatheterAorticValveImplantation(TAVI),ExtracorporealLifeSupport (ECLS) for both temporary heart and lung support(VV/VAECMO),andVentricularAssistDevices(VAD)whichprovideshorttermandmoredurable heart support.

MembershipTheDepartmentofCardiacScienceshas75cardiologists,12cardiacsurgeons,9cardiacanesthesiology,and10cardiaccriticalcarephysicians.

Improving the patient experience, read about new and innovative techniques used in the

Department in Appendix A

Caroline Hatcher takes a new leadership role in cancer care, read more about her impact in Cardiac Sciences in Appendix A


Cardiology

Section Chief - Dr. Carlos Morillo

TheSectionofCardiology(SOC)continuestoexpand its clinical footprint across the city of Calgary and southeastern Alberta. The SOC’s sevenaffinitygroupsprovidesupportonalltheclinicalanddiagnosticareasofcardiology.With75cardiologists the SOC is among the largest in the countryandisrecognizednationallyasaleaderinseveralfields.

ThestructuralinterventionalcardiologygrouphascontinuedtoexpandandhasstreamlinedtheTAVIprogram,whichisajointeffortbetweeninterventionalcardiologyandcardiacsurgery.Morethan125TAVI’sareimplantedannually.TheTAVIclinic,ledbyDr.AnnaBizios,isimplementingastreamlinedTAVIassessmentthatincludesanevaluationoffrailty.Otherstructuralprocedures,suchasPFOclosures,havealsocontinuedtogrowunderthecurrentleadership[Appendix B]

COVID-19significantlydisruptedthedailyoperationalactivitiesoftheDOCcity-wide.Outpatientclinicsanddiagnosticsserviceswerereducedbyalmost90percentofourusualvolumes. Strong leadership in the Department of CardiacSciencesandtheSOCcoordinatedazone-wideresponsetoensureappropriatecardiaccarewasavailabledespitethesereductions.Manyofour processes have been streamlined and adopted at the provincial level. Management of cardiac care wasmanagedacrossthecitythroughaCOVID-19dashboard.

Important highlights include establishing a WellnessCommitteeandanEquity,DiversityandInclusionworkinggroupledbyDr.VikasKuriachanandDr.MichelleKeir,respectively.

Advanced Heart Failure

Lead – Dr. Brian ClarkeTheheartfailure(HF)groupandcardiacfunctionclinicseesmorethan17,000patientsacrossthecityandhasstandardizedHFpathwaysinCalgary,reducing hospital admissions and improving care.

TherecruitmentofformertraineeDr.RobMillerfollowingfellowshiptraininginadvancedheartfailure&cardiactransplantationatStanfordUniversityandmulti-modality/nuclearimagingat UCLA is an asset to our program. Dr. Deb Isaac returnedfromsabbaticalthisspring.With thesuddenupcomingdepartureofDr.AndrewGrant,leavesan urgency for recruitment for the AHF program.

OurCalgarymembershavesignificantrolesinthe Canadian Cardiovascular Society including Dr.NowellFine,theco-chairoftheCCS/CHFSJointPositionStatementontheEvaluationandManagementofPatientswithCardiacAmyloidosis;Dr.BrianClarke,theco-chairoftheCCS/CCTNJointPositionStatementonHeartTransplantation:PatientEligibility,Selection,andPost-TransplantationCare;Dr.JonathanHowlett,CCSPrimaryPanelforHeartFailureGuidelines;andDr.KristinLyons,CCSGuidelinescommitteemember.

Highlights• Successful Launch of Invasive Heart Failure

MonitoringProgramwithWirelessPulmonaryArtery Pressure monitoring technology (secondin Canada).

• CelebrationofpatientsuccessfiveyearsonLVADtherapyHeartFailurePathwayforPCNs

• ActiveQI(QualityImprovement)andClinicalResearchProgram

• AHFmembershadmorethan15publicationsfor AHF members

Awards• Dr. Deb Isaac: University of Calgary

InternationalizationAchievementAward2019• Dr.DebIsaac:AlbertaMedicalAssociation

AwardforCompassionateService2019• Dr.AndrewGrant:DepartmentofCardiac

SciencesClinicianoftheYear2019• Dr.AndrewGrant:CardiologyTrainingProgram

PreceptoroftheYear2019• Dr.JonathanHowlett:HonoraryHeartFailure

societyofAmericaFellowship2019

Accomplishments and Highlights


Arrhythmias & Autonomics

Lead – Dr. Satish Raj

CIED Medical Lead – Dr. Vikas Kuriachan

Electrophysiology Medical Lead – Dr. Stephen Wilton

The arrhythmia group is among the largest academicgroupsinthecountrywith14activemembers.Thegroupprovideshighlyspecializedservicesfortheregionandon-siteclinics(AF,CIED,Arrhythmia Syncope) at South Health Campus (SHC) and Foothills Medical Centre (FMC).

Thisyear,Dr.ErkanIlhanwasrecruitedasaclinicalelectrophysiologist. Dr. Ilhan completed his Cardiac ElectrophysiologyFellowshipwithourgroup,butunfortunately,therewasnotapositionavailableat the end of his training. We are excited that he hasnowjoinedus.Heexpandsourabilitytoseepatientsinatimelymanner.

Highlights• OurcentrewasthefirstinCanadatoperforma

leftbundlebranchpacemakerleadimplant.• OurcentrewasthefirstinWesternCanada

toperformafluoroscopy-freecomplexatrialfibrillationablation.

• Same-day discharge for most device andablationproceduresatFMChasbeenimplemented seamlessly and has become thestandardoperatingprocess.Thisdecreasesstressonourinpatienthospitalbedsandallowspatientstogetbacktotheirfamiliessooner.Wehaveexperiencednosignificantsafetyconcernsindoingthis.Reducingthedemandforin-patientbedshasresultedinsignificantsavings to the health-care system.

Thecity-widearrhythmiaclinicunderwentaqualityimprovement(QI)processtoimproveandreducewaitlistsforclinicappointments.Thisledtoacity-widecentraltriagereferralprocess.Theprojectisongoingandfullimplementationisexpectedbytheendof2020.

COVID-19putsignificantstressonourhealth-caresystem.However,duetoahighlyintegratedlevelofcooperationbetweendifferentgroups,wewereabletotemporarilymovemostofourCIEDimplantationtotheCath/EPlaboratoriestoensureourinpatientdevicepatientsstillreceivedtheirdevicesinatimelymanner,thusavoidinganexcessofcomplicationsandprolongedhospitalstays.

NationalPositionStatements:Arrhythmiagroup members chaired or co-chaired Canadian CardiovascularSociety2019PositionsStatementson Postural Tachycardia Syndrome (POTS) and on ReconcilingMultipleSyncopeGuidelines(ESC/AHA/ACC/HRS).

AwardsTheHealthQualityCouncilofAlbertaPatientExperienceAwardRecipients2020wasawardedtoagroupledbyDr.DerekExnerandLucyReyes,RN.ThePerformanceEvaluationandRhythmFollow-upOptimizationthroughRemoteMonitoring(PERFORM)programwasfundedbyanAIHSPRIHSgrant.ItexploredtheappropriateimplantationofimplantabledefibrillatorsinAlberta,andtheexpansionofremoteCIEDmonitoring in Alberta to deliver care more appropriately,inatimelymanner,andinthepatient’shomeorcommunitywheneverpossible.


Nuclear

Lead – Dr. Ilias Mylonas

Thenuclearcardiology/CTgrouphascontinuedto expand its clinical services across the city and providesbothnuclearandCTtestingattheFMCandSHCsites.Over1,900nucleartestsandmorethan700cardiacCTsareperformedonayearlybasis.[Appendix B]

Dr.MylonashasdecidedtostepdownasmedicalleadoftheNuclearCardiologydepartmentaftersevenyearsofhardworkanddedicatedleadership.Duringhistenure,Dr.Mylonascontinuedthedevelopment of the nuclear cardiology departments atbothsitesandendeavoredtoensureuniform,comprehensivereportingwiththecurrentAPPROACHsoftware.

Highlights• Dr.RobertMillerrecentlyjoinedourteamand

tookoverasaffinitygroupleaderinJune2020

• StandardizedreportinghasbeenimplementedandwillbeusedwithConnectCareacrossthecity.

• Protocolsforimagingwithtechnetiumpyrophosphatetohelpdiagnosepatientswithtransthyretincardiacamyloidosishavebeenimplemented.

• Upgraded SPECT camera at FMC to the latestgenerationsolid-statecamerasystem.

Adult Congenital Heart Disease (ACHD)

Lead – Dr. Michelle Kier

The Adult Congenital Heart Disease group has hadanexcellentandproductiveyear.Ourbiggestachievement thus far is the recruitment of Dr. NitaGurontoourteamtohelpcareforourburgeoningandcomplexpatientpopulation.OtheraccomplishmentsthisyearincludethecreationofamultidisciplinarycomplexACHDclinic—withDr.StephenReynoldsatthehelm,Dr.MeredithBormanfrom Hepatology and Dr. Doug Helmersen from Respirology—toaddressthemulti-organdisease

that results from complex congenital heart disease. Wehavealsosignificantlyexpandedourresearchprogram,ledbyDr.MichelleKeir,andCalgaryisnowenrollingpatientsinnationalandinternationalregistries.Wearecreatingaparticipatoryactionresearchnetwork,involvingpatientpartnersatallstagesoftheresearchprocess,andaregratefultoourpatientadvocateswhohaveparticipatedinfocus groups this year.

Cardiac Magnetic Resonance (CMR)

Lead – Dr. James White

TheCMRgroupremainsoneofthemostactiveandproductivegroupsnationwide.Withover4,000CMRsayear,thegrouphasoneoftheworld’slargest databases in several cardiac pathologies. TheCMRgrouphasmultipleareasofinterestandhasdevelopahighlyspecializedsystemincludingAIandMLalgorithmsforthepredictionofsuddencardiacdeath.TheCIROCregistryhasauniquelargedatabaseofover10,000patientswithcardiovascular disease that is undergoing intense research.

Highlights High impact publications

• Morethan25publicationsoverpast18months

• Examplepublication:MINICORRegistryInauguralpublicationin“CirculationCardiovascularImaging”(April2020)

• Multi-nationalregistryledbyDr.JamesWhitefocused on dilated cardiomyopathy

• 1,762patientswithDCM-LGEpredictiveofsudden cardiac death and mortality

CIROC Registry• Registryturnsfiveyearsoldandtracksmore

than10,000patientswithcardiovasculardisease(>25,000patientyearsoffollow-up)

• ProvidesaccesstoCMR-basedphenotypesmatchedtoadministrativedatafromacrossprovinceofAlberta(labs,ECG,pharmacy,hospitalization&proceduraldata,vitalstatistics)


• Pre-definedsub-cohortscurrentlyunderstudy:Cardio-oncology,HCM,DCM,ICM/stressperfusion,PVablation(AFIB),amyloid

Personalized Diagnostic Program (PDP)• DataSciencePrograminRiskPrediction

Modelling

• Lead: Dr. James White

• Co-PI/Supervisors:Dr.JoonLee,Dr.RussGreiner,Dr.MarinaGavrilova

• Students:twopost-doctoralfellows,twoPhD,four masters

• Focus:Machinelearning/AI-basedriskpredictionofheartfailureadmission/arrhythmia(SCDandAFIB)/majorcardiovascular events

4DFlowResearchProgram• Lead:Dr.JulioGarcia

• Students:onepost-doctoralfellow,onePhD,twomasters

• Over1,0004DFlowMRIstudiesnowaccrued(second largest repository globally)

• Numerouscohortstudiesevaluatingbicuspidaorticvalvedisease,mitralvalvedisease,congenitalheartdisease,atrialfibrillation

CMR Quality Assurance Program Update• Completionofn=100HealthyVolunteerStudy

at the Stephenson Centre to establish normalhealthyrangesforallCardiacMRI-basedmeasurements,inclusiveoflocallydeveloped3DStrainsoftwareplatform

• UpgradetoCardiacMRIunitworkflow/reportingarchitectures(June2020):

• Greaterstandardization/reproducibilityofCMRreporting

• Updated references ranges (see above) appliedtoreporting

• Expansionofappropriateusecriteria/wait-timetracking

• Moreadvancedanalyticscapacity

Understanding Heart Failure, read about new and innovative

techniques used in the Department in Appendix A


Echocardiography

Lead – Dr. Nowell Fine

TheEchogroupprovidesregionalcoveragewithmorethan20,000testsperformedcity-widein2019-2020.Unifiedreportingacrossthecityhasbeen implemented in the past years and has been consolidated. Development of stress echo capabilitiesandthepurchaseofnewPhilipsEpicecho machines at Peter Lougheed Centre (PLC) has improved our capacity to provide these tests across the city.

SectionRecruitmentincludesDr.JacksyZhaowhojoinedtheEchoLabasastaffechocardiologistandHCMspecialist.Dr.NitaGuronalsojoinedtheEchoLabasastaffechocardiologistandadultcongenitalheart disease specialist.

Dr.JeffShawcontinueshisechocardiographyclinicalfellowshipwithplanstojointheEchoLabasstaffuponcompletion.

Foothills Interventional Cardiology Service (FICS)

Lead - Dr. Michael Curtis

TheFICSaffinitygroupisamongthetopthreecentresinCanadaaccordingtothe2019CIHIreport,withoneofthelowestSTEMImortalitiesinthecountry.Withover9,500catheterlabproceduresayear(>2,500PCIs)theFICSgroupremainsaleaderintheregionandnationwide.

Therehasbeenatransitionofleadershipwith Dr.Goodhart,whoassumedthedirectorshipoftheFICSgroupin2015,steppingdownandDr.CurtistakingoverleadershipinFebruary2020.Dr.Goodhartimplementedmanyinnovationsduringhistenure,includingtheCardiacNavigationthathas recently been streamlined for cardiology referrals.Dr.GoodhartandDr.Traboulsiwereinstrumental in developing the advanced CTOangioplasty program and advanced physiology testingincoronarycirculationamongmanyothercontributions.TheFICSgrouphasbeenactivelyinterviewingcandidatesandintendstohireDr.

2020.

SachedinawhohastrainedininterventionalcardiologyinTorontoandiscompletinghistraininginadvancedinterventionalheartfailureinHouston.Dr.SachedinawilljointheDOCinSept.1,


Cardiac Surgery

Section Chief – Dr. Imtiaz Ali

Vision:Toimprovethequalityoflifeofpatientssufferingfromtheburdenofcardiacsurgicaldisorders.

Mission:Tobeaninternationalleaderincardiacsurgicalpatientcare,education,andresearch.

TheSectionofCardiacSurgerywascomprisedof11cardiacsurgeonsformostofthe2019–2020fiscalyear.ThreemembershaveGFTappointmentsat the University of Calgary and the remainder have clinical appointments.

Dr.AndrewMaitlandreturnedfromayearsabbaticalinseveralcentresinEurope.HehasassumedamentorshiproleintheSectionwithhis learnings in MIVS surgery and complex valve surgery adding an important component to our section.

Dr.MuhammadAhsanwhohadbeenworkingasalocumsurgeonwithinoursectionsinceJanuary2019wasrecruitedtoastaffsurgeonpositioninSeptember. Dr. Ahsan came to us from Toronto andpossessesnicheexpertiseincomplexaorticsurgery.HewillworkcloselywithDr.ScottMcClure,theleadoftheAorticProgram,toprovidestate-of-the-artsurgicalcareforpatientswithaorticpathology.

Dr.McClure,anexperiencedaorticsurgeon,madehugegainsincollaboratingwiththeSectionofVascularSurgerytoensurethosepatientsgetthefull range of treatments available. This includes the startofanewcollaborativeAorticClinicatSouthHealth Campus.

ThisspringalsosawtherecruitmentofDr.CoreyAdamstotheSection,bringingthetotalnumberorsurgeonsto12.Dr.Adamsisexperienced in transcatheter valves and minimally invasivevalvesurgery.Dr.AdamswilladdimmenseexpertisetothealreadyexistingMIVSProgram.

B]

Memberscontinuedtoleadprojectsandinnovationsinclinicalcare,research,andeducation.Multidisciplinaryheartteamscontinuedtofunctionasthebasisforevidence-baseddecisionmakingforthetreatmentofallcardiacsurgicalpatients.TheRoyalCollege-approvedsix-yearResidencyTrainingProgram(RTP),ledbyDr.WilliamKent,continuedtoattractthebestandbrightest individuals.

Theprogramhasmaintaineda100percentexaminationsuccessratesinceitsinception.ExcellenceineducationishighlyvaluedinourSection.OurRTPishighlyregardedamongstapplicantsacrossthecountryandknowntoprovidefirst-rate,hands-ontrainingfromanearlystage.Thusfar,alltraineeshavepassedtheirRoyalCollegeCertificationexam.

All members contribute to the training of our residentsandthereisprotectedtimeeveryweekforformalteaching.Dr.TeresaKieseralsoleadsseveralinternationalteachingcoursesthroughtheEuropeanAssociationofCardiothoracicSurgeons.Inaddition,membersregularlycontributetotheteachingofmedicalstudentsandresidentsrotatingoncardiacsurgeryfromotherspecialtiessuchascardiology,vascularsurgery,andthoracicsurgery.

TheSectionofCardiacSurgerycontinueditsgrowthincardiacsurgicalcasevolumesinfiscal2019–2020.TheSectionperformedatotalof1,771casesincluding126trans-catheteraorticvalveimplantation(TAVI)casesthatweredoneinconjunctionwithourcardiologistsaspartoftheStructural Heart Team. This represents an increase of70percentrelativetofiscalyear2010–2011whensurgicalvolumesbegantoincrease.IsolatedCABGprocedures(976)continuetobethemostcommonsurgery(57percent).[Appendix


Operatingroomutilizationrateswerearespectful92percentand13percentofourcaseswereemergencycases.Sub-specialtyoperationsincomplexaorticsurgery,hybridaorticsurgery,minimallyinvasivevalvesurgery,completearterialcoronaryrevascularization,and(TAVI)continuedtogrowinnumber.Therightanteriormini-thoracotomyapproachtoaorticvalvereplacementsurgeryledbyDr.Kentisestablishedasaviablealternativetopatientsathighriskofastandardsternotomy that do not qualify for a TAVI.

AprimarygoalistoexpandtheresearchprofileofourSectionwithrespecttobothtranslationalandclinicaloutcomesresearch.Dr.Fedak’slabcontinuedtostudythenuancesofbicuspidaorticvalvepathologywithgrantsupportfromtheNationalInstitutesofHealth(NIH).Drs.McClure,Kent,andHolloway,aswellasothers,continuetoworkonclinicaloutcomesprojectsrelativetotheirareasofclinicalexpertise.CurrentlywecontinuetoquerytheAPPROACHdatabasefortheoutcomesstudiesandwilllooktoothervenuessuchastheSTS data base in the future.

Lastly,Dr.PaulFedak,along-timesectionmember,experiencedsurgeon,andrenownedresearcher,wasappointedastheDirectoroftheLibinCardiovascularInstituteandDepartmentHeadoftheDepartmentofCardiacSciences.TheSectionisveryproudofDr.Fedak.

Highlights• NewAorticClinicatSouthHealthCampus.

Thisclinicisnovelinthesensethatitismulti-disciplinaryandbringstogethertheexpertiseofour vascular surgery colleagues from the PeterLougheedCentre(PLC)andourinterventionalradiology colleagues from both the FoothillsMedical Centre and PLC sites.

• Innovationinpost-operativecareoccurredwiththeadoptionoftheKeepYourMoveIntheTube(KYMITT)concept.Initialstudyofthisconceptrevealed that it is safe and comparable to theoldersternalprecautionsapproachforpost-sternotomy care.

• Aformaland“proper”surgical“MAZE”programwasinitiatedbyDr.GaneshShanmugamincollaborationwithourelectrophysiology(EP)colleaguescontinuedtogrow.Patientsarehighlyselectedpre-operativelyandreceiveaformal MAZE IV procedure that ablates atrialfibrillation(AF)andleavesbothatriacapableofbeingactivatedduringnormalsinusrhythm.Post-operativefollow-upisdoneinconjunctionwithEPCardiologytodocumentandmaintainsinusrhythmwithappropriatepharmacologicaladjuncts.

• Dr.WilliamKentledateamofDepartmentof Cardiac Sciences and Libin CardiovascularInstitutemembersincludingDr.KenParhar,Dr.DucHa,andSteveMenzies,whotravelledtoGdańsk,Polandtoteachadvancedcardiacsurgery techniques and minimally invasivesurgicalskillstoheartsurgeryteams.Readmoreaboutthisexcitingeffort:https://www.ucalgary.ca/news/calgary-gdansk-team-teaches-innovative-heart-surgery-techniques-poland

Awards• Dr.WilliamKent:2019–2020PGME

OutstandingCommitmenttoResidency Education

• Dr.WilliamKent:2019–2020CardiacSurgery PreceptoroftheYearaward

• Dr.DanielHolloway:2019PeakScholarforinventingandpatentingasimulatorto helpcardiacsurgeryresidentspracticethe technicallychallengingtaskofsuturingthe heart during open heart surgery.

New recruit saves man's life - twice, read the details in Appendix A

Innovation and Education – read about how a cardiac surgeon invented a simulator to teach trainees how to

suture the heart in Appendix A


Minimally Invasive Valve Surgery (MIVS)

Lead – Dr. William Kent

TheMIVSprogramhasexpandedsignificantlyoverthelastyear.Establishedin2012byDr.AndrewMaitlandandjoinedbyDrs.DanHolloway,CoreyAdams,andWilliamKent,morepatientsintheCalgaryregionarenowtreatedwithinnovative,leading-edge surgical techniques to repair and replace diseased valves.

Astheprogramhasgrown,minimallyinvasiveaorticvalvereplacementandmitralvalverepairisnowofferedtomostvalvepatients.Theminimallyinvasivetechnique,whichusessternum-sparingsmallincisionsandthoracoscopicinstrumentation,is also used to repair atrial septal defects. With thesetechniques,patientsgainthebenefitsoflesspain,lessbloodtransfusion,shorterhospitalstay,andaquickerreturntonormalactivity.

Recentadvancementsinvalvetechnologyhaveled to the development of rapid deployment and suture-lessbioprostheticvalves,whichfurtherfacilitate minimally invasive surgery and provide patientsthebenefitofanaorticvalvereplacementthrough a right anterior mini-thoracotomy rather thanconventionalsternotomy.

The establishment of a dedicated Valve Clinic hasalsobeenasignificantachievementforthegroup.BasedattheSouthHealthCampuswiththesupport of cardiologist Dr. Jill Colbert and nurse clinicianDeborahLundburg,thismulti-disciplinaryclinicfollowsvalvepatientswithechocardiographicandclinicalfollow-uptominimizetheriskofvalve-relatedcomplications.

Theclinicalsooffersanopportunityforresearchendeavorsthroughparticipationinvalveregistriesand clinical outcome studies.

HighlightsTwopublicationsincludingapaperontheimportanceofqualitativepatient-centeredmetricstoguideinnovation.

Aortic Program

Lead – Dr. Scott McClure

TheCalgaryAorticProgramisabroad, multidisciplinarygroupofcliniciansandresearchers representingseveralspecialtiesinvestedinaortic diseasemanagement.Cardiacsurgery,cardiology, interventionalradiology,vascularsurgery,anesthesia,intensivecare,genetics,pathology,rheumatology,biomedicalengineering,andothersallcollaborativelyinterconnectedandsharesa commongoaltoachieveexcellencewithrespect thoracicaorticdisease.ItisanexcitingtimefortheAorticProgram.TofacilitateamoreunifiedandstandardizedapproachtothemanagementofcomplexaorticdiseaseinCalgaryandSouthernAlberta,the“AorticTeam”concepthascometofruition.WiththerecentopeningofthemultidisciplinaryCalgaryaorticclinicatSouthHealthCampus,cliniciansfromthevariousspecialtiesnowconveneandassessaorticpatientstogetherinacollaborativespacetodeterminebesttreatmentwithateamapproach to care. Our vision is to develop a city-wide aortic surgery team managing all such complex patients.


Multidisciplinary Departmental Programs

Mechanical Circulatory SupportSurgical Lead - Dr. William KentMedical Lead - Dr. Brian Clarke

PatientswithadvancedheartfailurerepresentagrowingpopulationandtheMechanicalCirculatorySupportProgram(MCSP),ledbycardiologistDr.BrianClarkeandcardiacsurgeonDr.WilliamKent,providesbothmedicalandsurgicaltherapyforthesecriticallyillpatients.Usingimplantablepumps for temporary and long-term support of thefailingheart,patientscanbestabilizeduntiltheyrecovercardiacfunctionorreceiveahearttransplant.

The program has focused on minimally invasive strategiestoreducetheriskofsurgicalinterventionand this year Foothills Medical Centre became the firstcentreinCanadatoimplanttheHeartMate3leftventricularassistdevice(LVAD)withabilateralmini-thoracotomyapproach.TheHeartMate3,togetherwiththeHeartWareHVAD,arethelatestgenerationofdurableLVADs,whichallowpatientswithend-stageheartfailuretocontinuetoliveactivelivesformanyyearsuntilahearttransplantbecomes available. The program also uses ECMO andImpelladevicestorescuepatientswhopresentacutelyincardiogenicshock.TheCentri-Magpumpisalsousedforacutelyillpatientswhorequire more prolonged support before a durable LVAD can be implanted or a donor heart can be procured.

TheMCSPappliesateam-basedmulti-disciplinaryapproachtothecareofheartfailurepatients.Dr.DanielHollowayrecentlyjoinedthegroupfromhisfellowshipatNorthwesternUniversityinChicago.HeisacardiacsurgeonspecializinginminimallyinvasiveimplantationofLVADs.Thegroup is presently involved in many clinical trials andresearcherandDepartmentalHead,Dr.PaulFedak,directsatranslationalresearchlaboratorywithagoaltodevelopinnovativetherapies,suchasepicardialinfarctrepair,whichmayeventuallyrestorefunctiontothemyocardiumofheartfailurepatients.

Transcatheter Aortic Valve Implantation (TAVI)Lead – Dr. Anna Bizios

TheTAVIprogramcontinuestoprovidehighqualitycareandlife-savingaorticvalvesforAlbertanswhoare unable or less suitable to undergo open heart surgery.Theprogramcontinuestoexpandandstreamlinethejointinterventionalcardiologyandcardiacsurgeryprogramthatincludesevaluationoffrailty.Wearecurrentlyperforming125TAVIperyearwithmostcasesbeingperformedinthecatheterlabwithpercutaneousfemoraltechniques. Outcomes remain excellent and many patientscanbedischargedfromthehospitalthedayaftersurgery.

AlternateaccessTAVIthroughtheleftaxillaryartery in the shoulder or through minimally invasive surgical techniques directly into the aorta arebeingperformedwithincreasedfrequency.ThesetechniquesenableTAVIforpatientswhomaynothavebeenabletoreceiveanewvalvepriortothesenewtechnologiesandtechniques.

TheTAVIteamhasbenefitedwiththeadditionofanothercardiacsurgeon:DrCoreyAdams,whobringsexperiencewithtrans-femoralandalternateaccess TAVI.

TheCOVID-19pandemichascreatedmanychallenges,buttheTAVIprogramhasbeenabletomaintain the same high volumes and outcomes for thepatientsweserve.

Living with the LVAD: A patient’s perspective, read more about it in Appendix A


Cardiac Anesthesia

Director - Dr. Chris Prusinkiewicz

Clinical PracticeCAGmembersworkinamultidisciplinaryenvironmenttoprovideanestheticcareforacomplexvarietyofcasesinanincreasingly”“elderlypatientpopulation.Anesthesiaservicesareprovidedforopen-heartsurgery,off-pumpcoronaryarterybypassgrafting,aorticreconstructionincludingdeephypothermiccirculatoryarrest,mechanicalassistdevicesupport,totalendovascularaorticrepair,minimallyinvasivevalvesurgery,andcomplexpacemaker/implantabledefibrillatorleadextractions.

Outsidethecardiacoperatingrooms,groupmembersprovideanestheticsinthecardiaccatheterizationlaboratoriesforboth electrophysiology procedures and for percutaneous structural heart procedures such astranscatheteraorticvalveimplantations(TAVI),atrialseptaldefectclosures,perivalvularleakclosures,valvuloplasties,andleftatrialocclusiondeviceinsertions.Uponrequest,membersalsoprovidecaretopatientswithcomplex cardiac disease undergoing non-cardiac surgery.Outpatientsawaitingheartsurgeryarereviewedbycardiacanesthesiologistsattheweeklypre-admissionclinic,whileinpatientsreceivepreoperativeassessmentsbycardiacanesthesiologists on an ongoing basis.

Demandforcardiacanesthesiaservicescontinuestobehigh.Inrecentyears,theCAGhasexpandedcoverage to meet the demands of the cardiac surgicalupliftandanincreasednumberofbothpercutaneous structural heart procedures and complex electrophysiology procedures. In the springof2020,cardiacsurgicalvolumesandcardiologyproceduralcasevolumeswerereducedduetotheCOVID-19pandemic.

TraditionalCAGassignmentsweretemporarilyreducedtoapproximately75percentoftheusualworkload.Duringthistime,CAGmemberscontributedtotheCOVID-19effortinmultiple

waysincludingservingontheontheECMOteam,amulti-disciplinaryteamcomposedofsurgeons,intensivists,anesthesiologists,nurses,perfusionists,andrespiratorytherapists,whichinserted and managed extra-corporeal membrane oxygenationmachinesinpatientsfailingtraditionalICUventilatortherapyCAGmembersalsoparticipatedinnumerousCOVID-19clinicalsimulationsandwereavailablefortheanesthesiaairwayteam.

TheCOVID-19responserequiredflexibilityevenintraditionalCAGassignments,suchasachangeinthepre-operativeassessmentclinicfromanin-person model to a phone-based model. In the comingmonths,theCAGanticipatesincreasingitsclinicalcommitmentfurther,inresponsetotheplanned increase in cardiac surgical volumes to allowfor“catch-up”fromtheCOVID-19operatingroomslow-down.AlthoughtheCOVID-19pandemicwasandcontinuestobeachallengingtime,theCAGhasbeenmostimpressedbythewayinwhichhealth-careprovidersfrommanydifferentfieldshavecollaboratedforthecommoncause.

EducationCAGmembersstrivetoprovidethehigheststandardofclinicaleducationandnumerousmembers have been recipients of teaching accoladesoverthelastyear,includingtheExcellenceinMedicalEducationAwardreceivedbyDrs.AlexGregory,ChrisNoss,andChrisPrusinkiewicz.Onaninternationallevel,Dr.DucHarepresentedcardiacanesthesiaaspartofamulti-disciplinarydelegationthattravelledtoalargehospitalinGdansk,Poland,toprovideeducationon minimally invasive cardiac surgery.

Anesthesiaresidentscompletetwoblocksofcardiacanesthesiaintheirfourthyear.Off-servicetraineesrotatingwiththeCAGincludefellowsfromcriticalcaremedicine,cardiology,andperioperativeultrasound,and,residentsfromcardiacsurgery.ThegroupwouldliketoacknowledgeDr.NicoleWebb,whohastakenoverthe role of cardiac anesthesia resident coordinator thisyearfromDr.Prusinkiewicz.


CAGmembersprovidedidacticteachingfortheanesthesia residency cardiovascular core program on a bi-annual basis. Computer-based learning is available through the TeachingMedicine.comwebsite,whichisdesignedbygroupmember,Dr.JasonWaechter,andincludesmodules on transthoracic and transesophageal echocardiography.

ResearchTheCAGhasanactiveresearchprogramwithnumerouspublicationsbymultiplemembers.HighlightsincluderecentpublicationsbyDr.Gregoryin“JAMASurgery,”“AnnalsofThoracicSurgery,”“JournalofCardiothoracic&VascularAnesthesia,”andthe“EuropeanJournalofCardio-ThoracicSurgery”(amongothers).

Regardingongoingresearch,wehavesuccessfullycompletedourparticipationinthemulti-centreCAMRA-1study(SiteLeadInvestigator:Dr.AGregory;StudyPrincipleInvestigator:Dr.V.Chan,UniversityofOttawaHeartInstitute)andthemanuscripthasbeensubmittedforpublicationin“Circulation”.CAMRA-1evaluatedthedifferenceintrans-mitral pressure gradients during exercise in patientswhoreceivedmitralvalverepairsurgeryusingoneoftwodifferentrepairtechniques.

FollowingapostponementinresearchduetotheCOVID-19pandemic,wehaveresumedrecruitmentforouractiveprojects:NETWON-CABG(RCTofPCSK9-inhibitorvsplaceboonCABGveingraftpatencyattwoyears);TITAN-SvS(atrialofearlysurgeryversussurveillanceinpatientswithintermediateriskaorticaneurysms);andapilotstudyontheimpactofCPBonplateletfunctionusing a novel platelet procoagulant membrane dynamicstechnique(incollaborationwithDr.E.Agbani).

RecruitmentisalsoongoingforthePREPAREStudy(SiteLeadInvestigator:Dr.R.Chun;StudyPrincipleInvestigator:Dr.DMcIsaac,OttawaHospitalResearchInstitute)whichisamulti-centrerandomizedtrialoffrailty-focusedpreoperativeexercisetodecreasepostoperativecomplicationrates and disability scores.

Dr. Seal is the project holder of the Foothills MedicalCentreStaffAnesthesiaResearchFund.ThefundwasestablishedthroughthegenerosityofDr.TimTang,aformerCAGmember,andwasdeveloped to promote research in the areas of cardiacanesthesia,patientoutcomes,andqualityimprovement.

Enhanced Recovery After Cardiac SurgeryTheCAGisontheforefrontofthedesignandimplementationofanEnhancedRecoveryAfterCardiacSurgery Enhancedrecoveryaftersurgeryprogramshavebeendevelopedinotherfieldstoimprovepatientcomfort and outcomes and to decrease the lengthofhospitalstay. involvesamultidisciplinaryteamofhealth-careprofessionalsincludinganesthesiologists,surgeons,intensivists,andnurses.The successfully launched in Calgary in the summer of2019,andcollaborationisongoingwiththeCardiacAnesthesiaSectionoftheMazankowskiHeartInstitutetoestablishanAlberta-wide program.

Perioperative Blood Conservation InitiativeDespite steady improvements over the last decade,cardiacsurgerycontinuestohaveahigh rate of blood transfusion compared to othertypesofprocedures.Preoperativeanemiasignificantlyincreasesapatient’schanceofrequiringperioperativebloodproductsandtheriskoftransfusion-relatedcomplications.ThePerioperativeBloodConservationInitiativehasbeenlaunchedtohelpidentifyandtreatpatientswithpreoperativeirondeficiencyanemiausingeither oral or intravenous iron. The algorithm also containsaprovisionfortheuseoferythropoietininaselectpatientcohort.ThemedicalleaderoftheinitiativeisDr.SealandnurseRebeccaRockisthePerioperativeBloodProgramcoordinator.

ERAS

waspathway

implementation

program.

ERAS

ERAS

(ERAS)


Cardiac Critical Care

Director – Dr. Andre Ferland

Patient CareThe Cardiovascular Intensive Care Unit (CVICU)isfocusedonprovidingpatientandfamily-centeredcare(PFCC).TheCVICUhasitsownPFCCcommitteewhichcontinuestobuildthefoundationtoincludethepatientandfamilymembersasintegralpartnersinhealthcare.Asanexample,thispastyearthemultidisciplinarycommitteehasimplementedthe“GettingToKnowMe”toolthatisusuallycompletedbythepatient’sfamilymemberwiththegoalofimprovingtheCVICUpatientexperiencebyknowingtheirindividualpreferences.

TheCVICUconsistsofalargemultidisciplinaryteam:

• 110registerednurses• One clinical nurse educator• Ten cardiovascular intensivists MDs• Seven intensivists have obtained advanced

echocardiography training• TwointensivistshaveadditionaltraininginECLS• 12cardiacsurgeons• 18registeredrespiratorytherapists• One physiotherapist• One clinical pharmacist• Tenunitclerks• 15health-careaids• Twohousekeepingstaff• Twosocialworkers

CVICU has the highest number of advanced certificationsincriticalcareincludingIABP,CRRT,threeVADdevices,pulmonaryarterycatheters,advancedpacing,lumbardrainsaswellasotherICUadvancedcertifications.

EducationTheCVICUhasaveryrobust,clinicallyengagedprocessofeducatingournurses.TheextensiveadvancedcertificationsrequireinitialcertificationaswellasannualrecertificationprovidedbytheCVICUclinicalnurseeducator.AllnewICU

CNE

Research

many other CVICU team members.

nursesarepartoftheDepartmentofCriticalCarementorship program. This program has been customizedforCVICUandprovidesasupportivelearningenvironmenttoallownursestobecomeindependentandhighlyskilled.

TheCVICUisheavilyinvolvedinasimulationprogram.Thepurchaseofaspecializedmannequinhas enhanced the learning experience for emergentpost-operativeprocedures.

TheECLSprogramisverythankfultobetherecipientofagenerousdonationfromtheRotaryClubforthepurchaseofanEbbtidesParallelECMOsimulatorwhichwillgreatlyenhancetheeducationforthemultidisciplinaryteamwhospecializeinthecareofthesepatients:

• Dr.AndreFerland,FMCCVICUMedicalDirector• KariFrance,FMCCVICUActingManager• ChrisColtman,FMCCVICU

OverthepastyeartheFMCCVICUwasoneofthefirstinCanadatoimplementanewcardiacsurgerypost-operativemovementprotocolcalledKeepYourMoveintheTube.Thisisdesignedtoimprovemobilityandindependencewithoutcompromisingthebreastbone/sternalwireintegrity.ThisresultedinasmallresearchprojectincollaborationwithDr.KathrynKing-ShierfromtheUniversityofCalgary.

The CVICU is also in the second year of the Early ChestOpening(ECO)afterCardiacSurgeryprotocoladoptedfromthenewEuropeanResuscitationCouncil guidelines. And the CVICU is proud of the teamwhohavepublishedintheMay2020SpecialPatientSafetyIssueinClinicalSimulationinNursingtitled:PreventingHarm:TestingandImplementingHealthCareProtocolsUsingSystemsIntegrationandLearner-FocusedSimulations:ACaseStudyofaNewPostCardiacSurgery,CardiacArrestProtocol.ThispublicationwasspearheadedbytheFMCleadsimulationconsultantMiretteDubealongwith


OurdynamicmultidisciplinaryCVICUteamcontinuesworkonQualityImprovementprojectsincluding:

• NewPatientFlowProject–OptimizingpatientflowfromCVICUtocardiacsurgerywardUnit91

• NewEarlyRecoveryAfterSurgery(ERAS)Phase1protocol

• Identificationandmanagementofdeliriumpost-operativelyconcentratingonearlymobilization

• WoundCareProject–ImplementationofanewsternaldressingSeptember2019

SitesThe Department of Cardiac Sciences operates in fouracutecarefacilitiesacrosstheZone:FoothillsMedicalCentre(FMC),PeterLougheedCentre(PLC),RockyviewGeneralHospital(RGH),andtheSouthHealthCampus(SHC).Thefollowingsectionprovidessitespecifichighlightsfromthepastyear.

Foothills Medical Center (FMC)

Executive Director: Amanda Weiss

Medical Cardiology – Units 81 & 82We have seen a change in management and leadershipwiththeteamsandwiththatchangehascomeanewlevelofengagementfromourstaff.ThishasbeenparticularlyvaluableastheteamsworkedthroughmanynewandrapidlychangingprocessesaspartoftheCOVID-19pandemicresponse.Inaddition,withourrecentlyexpanded telemetry monitoring capacity in the CardiacHighObservationArea,wehaverealizedadecreaseinpatientdayswithintheCardiacIntensiveCareUnitforspecificpatientpopulations.Wecontinuetohavefuturestatediscussionsaboutremotemonitoringofhigh-riskpatients,aswellasinnovativeapproachestofurtherdecreasethelengthofstayforvariouspatientpopulationsservedwithinMedicalCardiology.Wecontinueourfocusonfallriskassessmentandreductionand

haveintroducedanti-slipsocksforhighriskfallpatients.Wecontinuetopavethewaytohigherteaminfluenzavaccinationratesandhavean87percentvaccinationrate;whichexceedstheorganizationalgoalof80percent.

Cardiac Intensive Care Unit – Unit 103B, CICUTheCICUhasworkedcloselywithpartnersacrosstheCalgaryZonetocreateadditionalcriticalcaretreatmentspacesaspartoftheCOVID-19pandemic response. This is a testament to the adaptability,commitment,diligenceandexpertiseofthemulti-disciplinaryteamthatservesthedepartment.

TheCICUcontinuestoengagewiththeSouthernAlbertaOrganandTissueDonationProgramtofurthertheDCD(DonationafterCardiacDeathprocess.Thisprocessprovidestheopportunity,inappropriatecases,fororgandonationinsituationswheretheprognosisispoorandlife-sustainingtreatmentswillbediscontinued.Thisprocesshelpstoincreasethenumberofkidneysandotherorgans available for transplant.

CICUcontinuestosupportthetrans-aorticvalveimplantation(TAVI)programandweareseeingincreasednumbersofpatientcomingtoCICUpostimplant.Thesepatientsaremobilizedearlyafteradmissionandmanycangohomethedayafteradmission.

CICUstaffarehighlyengagedtoensurethatalladmissionsarescreenedforfallrisk,ARO,andDVTprophylaxiscontributingtoacultureofsafetyonthe unit.

Cardiovascular Intensive Care Unit – Unit 94, CVICUTheCVICUvaluesitscommitmenttopatientandfamilycareandhasworkedtofurtherrefinevariousinitiatives,includingnewadmitondateofprocedureprocesses,leaderroundingandapagersystemforfamiliesofpatientsintheCVOR.TheCVICUreceivedthepresident’sawardofexcellenceforitscontinuedworkonpatientdelirium.OngoingprojectsincludeworkingwithPCU91onnew sternalprecautions(KYMITT),reviewingpressureulcers,newsternaldressings,andEnhancedRecoveryAfterCardiacSurgery(ERAS).


Cardiac Surgery – Unit 91Unit91contains38bedsthatincludea12-bedtelemetryareatoreceivepatientsfromtheCVICU24-48hourspostcardiacsurgery.TheprocessKYMITTpromotesgreateruseofupperextremitieswhilelimitingrangeofmotion.Themultidisciplinaryteamspearheadingtheprojectpresented at the Canadian Cardiovascular ConferenceinOctober2019.PCU91continuestoworkonQualityImprovement,formalizingacommitteeandkeyperformanceindicatorsfor2020.

Peter Lougheed Center (PLC)

Executive Director: Emma Folz

Unit 48 – Coronary Care UnitUnit48isasix-bedstand-aloneCCU.Occupancyhasbeenquitehighthispastyear,andwehavetakeninitiativetorepatriateappropriatepatientstooursite.ThisworksupportsCCUcapacitywithinthezoneandalignswithaPatientandFamilyCenteredCareapproach.DuringtheCovid-19pandemic,wemovedtheUnit48staffandpatientstothehighobservationwardonUnit49wheretheyworkedandtookexcellentcareofpatientsforeightweeks.Thestaffonthisunitareresilientandprovidedbestpracticecarewithintheirnewspace.

Unit 49 – Medical CardiologyUnit49isa32-bedinpatientmedicineunitwitha specialty of Medical Cardiology and Internal Medicine.Weparticipateinzonaloptimizationofthecareweprovidetopatientswithadiagnosisofheart failure and COPD.

PLC CV LabsTheCardiacFunctionClinichasbeenfocusingonwaitlistmanagementstrategies,inalignmentwithPathtoCare,inanefforttodealwithcontinuedincreasesinreferralvolumes.WearealsoparticipatingwiththerestofthezonalclinicsinaQualityImprovementprojectfocusedonstandardizationofthefourclinics.Thisincludedadmissionanddischargecriteriaofpatientsandupdatedalgorithmstosupportpatientcare.

TheCongenitalHeartCliniccontinuestoseegrowthinclinicsize.Overthelastyearaortopathyreferrals,inparticular,havegrownsignificantlyinboth number and complexity and are related to improvementsingenetictesting.WewelcomedDr.NitaGurontoourteaminJanuary,2020andsawtheretirementofDr.TimPrieurandnurseclinicianYvonneBaloninJulyof2019.BothTimandYvonnehadbeenwiththeclinicsincethebeginningandaresorelymissedbystaffandpatientsalike.PhysicianleadershipwithintheclinichasalsorecentlytransitionedfromDr.NanetteAlvareztoDr.MichelleKeir.

The Echocardiography Department at the Peter LougheedCentreremainsverybusywithinpatientandoutpatientstudies.Similartoothersitesinthezone,weareworkingcreativelytosupportretentionofcasualstaffandoverallrecruitmentofsonographerstaffmemberstotheCalgaryzone.

Rockyview General Hospital (RGH)

Executive Director: Virginia Meyer

Unit 71Inthepastyear,Unit71hascontinuedtofocusonoptimizingheartfailureoutcomesforpatientsatRGH.AfterattendingtheHeartFailureOptimizationLearningCollaborativelastfall,ourteamwiththesupportoftheUnitQualityCouncil,focusedonensuringpatienteducationwasprovidedtopatientsduringtheiracutecareadmissiononUnit71. Unit71hasalsocontinuedtoencourageearlyandfrequentmobilizationforallpatientsduringtheiradmission;aswellas,promotingthePatientandFamilyCentredCare(PFCC)initiativeandthe‘EndPJParalysis’initiative,whichencouragespatientstogetupandgetdressedwhileinhospital.

Additionally,thisyearduringtheCOVID-19response,Unit71enthusiasticallypreparedforthepossibilityofacutecardiaccarestep-downbedson our unit should our site’s CCU beds need to be relocated during an ICU surge.

With the support of our cardiologists and cardiac nursepractitioners,staffreceivedtherequirededucationandskillstocareforacutelyillcardiac


patientsintheinpatientsetting.ThiseducationisongoingandwillbeusedifneededduringapotentialsecondwaveofCOVID-19.Furthermore,asaresponsetocontinuousmaskingandincreaseduseofPPE,Unit71hasalsobeenveryengagedinpromotingthePFCCpracticeofVisualNOD,whichencourageshealth-careproviderstowearalaminatedpictureofthemselvestohelppatientsrecognizetheircareteamandknowtheroleofeach care provider.

RGH Cardiac Function Clinic InthepastyeartheCardiacFunctionClinicatRockyviewGeneralHospitalhascontinuedtoseesteadyincreasesinthenumberofpatients.Thecliniccontinuestobeengagedinqualityimprovementpractices.InSeptemberof2019theclinicimplementedstandardizedprocessesdevelopedincollaborationwithallfourCardiacFunctionClinicsinCalgary.Theseprocesseswereaimedtoimprovepatientaccesstotheclinicbystandardizingthereferralprocess,alongwithimprovingotheroperationalprocesses.DuringtheCOVID-19pandemic,thecliniccontinuedto provide outstanding support to heart failure patients,sometimesvirtually,ensuringpatientsreceive the care and support they require in the communityduringthischallengingtime.

RGH CV LabInthepastyear,RGHCVLabhasperformedalmostthesamenumberoftests/proceduresaslastyear,soithasbeenanotherverybusyyear.WecontinuetoparticipateintheConnectCareCupidplatformdevelopmentasrequested.Overthepastninemonths,theechotechshavebeeninvolvedinaqualityassuranceinitiativethatinvolvesacardiologistreviewingfiverandomechoresultswitheachtechinordertoprovideconstructivefeedbackandensurebestpractice.

South Health Campus (SHC)

Executive Director: Paul Stewart

AllareaswithinCardiacSciencesatSHChavecontinuedtogrowanbesuccessful.Recently,considerableeffortshavebeenmadetopreparefortheimpactofCOVID-19.InadditiontothecomprehensiveSHCsiteplan,theCardiacSciencesteamworkedtoconsolidateandrelocateservicesthroughoutthesiteandzone.InparticularNuclearCardiology temporarily relocated to the FMC whilethecardiacclinicconsolidatedtoonefloor.TheCCUbedslocatedwithintheICUfootprintweretemporarilyrelocatedtoACU66withtheexpectationofadditionalICUpatientsduringthepandemic.

Movingforwardwithflatteningthecurve,clinicsarestartingtorelaunchandservicesarereturningtotheiroriginallocations.However,patients,staff,andphysiciansarepreparingforthenewwaystocareforourpatientswithmoreIP&Crestrictionsand the need for social distancing.

AllclinicsarecontinuingwithQualityImprovementspecificallyreviewingPathtoCareguidelinesandreferralprocesses.ACU66continuestoworkonCOPD/HF,andthesuccessesarenowbeingsharedbyspreadingthepathwaystootherinpatientunitsthroughoutthehospital.Datacontinuestoshowanimprovementinpatienteducationandambulationduringtheirinpatientvisit.

SHCcapacitycontinuestobetheprimarychallengeonACU66.Theunitisconsistentlyhostingfourextrapatients.Duringpeakdemandwewillopenanadditionaltwobedspaces,puttingtheunitsixpatientsoveritscapacity.

SHCwaspleasedtoassistFMCnuclearcardiologylastsummerbytemporarilyrelocatingpatientsandworkloadwhiletheFMCcamerawasbeingreplaced.

HeartHealthmonthatSHCgrowsintoalargereventeachyear.ItisnowasignificanteventbothwithinSHCaswellasthesurroundingcommunity.

Nurse practitioner-led cardiac unit among the first in Canada – read more about it in

Appendix A


Thefocusonpromotionofwellnessactivities,includingtheimportanceofanactiveandhealthylifestyle,addsasparktotheareathatlaststhroughout most the year. We also had strong communityparticipation,withlocalbusinesseschallengingbothoneanotherandSHCinaneffortto beat our total stair count. The Courtyard & ResidenceInnbyMarriot,CalgarySouthhasjoinedoureffortwithsponsorshipoftheevent,aswellasenthusiasticparticipation.

TotalCardiology

TotalCardiologyTMRehabilitationandRiskReductionhasbeenprovidingsecondarypreventionofcardiovasculardiseaseservicesthroughitsrehabilitationprogramtoresidentsof Alberta Health Services Calgary Zone for over 23years.Theprogramalsooffersscreeningandprimarypreventionservicesforthosewhoeitherself-refer or are referred by their family physician. Thefoundationoftheprogramcontinuestobeearlyaccess,qualitypatienteducation,healthcoaching,andtimelymedicalintervention.Wecontinuetostriveforthehighestqualityintegratedcardiovascularwellness,clinicalcare,educationandresearchasevidencedbelow

WecontinuetohavegreatsuccesswiththeEarlyCardiacAccessClinic(ECAC)AllSTEMI,NSTEMI,andACSpatientscontinuetobeassessedwithinfourto10daysofhospitaldischarge.Thesuccessofthisprogramhascontributedtotimelyprogramparticipationandanincreasednumberofseparations,definedasthosewhocompletethetraditional12-weekprogramorsatisfactorilygraduatedfromanindividualizedprogram.IntheperiodofJanuary1,2019-December31,2019wehad2,096patientseparations,whichrepresentsa six per cent increase from the previous year and fivepercentaboveourcontractedquota.

Wecontinuedtostreamlineourpatienteducationprogramwithafocusonensuringthatallpatientsreceivethecoreinformationneededtosupportthemintheirlifestylechange.Morethan80percentofnewpatientsattendourintroductoryeducationseries“TakingChargeofYourHeartHealth”.

Partnershipswithhospitalandcommunitygroupshaveallowedustoexpandourservicestonewpopulationsincludingatrialfibrillationpatients.Additionally,wehaverunpilotprojectsoverthepastyeartargetedatidentifyingcardiacrehabpatientswithundiagnosedperipheralarterydisease (PAD). We also promoted heart healthy livinginthecommunitythroughparticipationinhealthfairsofferingbasicriskscreeningandhearthealtheducationinpartnershipwiththeLibinCardiovascularInstitute.

Wecontinuetofostermedicaleducationwithinourclinicandcoordinatedrotationsforthosephysicianresidentsspecializingininternalmedicine,familymedicine,cardiology,sportmedicine,physiatryaswellasalliedhealthundergraduate and graduate students.

TheResearchCommitteecontinuestobeveryproductive.IthostedaResearchRetreatonMarch20,2019duringwhichfouroutstanding‘rising star’ scholars presented research on topics includingtheefficacyofcardiacrehabilitation,predictorsoftreatmentresponse,andtheinfluenceofpatienteducationandmotivationalfactorsoncardiacrehabilitationparticipation.ThefirstannualTCRNResearchRetreatwashighlysuccessfulandpositivelyreceived.Wewereaskedtosubmitaninvitedcommentarytothe“JournalofCardiopulmonaryRehabilitationandPrevention.”

Thepublicationwasintendedtodemonstratethatourapproachcanbedonewithlimitedextramuralresearchfundingandcanbehighlyproductive,as indicated by our history of conference presentationsaswellaspeer-reviewedpublishedmanuscripts and abstracts. It is our hope that this invited commentary inspires other groups toconsidersimilarinitiatives,atascalethatisfeasible,furtherexpandingtheCRevidencebaseinawaythatfacilitatesanevolutionofclinicalpracticethatoptimallyimprovespatientoutcomes.

Rapid Access Cardiology ClinicTheRapidAccessCardiologyClinic(RACCTMcardiology clinic) is an important part of TotalCardiologyservices.RACCTMcardiologyclinic


beganin2008andcontinuestoprovideessentialoutpatientcardiaccare.Weuseskilledpersonnel,technology,andadvancedaccessprinciplestooptimizeclinicoperations.

RACCTMcardiologyclinichasgrownfromitsinceptionofprovidingcareforpatientswithchest pain symptoms to a full-service cardiology clinic,receivingreferralswithawiderangeofcardiacanomalies.Today,RACCTMcardiologyclinic accepts referrals for all cardiac-related issuesandprovidesaccesstocardiacconsultation,tele-consultsandcardio-diagnostictesting.ConsultationservicesareprovidedatourSunridgelocationandinourClinicalCareCentreatourBridgelandlocation.

Referralsareacceptedfromcommunityclinics,physicianoffices,emergencydepartmentsandurgentcarecenters.Oursophisticatedaccessmodelsbeginswithmedicallysupportedtriagingofpatientsbyaregisteredcardiacnursefollowedbytimelyaccesscardiologyconsultation.

AllRACCTMclinicalconsultationlettersandTotalCardiologyServicesdiagnosticreportsareuploadedtoAlbertaNetcaresystemmakingthemreadily available to health care providers. This allowsforimprovedcontinuityofcare,avoidsredundanttestingandreducesoverallhealthcarecosts.

EducationEducationisessentialcomponentoftheDepartmentofCardiacSciences.Over260graduatestudents,40undergraduatestudentsand37postdoctoralfellowsundertookadvancedresearchtrainingwiththeDepartmentandInstitutein2019-2020.Ourstudentsreceivednumerousscholarshipsandawardsovertheyear.

Wehavetwooutstandingcoreclinicaltrainingprograms: Adult Cardiology and Cardiac Surgery whicharebothaccreditedtrainingprogramswiththeRoyalCollegeofCanada.

Postgraduate Medical Education

Cardiology Training ProgramProgram Director – Dr. Katherine Kavanagh

The2019–2020academicyearwasinterestingandchallenging.Wewelcomedeightnewtraineesintotheprogram:Drs.NabilaMahdi,AhmedMoustafa,AngellaWoodman,AlexeiSavtchenko,XiaoCai(Western),KimeshChetty(UofS),VincentLe(NOS),andYuanZhang(UofA).ThelatterfourjoinedusinOctoerandfilledourministry-fundedspots.FourtraineeswrotetheRoyalCollegeexamlastfallandweresuccessful.

Theinternalreviewofourprogram,inFebruary,wassuccessful,withnoweaknessidentified.Changeswill,however,bemadeinourRPCminutesprocesses.

Ourprogramadministrator,JulieO’Keeffe,isonmaternityleave.Whilesheisonleave,SajjadSuraniistakingonherrole.ThankyouJulieforallyourhardwork!

COVID-19broughtalotofchangestoourprogram,butweadaptedquickly.Withindays,wemovedour round and academic half-day sessions online. Attendanceforthesevirtualsessionshasbeenbetterthanwiththetraditionalformat.COVIDalsoimpactedclinicalrotations.Clinicvisitsandroutineinvestigationswerecanceled;therefore,somerotationsweremovedtothefollowingyearandothersweremodifiedtoprovideoptimaltrainingforourtrainees.Iwanttothankinterventionalcardiology,echo,nuclear,MRIandcongenitalcardiologyfortheircreativitythisyear.

Cardiologyelectiveswerecanceledacrossthecountry,leavingabsencesinourcallschedule.Thesewerefilledbycardiologytraineesandinterventionalfellows.Becauseofthecancellationoftheseelectives,wedidnothavethechancetoworkwiththefallof2020CARMSapplicantsasinpreviousyears.Thisposesariskforusinfillingourministry-fundedpositionsatCARMSthisyear.


Inter-provincialelectiveswilllikelybecancelleduntiltheendof2020.CARMSinterviewswillbevirtual this fall.

TheinitiationofCBDforadultcardiology,whichwassettobegininJuly2020,hasalsobeendelayedbyayeardue.However,ourcompetencycommitteeandfacultyadvisorsareinplaceandwehavehostedfacultydevelopmentsessionsforthem.Thesilverliningtothedelayisthatwehaveallofthepiecesinplacefornextyear,whichwillgiveusmoretimetofocusonpreparingforourRoyalCollegeexternalreview,scheduledforthespringof2022.

RoyalCollegespringexamswerealsoimpactedbyCOVID,withinternalmedicineexamsscheduledtobewrittenlocallyonSept.29-30,2020.Theschedulechangeimpactedourrotationandcallschedules.Thefallcardiologyexamwillalsobewrittenlocally,andtherewillbenoOSCEthisyear.OurCardiologySpecialtyCommitteestressedthatmorecomprehensiveSTACERswillbecompletedthisyear.TheCommitteeprovidedanewform.Dr.HamidBanijamali,previouslyaRoyalCollegeexaminer,hasgraciouslyagreedtodothecomprehensiveSTACERS.

Fourseniorsaregraduatingthisyear:

• Dr.PayamPournazariwillbepursuinganimagingfellowshipattheUniversityofTexasinHouston.

• Dr.JessicaPatzerwillbepursuingafellowshipin congenital cardiology at the University ofToronto.

• Dr.CvetanTrpkovwillbepursuinganechofellowshipinstructuralheartdiseasefollowedbyanICUfellowshipattheUniversityofBritishColumbia.

• Dr.SafiaChaturwillbepursuingafellowshipin advanced heart failure and transplant atHarvard.

Awards• Ourfourgraduatesweresuccessfulinobtaining

the Childs Scholarship to further their training.• Dr.CvetanTrpkovwontheCCTN-CHFS

ResearchCompetitionatthe2019CCCannualmeeting.Hepresentedhisproject“Intra-RenalDopplerVeinEvaluationofCardio-RenalSyndrome in Acute Decompensated HeartFailure.”

• Dr.SafiaChaturhasbeennamedtheHarvard“DanielPierceFamilyFellow”for2020–2021.

• Dr. Sudhir Nishtala received the University ofCalgary-FacultyofMedicineFacultyClerkshipTeachingAwardRecipientfor2020.

Resident PublicationsNineresidentpublicationsincludingthe“JournalofAmericanCardiology”(JACC)and“JournaloftheAmericanHeartAssociation”(JAMHeart)publications.

Cardiac Surgery Training ProgramProgram Director – Dr. William Kent

The Cardiac Surgery training program is fully accreditedbytheRoyalCollegethankstotheleadershipofDr.WilliamKent(ProgramDirector)andChristinaFaulkner(ProgramAdministrator).Thisyear,theprogramsuccessfullyunderwentaRoyalCollegeInternalreviewwithnoidentifiedweaknesses.

Itwasayearofsignificantchange.Drs.LucyJeffersonandAmyBrownwerewelcomedtotheprogramasfirst-yearresidentsandgraduatingtraineesandDrs.HollyMewhortandAaronSpoonerweresuccessfulintheirRoyalCollegeExams.

TherewerealsoleadershipandadministrativechangeswithDr.DanielHollowayassumingtheroleofprogramdirectorandMs.Faulknermovingontodepartmentadministrationafter13yearsofoutstandingwork.SelenaGilltookovertheprogram’sadministrativerole,bringingpastexperienceinfellowshiptraining.


Seven residents are enrolled in the Calgary training program,whichissupportedby12full-timededicated cardiac surgeons. All members of the divisionarecommittedtoresidencyeducationandworktoprovideasuperiortrainingenvironment.The academic curriculum consists of academic halfdaysfocusedondidacticteaching,journalclubs,thoracicaorticrounds,MandMrounds,andcardiovascular triage rounds.

TheacademicscheduleiswellpartneredwiththeDepartmentofSurgerycurriculum,includingcriticalthinking,surgicalskills,surgicalfoundationsandCanMEDs.Ourjuniorresidentsalsoattendateachertrainingretreat,whichpreparesthemto become educators and leaders in their future careers.

Thereisanincreasedamountofsimulationandhands-onskillsofferedbytheprogram,includinglabsforcadavericdissectionandminimallyinvasivevalvesurgery.Intheoperatingroom,residentsaretrainedincomplexopen-heartprocedures,pacemakers,mechanicalcirculatorysupport,endovascularaorticsurgeryandtranscathetervalveimplantation.Opportunitiesinclinicaloutcomes,basicscienceandtranslationalresearcharealsosupportedandthisyear,residentssuccessfullypresentedtheirworkatbothnationalandinternationalmeetings.

TheCOVID-19pandemicwasamajorchallengefor training this year and resulted in redeployment ofresidents,whoassumedcriticalcarerolesintheICU.Academicteachingwastemporarilysuspended,includingJohnBurgessResearchDayandourswinehearttransplantsimulationlab,whichhasbeenahighlightofthecurriculumsinceitsintroductionthreeyearsago.Overall,theeffectsof the pandemic on our senior resident clinical rotationswereminimizedandweareproudofourresidentsformeetingthechallengesofthisdifficulttime.Asinyearspast,thesuccessachievedbyourresidents has further established the University of Calgary as one of the top residency training programs in the country.

Awards• LBMitchellResearchAward–Dr.AliFatehi

Hassanabad• MichealJ.DavidsonFellowshipAward-Dr.

Aaron Spooner

Resident PublicationsNineresidentpublicationsincludingmultipleresidentcollaborations.

Fellowship Programs

TheDepartmentofCardiacSciencesoffersclinicalfellowshipsforadvancedtraininginthefollowingfourareas:Electrophysiology,InterventionalCardiology,Echocardiography,HeartFailure(CardiovascularMagneticResonanceTraining,CardiacRehabilitation).TheElectrophysiologyprogram is an Area of Focused Competence (AFC)ProgramandisaccreditedbytheRCPSC.Ourfellowshipprogramstrainbothdomesticandinternationalmedicalgraduateswhohavesuccessfully completed a residency training programinCanadaorelsewhere.

EchocardiographyProgram Lead: Dr. Sarah Weeks

TheAdultEchocardiographyFellowshipProgramattheLibinCardiovascularInstituteisa12-monthprogramwithastrongclinicalfocus.Thereiscapacityforonefellowperyear.InJune2019,Dr.Samir Basmaji completed his level III echo training throughtheprogram.OurcurrentfellowisDr.JeffShaw,whowillcompletehistraininginDecember2020.

Dr.ShawhasbeenawardedtheArthurJ.E.Childfellowshipforthedurationofhisechocardiographytraining.Dr.Shawhascompletedhiscardiologytraining,followedbyafellowshipincriticalcareandplanstouseechocardiographytooptimizepatientcareinthecardiaccriticalcaresetting.


ElectrophysiologyLead - Dr. George Veenhuyzen

The Adult Cardiac Electrophysiology Training ProgramisoneofafewprogramsinCanadarecognizedbytheRoyalCollegeofPhysiciansand Surgeons of Canada as an accredited Area of Focused Competency (AFC) Training Program. ThoughtheEPFellowshipTrainingprogramattheLibinCardiovascularInstituteisover30yearsold,thisrecognitionbytheRoyalCollegeisnew,andlastyear,ourfirstfellowsreceivedtheirAFCDiplomas.TheProgramcurrentlyhasfourfellowsincludingthreenewtraineesfromOntario,Israel,and Belgium.

Heart FailureProgram Leads: Dr. Brian Clarke

Theadvancedheartfailurefellowshipprogramdidnothaveafellowforthe2019-2020year.TheAHFfellowshiphasbridgefundingthroughSERVIERALBERTAInnovationinHealthFund(SAIHF)forthreeyears.DuetoCOVID-19,ourfellowfor2020-2021isunabletocompleteandwehaveaplannedfellowfor2021-2022whowillbecompletingacombinedAHF/EPfellowshipatLibin.TheAHFprogramhadbeenworkingtowardssubmittinganapplicationforRoyalCollegeaccreditationintheArea of Focused Competence (AFC) in Advanced HeartFailureandCardiacTransplantationandwillneedtoworkwiththeDepartmentofCardiacSciences,LibinCardiovascularInstitute,andUniversityofCalgarytosupportthisapplication.

Interventional CardiologyLead - Dr. Francois Charbonneau

Forthelast38years,theFoothillsInterventionalCardiologyService(FICS)hastrainedmorethan70cardiologygraduates.Thesefellowshavebecomeexpertsandleadersincatheterbased,diagnosticandtherapeuticinvasiveproceduresacrossCanada,Europe,theUS,Australia,andtheMiddleEast.

In2019–2020,ourprogramincludedsixfellows.TwosuccessfullycompletedtheirtraininginJune2020.OneindividualisreturningtohishomecountrytodevelopInterventionalCardiologyin

Trinidad&Tobago.TheotherwillpursuefurthertraininginstructuralInterventionalCardiologyinFlorence,Italy.IncollaborationwiththeUniversityofCalgary,FICSisintheprocessofapplyingforrecognitionofourtrainingprogrambytheRoyalCollegeofPhysiciansasanareaoffocusedcompetencyinAdultInterventionalCardiology.

Grand Rounds CardiacSciencesGrandRoundsrunfromSeptemberuntilJune.TheattendanceatourGrandRoundsisexcellent,withanaverageofmorethan40attendeesweeklybetweenphysicianstaff,trainees,researchersandnursingstaff.Inaddition,the rounds are held at the Foothills Medical Centre and telecast to all of the major teaching hospitals: PeterLougheedHospital,RockyviewGeneralHospitalandSouthHealthCampus.Wecontinuetoattractworldclassnationalandinternationalspeakers.Thesefeaturedspeakersalsomeetwithourtraineesandparticipatewherepossibleinouracademic teaching session.

OurGrandRoundsprogramissupportedbythe pharmacological industry and the Libin CardiovascularInstitute(LCI).SinceCOVID-19,GrandRoundshasmovedonlineandwehaveseenanincreaseinthenumberofattendees.AnotheradvantageofthisshiftindeliveryisthatthepresentationsarenowarchivedandfeaturedontheLibinYouTubeChannel:https://www.youtube.com/channel/UCrmaxT41CgMZcRNyDhDBYiA

The complete list of speakers can be found in the Appendix.


ResearchTheLibinCardiovascularInstituteisworkingtopreventandreducetheriskofcardiovasculardiseaseswhileimprovingdetection,treatment,survival and quality of life of impacted individuals andpopulations.Ourmembershavehadaproductiveyearin2019-2020.

Asnapshotofthecoreresearchmetricsisasfollows:

Publications• TotalnumberofpublicationsbyLibinInstitute

members:562• Meanimpactfactorofpublications:5.9• Numberofpublicationswithanimpactfactor

over10:53

Samplesofthesepublicationsinclude:

• Dr.AaronPhillips,PhD,waspublishedinNeurologyforhisresearchprojectwhichfoundthat disturbed breathing during sleep mayincreasetheriskofstrikeinpeoplewithspinalcord injury.

• Dr.DavidMontero,PhD,waspublishedinTheLancet Diabetes & Endocrinology for his studywhichfoundthatenduranceactivitiesmayleadtomajorhealthbenefitsforpeoplewithdiabetes.

• Dr.PaulFedak,MD,PhD,wasco-leadofastudythatdiscoveredapreviouslyunidentifiedcellpopulationinthepericardialfluidsurroundingthehearthasthepotentialtorepairdamagedhearts.TheresultingarticlewaspublishedintheinternationallyrecognizedjournalImmunity.

TraineesNumberofstudents(undergrad,graduate,PDF)supervised by a Libin member• Undergrad-40studentsinSummer2020• PDF-37• GSS–

Number of students registered in the Cardiovascular/RespiratoryScienceprogram-68

260

Patients as partners – read about a $3M research project designed to improve patient outcomes and their health care experiences

in Appendix A

Award winning women’s cardiovascular health program – read more about it in Appendix A

New cell discovered that can heal hearts – read more about it in Appendix A


• Dr.DerekChew,MD,receiveda$140,000BantingScholarshipfromtheCanadianInstitutesofHealthResearch.

• Dr.CvetanTrpkov,MD,asixth-yearcardiologyresident at the Cumming School ofMedicine,placedfirstintheCCTN/CHFS ResearchCompetitionatthe2019CanadianCardiovascular Congress.

• Dr.AaronSpooner,MD,wasawardeda$25,000MichaelJ.DavidsonFellowshipAwardfromtheThoracicsurgeryFoundation,thecharitable armof The Society of Thoracic Surgeons. The grantwillhelpsupportaneducationprogram,“TranscatheterAorticValveReplacement.”https://www.sts.org/media/news-releases/tsf-announces-951500-funding-cardiothoracic-surgery-grants-2019

• Dr. Norm Campbell received an honorary degreefromMemorialUniversityforhisdedicationtochampioningthepreventionandcontrolofhypertension.https://gazette.mun.ca/campus-and-community/convocation-approaches-2/

• UniversityofCalgaryEquity,DiversityandInclusionTeamaward:LibinCardiovascularInstituteofAlberta’sWomen’sCardiovascularHealthInitiative:CV&ME

Grants/Research Revenue

TheInstitutegarnered$31,885,305.91inresearchrevenuein2019-2020.Thatis$1.02M/REincomparisontothe$0.77M/REfortheCummingSchool of Medicine.

Awards and Recognition

Ourmembersworkwasrecognizedmanytimesthroughout2019-2020,withintheUniversityandAHSandbyexternalstakeholders.

• Dr.BradenMannswasnamedasafellowtotheprestigiousCanadianAcademyofHealthSciencesfellows

• Dr.JamesWhite,MD,receivedanASTechawardinthecategoryofhealthinnovationsforhisdevelopmentandcommercializationofsoftwareenablingprecisionhealthcaredeliveryincardiovasculardiagnostics.

• Dr.JordanSquair,PhD,apostdoctoralfellowattheCummingSchoolofMedicinewasnameda2019KillamLaureateforhisspinalcordstimulationprojectfocusedoncardiovascularhealthofspinalcordinjuredpatients.

• Dr.HudeQuanreceivedaprestigiousKillamAnnualProfessorAward,https://www.ucalgary.ca/utoday/issue/2019-04-12/five-ucalgary-faculty-members-awarded-killam-annual-professorships

TheworkofDr.EdO’Brien,MD,wasfeaturedduringthecovetedLateBreakingSciencesessionsat the European Society of Cardiology (ESC) Congress—thelargestcardiologyconferenceintheworld.

MeghaMurali,aPhDcandidateinthelabofDr.JustinMacDonald,PhD,wasinvitedtopresentarapidfiretalkinbasicscienceatHeartFailure2019,heldinMayinAthens,Greece.Herabstractwasalsopre-selectedtobehighlightedonthefinaldayoftheconference,organizedbytheEuropeanSociety of Cardiology.


ChallengesThe Department of Cardiac Sciences faces numerous challengesandsimilarlyinnumerableopportunitiesforthefuture.

Wehaveseenunprecedentedgrowthinopen-heartsurgery,electrophysiologyablationprocedures,theneedfordiagnostictestingandoutpatientconsultations.Incompatibly,thisincreaseddemandcomesatatimeofincreasedfiscalrestraint.Accordingly,theDepartmentischallengedtodelivertimelyaccesstocardiovascularserviceswhile“holdingtheline”oncosts.Toaddresssuchgrowth,theDepartmentmadeeffortstoenhanceefficiency,increasetheappropriatenessof procedures and improve access to care through central triage models. We believe that a central referral system both for open-heart surgeryand all life-savingcardiovascularinterventions,forexample,mayincreaseaccessibilitytocareforpatientsandimprove appropriateness of procedures.

Thepatientwaitlistforopen-heartcardiacsurgerycontinuestobeaconcernandmajorpriorityarea.Surgicalresultshavebeenoutstanding,andqualityhas remained excellent despite an increased acuity ofthenatureofthepatientsandincreasedco-morbiditiessuchasage,diabetes,andotherchronicdiseasesthatcannegativelyinfluenceoutcomes.

Thewaitlisthasbeenstableoverthepastyear(despiteanupliftofcasevolumesandincreasedreferrals)butcontinuestobehigherthanoptimal.Thisyear,thetotalamountofcardiacsurgeryopenheartcaseswillexceed1,800.Itwillbeoneofthehighest volumes of all open- heart surgery centers inNorthAmericaasasingle-siteprogram.Patientsrequiringthenicheexpertiseofaparticularsurgeonwillbeappropriatelyassignedtothatsurgeon.However,mostpatientsneedingheartsurgerywillbereferredtothe“nextavailablesurgeoninanefforttominimizewaittimesthatremainasignificantandpressing issue.

AworkinggroupledbyourQIleadisexploringtheunderlyingmechanismsresponsiblefortheunrelentinggrowthofthisprogramoverthepasttenyears,andtheopportunitiesforimprovementthatmayexistinthisarea.Recruitmenthasoccurredtomeettheseneeds.

Limitedinfrastructurewithinthefouracutecaresites around the Zone constrains our ability to meet patientneeds.TheFoothillsMedicalCenter,ourlargestoperationalsite,iswheremostresource-intensiveprocedurestakeplace.Withcreativityfromourexecutiveleadership,growthhasoccurreddespitethelimitedinfrastructure(i.e.open-heartsurgeryuplifts).However,wewillbechallengedinthefuturetoberesponsivetowait-listpressures(i.e.AlbertaSurgicalInitiative)aseffortstoreorganizeandmaximizeourexistinginfrastructurehavealreadybeenexhausted.

TheincreasinggrowthandrestrainedresourcesthroughouttheDepartmentpresentarecontributingtophysicianwellnessandphysicianburnout.Forexample,wehaveseenincreasingstrainrelatedtocity-widecardiology night coverage across the Zone to provide 24/7careatallfouracutecarehospitals.Theseincludeemergencyadmissionsaswellascriticalcarebeds,whichmustbeservicedwithcardiologyexpertise.Givenchangingpressuresineducationalprogramsandthelackofadequatephysicianextenders,weremainedchallengedwiththethreatofphysicianburnoutforourcardiologistswhocoverallsitesatalltimes.Weviewthisasanopportunitytoexplorenewwaystodelivercareandalterservicemodels.RecruitmentofnursepractitionersateachlocationmayalleviatesomeburdenastheyhavetraditionallyperformedoutstandinglywellforourDepartmentatsiteswherethey currently reside.

We have an opportunity to explore this model further atallacutecaresiteswithpossiblecentralizationofsomeoftheseservices.Additionally,wehavemadeeffortstoaddressphysicianwellnesswithanewcommitteeanddedicatedresourcesandattentiontowardacultureofwellnessforphysicians.

• Increaseddemandforserviceinatimeofunprecedentedfiscal

Currentissuesreflect:

• Insufficientinfrastructuretomeetspecifictypeandvolumeofpatientconcerns

• Physicianburnoutandresultinginabilitytoprovideappropriatecoverageacrossthezone

restraint• Increased procedural wait times


OpportunitiesThoughwehaveidentifiedopportunitiesineachofthecurrentchallengeareas,therearealsofivedistinctopportunitiesthatcouldbepursuedtoenhancepatientcareintheDepartmentofCardiacSciences:

• Fosteringthegrowthofthestructuralheartprogram and the role of academic medicine ininterventionalcardiology

• Embracinganeffectivemulti-disciplinaryheartteam approach involving all aspects of theDepartment of Cardiac Sciences.

• Reducingrecoverytimeandpromotingearlydischargetomanagesurgicaldemand,mitigatecostsandenhancetheoverallpatientexperience

• Cultivatingamulti-disciplinary,collaborativeapproach to cardiovascular disease

• Utilizingexistingdataplatformstoenhancereal-timedecisionmaking

TheinterventionalcardiologygroupisamongthelargestinNorthAmericaandperformsalmost10,000proceduresayear.TheCanadianInstituteforHealthInformation(CIHI)reportplacesourgroupamongthetop three centres in the country based on a number of quality indicators.

Theadjusted30-daySTEMIandPCImortalitywassignificantlyloweratourcentrecomparedtothenationaladjustedaverages,whichplacesCalgary at the top in care for STE and ACS across thenation.Theremayalsobeopportunitiestoexpandintostructuralheartinterventions,andourmultidisciplinaryTAVIprogramcontinuestogrowwithexceptionalresults.Suchpatientscannowreceiveanaorticvalveinterventionwithoutgeneralanesthesia,whichresultsinrapiddischarge(withinone-ortwo-dayspostop).Structuralheartinterventionsareanopportunityforenhancedvalueandpatientsatisfaction.

Webelievethatasweexpandintostructuralheartinterventions,wecandecantsomeresource-intensive open-heart surgeries and improve our

capacity and access to life-saving procedures. To that end,recruitmentshaveoccurredandwillcontinuetobeafocuswithfurtherexpansion.

Thegrowingprevalenceofriskfactorssuchasdiabetes and obesity have resulted in high demand forrevascularizationprocedures.Thequalityofourpercutaneousinterventionprogramhasbeenabenchmarkofexcellencefordecades,despiteincreasing pressures.

Theremaybefurtheropportunitiestoinvestigateincreaseduseofpercutaneousinterventionsforcoronarydisease,whichmayhelpdecanttheneedforsurgicalrevascularization,whichismoreresource-intensiveandlessfavouredbyourpatients.Ourmulti-disciplinaryteamsattendcardiacsurgerytriageroundsonatwice-weeklybasistoprovidemultipleperspectivesforeachpatient.

We believe that appropriateness has improved due tothevariousinputsofcardiology,cardiacsurgery,cardiacanesthesiaandcardiaccriticalcare.Theimpact of this approach highlights an enormous opportunitytoimplementroutinemultidisciplinaryheartroundsacrossthewholeDepartmenttoenhance appropriateness and increase access to care.EnhancingconnectionswiththePersontoPopulation(P2)programattheLibinCardiovascularInstitutecanalsohelpreducedemandonthesystembyincreasinghealthpromotionandchronicdiseasepreventionactivitiesinthecommunityandprimarycaresetting.

Innovationstoreducethesurgicalwaitlistremainsomewhatchallengingduetofinancialconstraintsandeffortstofocusonmaintainingthecurrentquality service at the increased volume. The departmentisfocusingoninitiativesthatimproveefficiencyandprovidebettervalueforourpatients.Forexample,theenhancedrecoveryaftersurgery(ERAS)programledbyourcardiacanesthesiagroupmayoffermorerapidrecoveryandearlydischarge,whichcouldprovidemorecostsavingsandimprovedpatientoutcomes.

Alongthesamelines,minimallyinvasivecardiacsurgeryhasgrownwithintheSectionandisakeypriority.Weobtainedoutstandingresults,andwearecollectingdatatodeterminethepossiblebenefitsof


this approach to accelerated recovery and decreased lengthofstay.Wewillassessthepatientexperiencebymonitoringpatient-centredmetricstoconfirmwhetherornotpatientsfavoursuchapproaches.

Furtheroversightandcollaborativeeffortforcardiovascularpatientsmayallowustoimproveefficiencyandaccesswhilestilldeliveringoutstandingquality.ThiswillrequirecoordinationbetweenAHSclinicaloperationalleadersandallmembersofourDepartment.SectionChiefswillneedtoprovidestrongleadershipandinfluenceculturalandbehaviouralchangesinreferralpatternsandpractices.Focusedleadershipandservicelinephilosophy of our Department of Cardiac Sciences shouldputusinanexcellentpositiontobeleadersinacollaborativeapproachtocardiovascularcare.

Leadership in the Department is spread out at fourdifferentsitesacrossthecity,limitingorganicinteractionsandcommunications.WemadeeffortsthisyeartoimprovecommunicationacrosstheZone.IndealingwiththeintenselystressfulsituationcreatedbytheCOVID-19pandemic,welearnedhowcollaborativeandagileourleadershipcanbewhenfacedwithaspecificthreat.Usingvirtualplatforms,weconnectedallleadershipwithintheZoneforregularmeetingsandfoundthatwewerenimblerandmoreresponsiveasaresult.Wewillcontinueto explore such approaches to reduce isolated structuresandbettercoordinatecareacrossthefoursites.

Thereisasignificantopportunitytoutilizeexistingdataplatformstoenhancerealtimedecisionmaking.Duringthepandemic,wehadanexcellentexperienceusingsomeAHSinformaticsplatformssuchasTableautolinkourleadershipandprovidetimelyactionabledataacrosstheZone.Forexample,weusedaTableau-baseddashboardtoshowallbeds across all sites and their current status. This allowedacentralizedapproachtoensureadequatecoverage and accessibility of care across the Zone.TherearealsoopportunitiestolinkwiththeprovincialSCNnetworkstolearnfromothersitesandshareourlearningsacrosstheprovince.WorkingthroughtheLibinCardiovascularInstitute,wewillbeginintegratingourexistingdataassetsandbuildphysiciancapacitytoutilizedatatosupportclinicaldecisionmaking.


Workforce Planning

Cardiology

Summary of RecruitmentRecruitmenthasbeenfocusedinincreasingourpoolofgeneralcardiologists:sevennewrecruitshavejoinedtheSectionofCardiologywithprimarygeneralcardiologyfunctions,twowithmajorinterestsinechoandadultcongenitalheartdisease.AnadditionalrecruithasjoinedtheSectionfocusedonadvancedheartfailureandmulti-cardiacimaging.AninterventionalcardiologistwillalsojointheSectioninthefallforatotalof10recruitments.

Future NeedsTheDOCcontinuestogrowandassomeofourseniormembersretireorreducetheiractivitiesfuturerecruitmentswillbeneededinthenextthreetofiveyears.Dr.JamesCohenhaspracticedinCalgaryfor40years,andDr.PatrickMahaspracticedfor35yearsasageneralcardiologist–bothhaveretiredthisyearandtheirsignificantcontributionstotheSectionofCardiologyandcardiaccareinCalgarywererecognizedattheLibinAwardsdinner.

Dr.AndrewGrantisrelocatedtoCharlottetown,PEIwithajointappointmentatDalhousieandMemorialUniversity,onAug.1.Severalareasthat are of great interest for the development of the DOC include cardio-oncology and geriatric cardiology. Further general cardiology recruits are needed to implement and improve cardiac outpatientcareacrossthecity.Asthemanagementofcriticalcardiacpatientsevolveinthenextyear,twotothreecross-trainedcardiologists/criticalcarephysicianswillberecruitedandtransitionofleadershipwithinourcardiaccriticalcaregroupwillbeensured.Academicrecruitsfocusedonbig-data,qualityassuranceandimprovement,healtheconomics and electrophysiology are planned withinthenexttwotothreeyears.

Goals and StrategiesThegoalsoftheSectionofCardiologyaretoprovidethebestpersonalizedandtimelycardiaccare to Albertans in Calgary and the southeastern region of the province.

2019-2020 Retirements

James Cohen(cardiologist)

PatrickMa (cardiologist)

JamesMcMeekin(cardiologist)

Timothy Prieur(cardiologist)

2019-2020 Recruitment

Muhammad Ahsan (surgeon)

Corey Adams(surgeon)

NitaGuron(cardiologist)

RobertMiller(cardiologist)

David Campbell (Libin - endocrinologist)

2019-2020 Libin Members

Liane Tomfohr-Madsen (Psychology)

Jonathan Smirl (Kinesiology)

LynYang(CommunityHealth Sciences)

AmelieStritzke(Pediatrics)

2020-2021 Recruitment

InterventionalCardiologist-Dr.AyaazSachedina

GeneralCardiologist-Dr. Nishant Sharma

GFT

Advanced Heart Failure Cardiologist

InterventionalCardiologist

Surgical Assistant

Cardiologist/Scientist


Toachievethis,activerecruitmentisinplaceandstrategiestowardsstandardizingcareacrossthecity have started to be implemented. Central referralandtriagingtoimproveourwaitlistsandability to provide expedited care across the city are currently being developed. Overnight and weekendcoveragehasbeenapainpointwithintheSection,butthedevelopmentofaneveningnursepractitionerinitiallyatRGH,hasbeenhighlysuccessful and the goal is to implement these programsacrossalloursites.Thisprogramwillensure appropriate coverage across the city and increasepatientsafetyandphysicianwellness.

Impact on other Department and Regional ResourcesInprinciple,nomajorimpactonotherdepartmentsand regional resources are expected.

Cardiac Anesthesia

The most pressing current challenge for the cardiacanesthesiagroupinvolvesunknownsaboutintermediate-termmanpowerneeds,duetostilldevelopingplansforfuturecardiacsurgicalcasenumbersandinterventionalcardiologycasenumbers,asaresultoftheCOVIDpandemic.Overthenextyearthegroupisseekingadequatesupport to further develop the research program. Additionally,thegroupneedssupportforourdevelopingQualityAssurance/QualityImprovement(QA/QI)program,includingintroducingournewcardiacanesthesiologisttomentorsinthefieldandconnectinghimtoappropriatelocalQA/QIresources.

Future NeedsCalgaryisaleaderincardiacsurgicalERAS(EnhancedRecoveryAfterSurgery).FutureERASopportunitiesincludea)performingdataanalysisonexistinginterventionstodeterminetheireffectivenessandstreamliningtheERASpathwaybyeliminatinginterventionswhicharefeltunlikelytobeeffectiveandreplacingthemwithhigher-yieldinterventions;b) expandingthecardiacsurgicalERASprogramtobecomeaprovince-wideinitiative;andc)publishingtheresultsoftheCalgarycardiacsurgeryERASexperience.

The cardiac anesthesia group is developing our qualityimprovement/qualityassuranceprogram,includingthehireofanewcolleagueinthesummerof2021whowillleadthisinitiative.Areasoffutureworkmayincludea)examiningtherateofperioperativeneurologiccomplicationsfollowingcardiacsurgery,suchasdeliriumandstroke;b)examiningtherateofperioperativelineinfections;andc)furtheroptimizingperioperativebloodconservation.Therelationshipbetweencardiacanesthesia,cardiacsurgery,cardiacICU,andcardiologyiscloseandhighlycollaborative.Afuture“big”ideawouldbetoleveragethisrelationshipandourlocalexpertiseintocreatinga“CardiacSurgicalCentreofExcellence”-forexampleinminimallyinvasive cardiac surgery.

Quality Assurance, Quality Improvement and Innovation

General

Cardiac Sciences Quality Assurance Committee: Thiscommitteeformerlyco-chairedbyJamieMcMeekinandCarolineHatcherisnowco-chairedbyBillKiddandAmandaWeiss.Onecasehasbeenreviewedanddiscussedwithrecommendationspresented,twocasesarestillinprogress.

Cardiac Sciences Quality Improvement and Innovation Thisteamlooksatsystemsafetyandprocessreviewandhas7projectsunderwayrangingfromCardiacSurgerywaittimes,STEMItransferstosustainedimprovementswithCardiacFunctionClinicreferralsanddevelopingappropriatepalliativeathomecareforheartfailurepatients.OurteamsmobilizedandutilizedmanyresourcestosurgeplanduringCOVIDtoensurepatientflowandthatstaffandpatientneedsweremet.ThisincludedsurgeplanningbetweenICU,CICUandCVICUinresponsetotheCOVID19pandemic,CardiologypatientflowforsuspectedorconfirmedCOVID19casesanddefinedpatientflowforcardiologypatientswhorequireCCUcareduringdifferentlevelsofCOVID19pandemicresponse.OneoutcomefromthepandemicthatwillhavepositivelongtermaffectsforourdepartmentwasthedevelopmentofourpatientdashboardinTABLEAU.


Future Directions and Initiatives

Overthecomingyearwewillleverageouruniqueorganizationalstructure-afullyintegratedmulti-disciplinary clinical department and cardiovascular researchinstitute–topursueacomprehensiveapproach to precision medicine.

Wewillleverageouruniquecapabilitiestoadvancepatient-centred,valued-basedpracticesthatwillenhancepatient-reportedoutcomes,increaseaccesstocare,andimprovequalitywhilereducingcost.Inbrief,wehopetopromotea“bettermodelforbettercare.”In2020-2021wewilllaunchaflagshipdatainitiativetointegratetheexistingcardiovascular-orienteddataassetsandallowustomakeenhancedreal-timeclinicaldecisionsforoptimalpatientcare.Thedatainitiativewillbuildonthesuccessofthe Stephenson Cardiac Imaging Centre and their predictivemodellingwork,aswellasleveragetheresourcesintheCentreforHealthInformaticsattheUniversity of Calgary.

We have had an excellent experience in our Choosing WiselyprogramtobetterunderstandtheroleoflowvaluediagnostictestinginourZone.

ThisworkhasreducedtheamountofdiagnostictestingintheareaofECGs,andwecanextendthisefforttoothernon-invasivecardiacdiagnosticmodalities.Theseopportunitiescancreateneededcostsavingswithoutalteringpatientoutcomesorplacingpatientcareatrisk.Withfurthercentraltriagingandmorecentralizedleadershipandimprovedcommunication,alow-valuetestingreductionisalowhangingfruitthatdeservesfurtherattention.


AfteroveradecadeasexecutivedirectorofCardiacSciencesatFoothillsMedicalCentre,CarolineHatcherissteppingdowntotakeonanewchallengeasexecutivedirectoroftheTomBakerCancerCentre.

Hatcherisleavingalegacyinpatientcare,leadershipandqualityimprovementthatwon’tsoonbeforgotten.

“Sheisaverystrongandinspirationalleader,”saysDr.ToddAnderson,MD,ViceDeanoftheCummingSchoolofMedicine.AndersonknowsHatcherwell.AsformerheadoftheDept.ofCardiacSciences,AndersonandHatcherco-ledtheDept.ofCardiacSciencesfor10years.

AndersonexplainedHatcher’sstrengthswerevaried,makingherawonderfulcollaboratorandpartner.Hatcher’sabilitytogetthingsdone,hercommitment to her team and her passion for patientsstoodouttoAnderson.

Hatcher’smastersdegreewasintheareaofhealthstudiesandleadership,andthisenabledhertomakegreatstridesinimprovingcareforcardiacpatients.Shewasastrongsupporterofclinicalresearchandhadseveralwinsinthisarea,suchasrevampingclinicsandreducingwaittimesincriticalcareandcardiacsurgery.Shealsohelpedsecurefundsfornumerousprojects,suchasthehybridoperatingroomandinnovationsincardiac surgery.

Hatchercollaboratedwithnumerousorganizationsaroundtheprovince,andwasontheCardiovascularHealthandStrokeStrategicClinicalNetwork(SCN),whereherrolefocusedonmetrics and outcomes.

Theword“advocate”comesupoftenwhendiscussingHatcher.Whethersheisbackingherstaff,hercolleaguesandfriendsorthecardiacpatientssherepresents,Hatcherisknownforherpassion and strength.

“Shehasalwaysbeenaforcetobereckonedwith,”saysJenniferCoulthard,acolleaguewhohasknownHatcherfor10years.“Sheset and maintained the bar for excellence and professionalismandwassuchasstrongbeaconofleadershipforotherstoaspireto.”

CoulthardsaysHatcher’skeeneyefordetailandhercommitmenttobuildingrelationshipswentalongway.

Hatcher’sformerbossShawnaSyverson,thesenioroperatingofficeratAlbertahealthServicesforFoothillsMedicalCentre,agrees.

“Shewasalwayslookingatwhatisbestforpatients,”saysSyverson,whohasknownHatcherformorethan20years.“Wearequiteproudofhowshere-profiledthecardiacsciencesfootprinttooptimizethings,despitefixedresources.Itisanareaofconstantgrowthandinnovationwherethetechnologyadvancesveryquickly,andshehasaverystrategicmind.”

Inherrole,Hatcherledamassiveteamthattouchedthousandsofpatientseachyear.Cardiaccare in Calgary leads the country in numerous areas,includingsurvivalrateforheartattackpatients.

Despitehavingsuchalargeportfolio,Hatcheralwaysmadetimetomentorherleadersandteams.

Longtime executive director with a passion for patients steps down

Caroline Hatcher taking on new role in cancer care

Appendix A


“Sheisconstantlylookingtogrowpeople,”saysBarbJones,whoreportedtoHatcherfornineyearsasaclinicalnursespecialistwithinCardiacSciences before becoming the manager of cardiac diagnostics,clinicalinformaticsandqualityatAlbertaHealthServices.“Shegrowspeopleoutofworkingforher,whichisthesignofareallygoodleader.”

Syversonconcurs,sayingHatcherprovideduniquementorshipandconnectionopportunities,likeleadershipbookclubs,breakfastsandparties,forher teams.

“Sheisreallycommittedtothementorshipoftheleadersandmanagersonherteam,”saysSyverson.“Shespendsalotoftimehelpingthemtogrowasleaders.”

ButHatcher,amomtotwogrownchildrenandcaregivertobothofheragingparents,hasaplayfulsideaswell.

HerstaffwillalwaysrememberDanceOffFridaysinHatcher’soffice,whichinvolvedcompetingtosee

whohadthebestmoves.Shewillalsobefondlyremembered for convincing members of her team tojoinlipsyncperformancesandkaraokevideos.

“Sheengendersalotofloveandplayfulness;thereisalotoffunaroundherteams,”saysSyverson.

Hatcher’scompassionforothers,showninnumerousways,includingthroughherhumanitarianworkaroundtheglobe,endearhertomany.Infact,herempathyandkindnessindealingwithherstaffandcolleagueshaveresultedinnumerousgenuineconnections.

“Sheleadswithheart,kindnessandcompassion,”saysSyverson.“Youwouldhavetodescribeherasatrustedcolleagueandfriend.”

Anderson feels the same.

“Sheisanincrediblyvaluedfriendandcolleague,”he says.

By Dawn Smith, Dawn Smith/Libin Institute


Cardiologist uses innovative techniques to improve patient experience

IthasbeencoupleoftoughyearsforAlCheney,75. Theretiredoilandgasworker’squalityoflifeplummetedaftersufferingamassiveheartattackin2017.

Sufferingwithsymptomssuchasanirregularheartbeat,swellinganddifficultybreathingthatmademobilitydifficult,Cheneywasdiagnosedwithheartfailurefollowingtheheartattack.Hehasspentagreatdealoftimeinthehospital–oftenweeksatatime.

AlthoughCheney’slifeimprovedsomewhataftertreatment,doctorsdeterminedheneededanimplantabledefibrillatorwithaspecialpacemakerleadtohelpimprovehisheartfunction.Cheneyreceivedthedefibrillator,protectinghimfromdangerousheartrhythms.However,hiscardiacresynchronizationtherapyimplantprocedure—whichinvolvesaddingapacingleadthroughthecoronarysinus,aspecialveinintheheart—wasnotsuccessful because of the anatomy of his heart. ButinAugust2019,Cheney’sphysician,Dr.JacquesRizkallah,MD,ayoungcardiologistwhobeganworkinginCalgaryin2016,wasabletoovercomethisusinganoveltechniqueknownasLeftBundlepacing.ItwasthefirsttimethatthissurgicaltechniquewasperformedinCanada.

Rizkallah,whoreceivedspecializedtrainingatHarvardMedicalSchool,explainsthatinstandardpacemakerimplantprocedures,doctorsinsertoneormorepacemakerwiresintothehearttoactivateitbasedonthespecificneedsofthepatient.

Althoughthepurposeofapacemakeristotreatpatientswithslowheartrates,insomerarecases,activatingtheheartwiththepacemakercancauseittoenlargeandweaken.Knownaspacemakermediatedcardiomyopathy,theconditioniscausedbyactivationoftheheartoutofsync.

Inthenewapproach,alsoreferredtoas

physiologicpacing,thepacingwireisimplantedinaspecificpartoftheheartalongitsnormalconductionsystem,reducingtheriskofpacemakermediatedcardiomyopathyandtreatingheartfailure in some cases.

“Thisallowsustostimulateandactivatetheheartwiththepacemakerthewayitisnaturallydesignedtobeactivated,”saysRizkallah.

Therearetwosurgicaltechniquesinvolvedin physiologic pacing: HIS bundle pacing and LeftBundlepacing.HISBundlepacingplacesthepacemakerleadclosertothecentreoftheheart’sconductionsystemalongtheventricularseptum.LeftBundlepacingpositionstheleadinadeeper,specificlocationintheheartmusclethatis more challenging to reach but provides a good alternativeforpatientsinwhomtheHISBundlelocationisn’ttechnicallyfeasible.

Cheneynotestherewassignificantimprovementinhisqualityoflifeaftertheleftbundlepacingprocedure. “Everythingisbetter,”hesaid.“Ihavenothingbutgoodthingstosayaboutthatsurgery.”

AlthoughtheHISbundleandLeftBundlepacingtechniques are more technically challenging and requiremoretimetoperformthanthestandardpacingmethods,Rizkallahispleasedwiththeresults.

“Perseveringthroughthesesurgeriesisveryrewardingwhenweseepatientsbenefitwithimprovementsintheirheartfunction,”hesays.

Radiation-free ablation RizkallahwasalsothefirstinWesternCanada—andamongstthefirstinCanada—toperformaradiation-freecomplexablation,aprocedurethatusesspecialcatheterstoburnorfreezecircuitsinthe heart that cause abnormal rhythms.

CARDIAC SCIENCES ANNUAL REPORT46

MostphysiciansrelyonfluoroscopyusingX-raystovisualizetheirtoolsintheheartwhenperformingcomplexablations,butthisstandardprocedurehasapotentiallyseriousdrawback.Bothpatientsandphysiciansareexposedtoradiation,withtheamount dependent on the length of the procedure.

Overtime,thecumulativeexposureincreasestheriskofcancerforhealth-careproviders.Toshieldthemselvesandreduceradiationexposure,physicianswearacumbersome,leadapronweighingabout30poundswhileperformingablations.Notusingfluoroscopyduringablationsavoidsallthosecomplications,explainsRizkallah.

Althoughfluoroscopy-freeablationsareperformedatmanycentresinCanada,Rizkallahisemployingitforcomplexprocedures,suchasthosethatrequirethe atrial septum of the heart to be punctured to treatarrhythmiaslikeatrialfibrillation.

Theapproachusesultrasoundimagingwithintheheartasaguide,amethodthatisperformedatjustafewofthelargesthospitalsinCanada.Thezero-fluoroscopyultrasound-guidedtechniquehas only been around for a couple of years and is harder to learn and implement.

“Thefirstcasewasalittlenervewracking,butexciting,”saysRizkallah.“Iwasfortunatetohaveaccesstotherighttechnologyatourinstitution,whichallowsustobeinnovative.”

Rizkallahsayshiscolleaguesarealsokeenonlearningthenewmethod.

“Iworkwithagreatgroupofcolleaguesthatarealwayslookingtoadoptinnovativewaystodeliverthebestcaretoourpatients.”

By Dawn Smith, Libin Institute


Researcher leads international study of patients at risk of heart failure and death

HeartFailureimpactsbetweenthreetofourpercentofthegeneralpopulation.Itiscommonlyrelatedtoheartattacksbutcanalsobelinkedtoaconditioncalleddilatedcardiomyopathy(DCM),aconditioncharacterizedbyanenlargedandweakheartmusclethatcan’tefficientlypumpblood.Aninternational,multi-centrestudyledbyDr.JamesWhite,MD,PhD,aclinicianandresearcherat the University of Calgary’s Cumming School of Medicine(CSM),hasrevealedmagneticresonanceimaging(MRI)canbeusedtopredictmajorcardiacevents for people diagnosed DCM.

White’sstudy,publishedinCirculationCardiovascularImaging,confirmsabout40percentofpatientswithDCMhaveinjurypatternsontheirheartmuscle,whichcanbeseenwithMRI.Thesepatternsareassociatedwithhigherriskoffutureheartfailureadmissionstohospital,life-threatening heart rhythms and death.

Thestudy,whichwasthelargesteverconductedusingMRIinpatientswithDCM,alsoshowsthatcardiacMRIcanplayanimportantroleinguidingthecareofindividualpatientswithheartfailure.The results of this study could lead to trials lookingathowpatientsathigherriskmaybenefitfrom more intensive treatments. White says that treatingpatientswithDCMischallengingbecausethereisalackofunderstandingintowhatcausesthediseaseandwhypatientsresponddifferentlytothe available treatments.

“Wehavetendedtothinkofdilatedcardiomyopathy as one type of heart disease and thatallpatientswiththeconditionshouldrespondthesame,butwearelearningthatitisacollectionofdiseasesthataffecteachpatientdifferently,”saysWhite,explainingthosethatdon’trespondwelltotreatmentsaremorepronetocardiacarrest,whichkillsabout35,000Canadiansannually.“Thepurposeofourstudywastoseeifwecouldfindindividualpatientfeaturesthatcanhelpus

prescribelife-savingtherapies,suchastheICD(implantablecardioverterdefibrillator).”

WhiteandhisteamassembledtheMINICOR(MultimodalInternationalCardiovascularOutcomesRegistry)group,whichinvolves12centresinCanada,theUnitedStates,SpainandItaly,toprovideresearchersaccesstohighlystandardizeddatacollectedfrompatientsaroundtheworldwiththegoalofpromotingpersonalizedcareforpatientswithcardiovasculardisease.

“Youcanhaveamuchgreaterimpactonpatientcareandonclinicalpracticeingeneralwhenyouworktogether,”saysWhite“Thetruebenefitofinitiativeslikethisistheabilitytotestinnovative

Dr James White

https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.119.010105

https://www.ahajournals.org/doi/10.1161/CIRCIMAGING.119.010105

https://www.minicor.org/


ideasquicklyandshowthattheycanworkindifferenthealth-caresystemsandpatientpopulations.Thisistheuniquepowerofmulti-nationalcollaborations.”

Whiteandhisteamofdatascientistsandstudentsarecurrentlytrackingthehealthofover10,000AlbertanswhohaveundergonecardiacMRI.Withthisdatatheyaredevelopingnewapproachestodeliverpersonalizedriskpredictionsforpatientswithcardiovasculardisease.

LibinInstituteDirectorDr.PaulFedak,MD,PhD,isexcitedaboutthepotentialofthisprojectanditsalignmentwiththeInstitute’saimtoleadintheareaof“precision”cardiovascularmedicine.

“Theseareimportantstepstowardspersonalizingcaredecisionsforindividualpatients,”saysFedak.“Weareconstantlybeingremindedthatthemoreweknowabouteachpatientandtheirowndisease,thebetterwecanmakedecisionstoimprovetheirhealth.”

By Dawn Smith, Libin Institute


Cardiac surgeon invents simulator to help teach new trainees how to suture the heart

DanielHollowaywasacardiacsurgeryresidentwhenhecreatedasimulatortohelphimpractisethetechnicallychallengingtaskofsuturingtheheartduringsurgery.WorkingwithInnovateCalgary,Dr.Holloway,MD,anassistantprofessorattheCummingSchoolofMedicine,securedapatentfor the training device.

The accomplishment recently earned him recognitionasa2019PeakScholarbyUniversityofCalgary President Ed McCauley.

“Securingthepatenthasbeenasteeplearningcurveandsomethingquitedifferentfrommynormaldayjob,butIenjoyedit,”saysHolloway.

Prototype built at home

The busy surgeon developed the simulator at home,creatingthecircuitboardandelectronics,developingthemodelusing3Dprintingandcarefully choosing the silicone product that best replicatesasurgeon’sexperiencewhilesewingthroughtissue.

Severalprototypeslater,thesimulatoruseselectronicstomeasurethetimerequiredtoperformrandomlyassignedsuturingtasksat varying angles. The idea is to improve the efficiencyandproficiencyofsuturingonandaround the heart.

Thedeviceisnowbeingusedonaregularbasisby residents at the Foothills Medical Centre and hasinspiredabitoffriendlycompetitionbetweentrainees.ThedevicewasalsoatthecentreofacompetitioninvolvingtraineesfromacrossthecountryattheCanadianCardiovascularCongress,held in Montreal last fall.

“Twoofour[local]residentswonthecompetition,”saysHollowaywithalaugh,notingthedevicewaswellreceived,notonlybecauseitisfuntouse,

butalsobecauseithelpsdevelopthecriticalskillssurgeons need.

Havingthesimulatorshowcasedatthelargestcardiology conference in Canada has created a demandfortheproduct.Hollowaysayshisnextstepwillbeinthemanufacturingandbusinesssideofhisinvention.

Dr.WilliamKent,MD,thedirectorofthecardiacsurgeryresidencytrainingprogram,isproudofHolloway.

“Dr.Hollowayisatremendousinnovator,andhissuturesimulatorisnovel,simpleandhighlyeffectiveforteachingbasicsuturingskills,”hesays.“Withhissimulator,hehascontributedtothesurgicaltrainingofresidentsinCalgary,andIexpectthatitwillbeacomponentoftrainingateverycentre.WeareveryproudofDr.Holloway’ssuccessandtherecognitionitwillbringCalgaryandourtrainingprogram.”

Dr.ImtiazAli,MD,thechiefofcardiacsurgery,saysHolloway’sprojectisagoodexampleoftheexcellence of the Libin’s cardiac surgery program.

“Weareproudofthequalityofoursurgicalprogram,whichattractssomeofthetoptraineesinCanada,”hesays.“Dr.Holloway’sinventionisagoodexampleoftheinnovationthatourteamstrives for each day. We are pleased he has been recognized.”

HollowaycompletedhissurgicaltrainingatUCalgaryin2017beforeheadingtoNorthwesternUniversityinChicago,wherehecompletedafellowshipinmechanicalcirculatorysupportandcardiac transplant before returning to Calgary to practice.

By Dawn Smith, Libin Cardiovascular Institute


New recruit to Cumming School of Medicine’s Libin Cardiovascular Institute saves man’s life — twice

DoctorCoreyAdams,MD,returnedtotheUniversityofCalgaryonApril1asanewrecruitto the Cumming School of Medicine’s (CSM) Libin CardiovascularInstitute.Heearnedamaster’sdegreein‘04inkinesiologyatUCalgary,laterdiscovering his passion for heart surgery. He couldnotresisttheoffertocombinehispassions;performsurgery,conductresearchandteach,inacity that holds many fond memories for him.

“AfterfiveenjoyableyearsworkinginSt.John’s,N.L.,mywifeandIdecidedtolookfornewpersonalandprofessionalchallenges.Withtwoyoungchildren,hergynecologypractice,andmycardiacsurgerypracticeIwasreallylookingforalocationthatprovidedlong-termfamilystabilityandwascommittedtoprofessionalexcellenceandgrowth,”saysAdams,aclinicalassociateprofessorin the Department of Cardiac Sciences at the CSM.

“TheLibinInstitutehasanoutstandingreputation,andhavingknownseveralmembersofthesurgicaldivisionbefore,it’sexcitingtocomebacktoCalgary. Our boys love the sunshine and outdoor adventures.”

OnJune20,thefamilywentontheirfirsthikeatGrassiLakeTrail,nearCanmore.Astheyweredrivingawayfromthetrailhead,trafficstopped,andsomeoneyelled,“Amanisunconscious,andturningblue”.Adamsandhiswife,Jennifer,jumpedout of the vehicle to see if they could help.

JustoffthetraillayDarrellParker,whowasalsoonahikewithhisfamily,unconsciousafterhavingaheartattack.Anotherhikerhadjuststartedcardiopulmonaryresuscitation(CPR).TheAdamsesassisteduntilfirefightersandparamedicsarrived.

“Collectively,severalofusbeganaco-ordinatedresuscitation.AsacardiacsurgeonIworkdailywithteamswhoareexpertsatrevivingpatients;however,itwastrulyspecialtoworkinthefield

withparamedics,firemen,andmywifetorespondtothisemergency,”saysAdams.“IreallyfeelthecollectiveteamworkofthisgroupsavedDarrell’slife.It’sanexampleofknowingtheimportanceofCPR,andremainingcalm.”

TheambulancesetofffortheCanmoreGeneralHospital;however,Adams’sconnectiontotheParkerfamilywouldnotendthere.Duetosevereblockagesinhisheart,doctorstransferredhimtothe Foothills Medical Centre (FMC) for surgery. The FMC team learned that Adams had been the one whoperformedCPRandthoughtwhobettertoperformtheoperationthanthedoctorwhohadalreadysavedthe60-year-old’slife.

“Wecouldn’tbelieveourluck.ThesamedoctorwhohappenedtobeonthetrailthatdayatthesametimeDarrellhadhisheartattackwasalsogoingtobeoursurgeon,”saysShirleyParker,Darrell’swife.“Itwasamazing.”

TheParkershadtravelledtoCanmorefromParadiseHill,Sask.,justacrosstheAlbertaborder,forahikingtripwiththeirson,Travis,andhiswife,Seanna.

Darrell Parker and his wife

https://cumming.ucalgary.ca/

https://libin.ucalgary.ca/


https://libin.ucalgary.ca/departments/cardiac-sciences


“Iworkintheoilfield,I’mveryactiveandhavealwaysconsideredmyselfveryhealthy.Ihadnoideawhatpoorconditionmyheartwasin,”saysParker,afterhavingfivebypassestoimprovebloodflowtohisheart,ninedaysafterhisheartattack.

AccordingtoHeartandStroke,therearenearly60,000hospitalizationsayearforheartattackinCanada.

“Withoutquestionthiseventwillbeahighlightofmycareer.Ashealth-caremembers,weoftentakesomeofthethingswedoasjustpartofthejob.ButaftertalkingwithDarrellandhisfamily,itstressestheimportantrolethatwecanmakeinpeople’slives,”saysAdams.

Parkerislookingforwardtoreturningtoworkinaboutthreemonths.Heplanstostartwalkingregularly,andmaybeevengohikingagain.Meanwhile,Adamssayshisfamilyislookingforwardtomanymoretripstothemountains—butitislikelygoingtobetheirveryfirstAlbertahike,atGrassiLakesTrail,thatistalkedaboutandremembered the longest.

By Kelly Johnston, Cumming School of Medicine

https://www.heartandstroke.ca/heart


Living with the LVAD - A valuable exchange for a better life

ItisindeedfiveyearsagoonFeb.10,2015thatIstartedlivingwiththeVAD,amajormilestoneinmylife,whichhasbecomemysecondbirthday.Thiswasagreatopportunity,andIamthankful,gratefulandblessedtobealive,celebratingabetterlifewithmywonderfulfamily,lovedonesand friends. The journey had been great and exciting,albeitwithcertainlysomeupsanddowns.

IrecallwakinguptotherealityattheendofJanuary2015,followingaverysuccessfulyear,presentingtoaglobalaudience,teaching,workingonprojects,vacationingwithmyfamilyandcelebratingour25thanniversarywithmywonderfulwifeDaphne.

Itallstartedwithafeelingoffatigue,breathlessness,lossofappetiteandswollenankles.IchosetosufferinsilenceandtriedhidingtheseobservationsfrommywifeuntilthenightofJanuary28,2015afteralongdayattendingmeetingsupto8pm.00PM.

Onarrivingathome,Icouldnotclimbthestairs.IfinallygaveupandtoldmywifethatIneedtogothehospitalthenextmorning.Mywifehearingthatfromherhusbandforthefirsttimein25years,immediatelywentupstairs,ensuredthekidswereinbedandinsistedthatwecheckintoemergency at the Peter Lougheed that same night. Thisprovedtobeastepintherightdirectionasthemedicalteamstartedworkingimmediatelytostabilizeme.MyfamilywasinformedthatIwasinsuchbadshapewithbarely48to72hourstolive.

Thefollowingweek,IwastransferredtotheFoothillsMedicalCentrewhereIwasdiagnosedwithadvancedendstageheartfailure.TheamazingpersonnelattheLibinCardiovascularInstitutestartedworkingonmycaserightawaytoturnthingsaroundforthebetter.Dr.DebraIsaacwhilstworkingfranticallyonmycasesaidthistomywife,–“‘Weareheretogivelife......”.’.Aftertreatment

foraboutaweek,IfeltbetterthanIcouldrecallfordecadesinmylife.IwasnowhopingthatitwastimeformetobedischargedsothatIcouldnowjoinmyfamilyagainandcarryonwithmylife,whenIwaspresentedwiththeoptionofsurgeryfortheimplantationoftheVAD.

Thisdecisionwasdefinitelynotreceivedverywellanditturnedouttobemygreatest‘CHAlleNGE’ever.Asyouwillprobablynotice,theword‘CHANGE’isembeddedinCHALLENGE.Fortheveryfirsttime,Ihadafeelingofvulnerability,‘shock-prised’forthelackofabetterword,havinglivedahealthylifestyleallthroughoutmylife.Iwasnowleftwithnoalternativebuttofacethisinevitablechange.

ItstartedoffwiththeDENIALphase.IremembermysurgeonDr.PaulFedak,MD,PhD,standingbymybedside,introducinghimselfandwalkingmethrough the procedure for the surgery. I heard himsayatonepointthat“‘Wewillbreakyourbreastbone.”....’.Thisdidnotsoundrighttomeatthetime,goingthroughmydenialphase.However,Igottorealizelaterthatprobablytherewasn’tabetterwaytohaveputthisacross.

OnthemorningofTuesday,Feb.10,2015whenIwaswheeledtotheoperatingroom.Mysurgeondidanamazingjobandtoldmywifeafterwardsthattherewerenoissuesduringmysurgeryandwasquitepleased.Hewentonfurthertosay,that“yourhusbandwasthekindofpatientIliketoworkon.”IwokeupintheICUandwasn’tfeelinganypain,hopingthattheVADwasnotimplantedafterall.

This feeling of false hope did not last for too long,whenIsuddenlyheardthealarmbeepingneedingareplacementofthebatteries.Now,thedenialstagewasfadingawayfastanditwastimetoaccept.Duringthatperiodoftransition,Iwasunnecessarilymeantotheamazingstaff


attheCVICU(Unit94),physiotherapistsandVADteamwhoremainedveryprofessionalandunderstanding,exercisingalotofpatience.ThecriticalcaredoctorsincludingDr.TomasGodinezandalltheothermedicalpersonnelworkedhardandeventuallyIwasnowmovedtoUnit91.

IquicklymovedfullytotheacceptancestagebeingaloneinmyroominUnit91.ThispresentedmewithasereneenvironmenttoreflectonmylifeandtherecenthappeningsthatwhichIwasstilltryingtograpplewith.ItbroughtwithitsomemajorchangesandIgraduallystartedshowingappreciationforthemedicalpersonnel.

IwasdischargedinMarch2015andstartedtolearnhowtolivewiththeVAD,especiallythealarms–batteryreplacement,lowflow(byfarthemostirritatingtoneintheworldandcannot

beignored).Theonce-a-weekshowerswasalsosomethingnewtome.Icouldn’tgobacktoplayingmyfast-paced,stressrelievingsports-squash.ThereweremanytimeswhenIgetupfrommybedorachairforgettingthatIhadthisamazingpieceoftechnologyattachedtome.Iwasalwaysgentlyreminded by the sudden pull of the driveline on my abdomen.

Throughoutthistimemyfamilywasveryhelpfulandsupportive,astheyacceptedtheir‘bionic’husbandanddad.Itwasunbelievablethatwithinamonthafterdischarging,Ireturnedtomyjob,workingfromhomeandteachingmyfirstcourseatMountRoyalUniversityfortwo(2)-8eighthourdaysonmylegsthewholetime.AnotherchallengeIwasfacedwithwastryingtobeasdiscreteasIcould during my classes.


Havingthecontrollerandbatteriesinafannypackinitiallylookedlikeagreatidea,untilastudenthadthiscommentintheevaluationfollowingone of my Leadership classes at the University of Calgary.Thecommentwas“‘HowcanwetakeCliftonasaseriousleaderifheisalwayscarryingafannypack?’”.Thiswashilariousandseriousatthesametime.IsharedthiswithJillRoy,myVADCoordinatorwhosuggestedthatIshouldtellthemmy story.

I reluctantly shared my story in the next course usingthedifferentstagesofchange(denialandacceptance),whilstteachingamoduleonthe‘Leader and Change.’. It turned out to be a story verywellreceivedandthestudentsgottorealizehowvulnerableonecouldbe.

ThisexperiencemadememorecreativeinmyattemptsatbeingdiscreteandithadbeeninterestinglookingatalltheoptionsIhavetried.TherewereacoupleofothermomentsonthelightersidewhichIwouldliketoshare.Iwasapproachedatthegymandtherewassomeonewhowascuriousenoughtoaskwhatisallthe‘stuff’Ihavestrappedaroundmywaist?.Ididnot even hesitate to respond that it is a personal stereo system.

Iwentonfurthertoexplainthatthecontrollerwasthesystemwhichhasabuilt-inharddrivetostorethemusicandamplifier,withthebatteriesasthespeakers.Thissoundedveryinterestingandthisindividual believed every bit of it before I could evensayexactlywhatitis.Itwassurprisingtomecoming across so many personnel in the hospitals andclinics,thecountlesstimestheywouldaskthatItakeoffmyvaluableattachmentbeforesteppingonthescaletogetmyweight.Iamcertaintheywouldnothavelovedtoseethathappen.

TheVADasapartofmeforthepastfive(5)years,has no doubt being a valuable exchange for a betterlife.Thisequipmentandespeciallythepumphasbeenrunningforjustunder160millionseconds.WiththisIhavefullyreturnedtoabetterlifephysicallyandmentally.Istillteachmytwo2-day marathon courses at the university and also managedmulti-milliondollarprojectssince2018.

Iwouldliketotakethisopportunitytoexpressmysincerethanksandappreciationtothemedical personnel at the Libin Cardiovascular InstituteFMC,theVADteam,Unit94,Unit91,physiotherapistsandsocialworker.Withouttheirgreatsupport,advice,patienceandprofessionalism,Iwouldn’tbecelebratingthismajor milestone.

By Clifton Thornton


Nurse practitioner-led cardiac unit amongst first in Canada

Thereweresomeexcitingchangestothemedicalcardiologycoronarycareunit(CCU)atCalgary’sRockyViewGeneral(RGH)hospitalin2019.

OnFebruary1,2019,theseven-bedunit,whichtreatspatientsadmittedwithheartproblems,becameoneofthefirstinCanadatobeledbynursepractitioners,health-careleaderswithadvancedtraininginnursing.

NursepractitionerNancyClarke,whospearheadedtheinitiativeandisnowtheclinicnursepractitionerleadfortheclinic,saysthemodelprovidesconsistentcareforpatients,asthereisnowadedicatedteamofprofessionalsonhandwithadvancedknowledgeincardiology and the ability to diagnose and prescribe medication.

“Wearethefirstinlinetoconsultwiththeemergencyroomoncardiologymatters,”shesays.“Weareavailableforallhours,coveringallshifts.Weseeallpatients.”

RockyView’scardiologyprogramisoneofthebusiestinCalgary.Thehospitalhasa35-bedcardiologywardandseven-bedCCU.Priortothechange,itoperatedlikemostacrossthecountry,althoughitdidhavesupportfromnursepractitioners,includingClarke.

Butwhenthenursepractitionersweren’tonshift,theunitwasdependentonextendersandclinicalassistants to cover the load. These clinicians came andwent,coveringshiftsinhospitalsaroundthecity.AccordingtoTeresaThurber,theexecutivedirectorofcriticalcareandwomen’shealthatRGH,althoughcarewasexcellent,itwasdifficulttoensuretherewasconsistencyandaround-the-clockexpertiseforpatients.Thisnewmodelhassolvedtheseissues.Eightnursepractitionerswithspecializedtrainingincardiologylookaftertheunit.Thereisalwaysone,andoftentwo,ofthesehighlyeducatedprofessionalsonduty.

Theyworkinconjunctionwithaconsultingcardiologisttoensurethecriticallyillpatientshavewhattheyneed.Theseprofessionalsareresponsibleforthefirstlineof

care in the unit doing everything from assessments and urgentbedsideconsultstodiagnosticsandtreatments.

Thenursepractitionersarealsothefirstpointofcontactbetweentheemergencydepartmentandtheunit and provide cardiology consults for the emergency team.

“Thiscreatesconsistencyandcontinuityincoverage,”saysThurber,notingdespitethefactthatthesupportingcardiologistontheunitchangesweekly,therearenowprofessionalsinplacewho“knowthepatientsreallywell.”

Thurbersaysalthoughdataispreliminary,sheexpectsittoshowthatpatientsarehavingbetterexperiencesandoutcomeswithintheunit.Sheisconfidenttherewillbeareductioninlengthofstayandreadmissionratesforpatients.Thurberisimpressedwiththenursepractitioners’commitmentandpassiontothemodel.

“Wehaveanexceptionallywonderfulgroup,”shesays.“Whenwetalkaboutputtingourpatientsfirst,theseprovidersaretrulycommittedtodoingthat.TheyfollowtheirpatientsfromtheemergencydepartmenttoCCUorthewardandevenintothecommunity.”

Dr.NakulSharma,whohasworkedalongsidethenursepractitionersasthelead

By Dawn Smith/Libin Institute

The nurse practitioner led team at Rocky View General's medical cardiology coronary care unit


Researchers receive $3M CIHR grant to conduct trials co-designed with patients

Randomizedclinicaltrialsarewidelyconsideredthemostrobustformofevidencewhenitcomestomedicalresearch.Theultimategoalisdesigningtrials that advance science and address issues importanttopatients.Itrequirescliniciansandscientiststoincludepatientadvisorsintheprocess.

ResearcherswithintheLibinCardiovascularInstituteattheUniversityofCalgary’sCummingSchoolofMedicine(CSM)receiveda$3milliongrantfromtheCanadianInstitutesforHealthResearch(CIHR)toconductthreeinnovative,patient-orientedtrials–sciencethatcaninformhealthcareandmedicalpracticeswhileaddressingissuesthatmattertopeoplelivingwithchronicillness.Thesetrialsuseclinicalregistries,existingsurveys and electronic health record systems to recruitpatientsandcollectdatamoreefficientlythantraditionalrandomizedtrials.

“Weworkedwithpatientstoidentifyresearchprojectsthatarepracticalandaddresstheconcerns they have about improving their quality oflife,andinteractionswiththehealthcaresystem,”saysDr.MatthewJames,MD,PhD,akidneydoctor,associateprofessorattheCSMandoneoftheleadresearchers.“Ourfindingswillberelevanttopatientsandthehealth-carecommunity.”

Overthenextfouryears,theteamplanstotesthealthinnovationsandinterventionsthataimtoimprovecare,safetyandoutcomesforpeoplewiththreecommonandcloselyrelatedchronicdiseases:heartdisease,diabetesandkidneydisease.

Thesestudieswillfocuson:thewaypatients’symptomsandexperiencesarerecorded,communicated,andacteduponduringdoctors’visits,andwhetherthesechangesimprovepatientoutcomesandexperiences;theimpactofusingelectronichealthrecordsystemsonpatients’

experiencesandoutcomesinvarioussettingsacrossAlberta;and,strategiesusingpharmaciststoimprovesafetyinusingcommonmedicationsduringtimesofillness.

WinniePearsonhasbeenacardiacpatientfor30years,andisatrainedpatient-researcherandpatient-advisorwithintheprovince’sStrategicClinicalNetworksandtheLibinInstitute.Shebelievespatientslikeherselfcanhelpresearchersand physicians improve Alberta’s health care system.

“Involvingpatientsinchoosingwhattoresearchandhowtoresearchmeanswelearnhowtocorrectmistakesanddothingsbetterthanwedidbefore,”shesays.“Patientexperiencescanrevealalot,bothgoodandbad.”

Atage73,PearsonregisteredatUCalgarytogaintheeducationrequiredtohelpdesignscientificstudies.Shesaysbeinginvolvedinthisworkhasbeenrewarding,especiallyinrecentyears,whenpatient-orientedresearchhastakenoff.

“Iamvery,verypleasedandhonouredthatIamabletobepartofthisresearch,”shesays.

The researchers are part of the Interdisciplinary ChronicDiseaseCollaboration,amulti-discipline,multi-siteteammadeupofhealth-careleaders,researchers,patientsandcareproviderswhohaveunitedtoaddresskeychallengesinchronicdiseasecare.

By Dawn Smith/Libin Institute

“Patient experiences can reveal a lot, both good and bad.” - Winnie Pearson, patient advisor

http://www.ICDC.ca

http://www.ICDC.ca


The CV & Me Women’s Cardiovascular Health ProgramwithintheLibinCardiovascularInstituteattheUniversityofCalgarysupportsthe conduct of novel cardiovascular research thatimpactspatients,trainsfuturescientistsandleadsinstitutionsinincorporatingsexandgenderconsiderationsintoresearchandcare.

Ourworkspanssex(biologicalattributes)andgender(sociallyconstructedroles,behaviors,expressions,identities)considerationsincardiovascularresearchandpatientcare.

InthefirstsixmonthsoftheInitiative,CV&Mehas executed three community engagement eventsfeaturinginternationallyrecognizedexpertsinsexandgenderdifferencesincardiovascularhealth,reachingnearly700peopleinthecommunity.Additionally,theinitiativehostedanInternationalTraineeSymposium:ResearchisBetterwithSexandGender,where75traineesfromacrossCanada and the Netherlands came together to learnhowtobetterintegratesexandgenderconsiderationsintheirresearchmovingforward.

Members of CV & Me pose with UCalgary President Dr. Ed McCauley (far left) after receiving th University of Calgary Equity, Diversity and Inclusion Team award.

https://libin.ucalgary.ca/cv-me

https://libin.ucalgary.ca/cv-me


New cell discovered that can heal hearts

University of Calgary researchers are the first to discover a previously unidentified cell population in the pericardial fluid found inside the sac around the heart. The discovery could leadtonewtreatmentsforpatientswithinjuredhearts.ThestudyledbyDrs.PaulKubes,PhD,JustinDeniset,PhD,andPaulFedak,MD,PhD,is published this month in the internationally recognizedjournalImmunity.

TheKubeslab,incollaborationwiththeFedaklab,foundthataspecificcell,aGata6+pericardialcavitymacrophage,helpshealaninjuredheartinmice.Thecellwasdiscoveredin the pericardial fluid (sac around the heart) of amousewithheartinjury.WorkingwithFedak,a cardiac surgeon and incoming director of theLibinCardiovascularInstituteofAlberta,thesamecellswerealsofoundwithinthehumanpericardiumofpeoplewithinjuredhearts,confirming that the repair cells offer the promise ofanewtherapyforpatientswithheartdisease.

Photoabove:Clinician-scientistPaulFedak,left,withimmunologyresearchersPaulKubesandJustinDeniset.PhotobyAdrianShellard,fortheCumming School of Medicine

“ThefuelthatpoweredthisstudyisthefundingfromtheHeartandStrokeFoundationofCanada,thecollaborationbetweentwomajorresearch institutes at CSM (Snyder and Libin) and the important contribution of philanthropy from the Libin and Snyder families to obtain imaging equipmentavailabletoveryfewprogramsglobally,”saysKubes,thedirectoroftheSnyderInstitute for Chronic Diseases at the Cumming School of Medicine (CSM) and professor in the Department of Physiology and Pharmacology.

Heart doctors had never before explored the possibility that cells just outside the heart could participate in healing and repair of hearts after injury.Unlikeotherorgans,thehearthasavery

limitedcapacitytorepairitself,whichiswhyheart disease is the number one cause of death in North America.

“Ourdiscoveryofanewcellthatcanhelphealinjuredheartmusclewillopenthedoortonewtherapies and hope for the millions of people whosufferfromheartdisease.Wealwaysknewthattheheartsitsinsideasacfilledwithastrangefluid.Nowweknowthatthispericardialfluidisrichwithhealingcells.Thesecellsmayhold the secret to repair and regeneration of newheartmuscle.Thepossibilitiesforfurtherdiscoveryandinnovativenewtherapiesareexcitingandimportant,”saysFedak,aprofessorin the Department of Cardiac Sciences.

Workingtogetherandbringingexpertiseacrossdisciplines,thebasicresearchersworkingwiththecardiacsurgeon,clinicianresearcher,haveidentifiedthecellinlessthanthreeyears—arelativelyquicktimeframetomoveresearchfrom the lab and animal models to people.

JustinDeniset,whoisthefirstauthoronthisstudy,hasworkedonthisresearchsinceit

Justin Deniset uses live imaging microscopy to watch the cell as it travels through the heart. By Adrian Shellard, for the Cumming School of Medicine


https://snyder.ucalgary.ca/

https://snyder.ucalgary.ca/


began.“Thisprojectstemmedfromwantingto integrate my previous research training in cardiovasculardiseasewithmycurrentfocusontheimmunesystemwithintheKubeslaboratory. The diverse expertise in both areas combinedwiththestate-of-artinfrastructurewehave here at the Cumming School of Medicine madeittheidealsettingtoundertakesuchanendeavour.CollaboratingwithaclinicianscientistsuchasDr.Fedakprovidedadifferentperspective to our research questions and enhancedtheimpactofourwork.Thistypeofpartnershipalsopavesthewaytoexplorehowto translate our findings from the bench to the clinic,whichisultimatelyourgoal,”hesays.

NextFedakhopestorecruitabasicscientisttomove the research to a broader study of human heartrepair.Thisnewprogramwillextendthecollaborationbetweenbasicandclinicalresearchtofindpotentialnewtherapeuticstoimproveheart repair.

Philanthropy fuels advances in research BoththeKubesandFedaklabshaveasolidfoundation of support from some of UCalgary’s

mostgenerousphilanthropicpartners,includingtheSnyder,LibinandCampbellfamilies,whosecontributionsovertheyearshaveallowedtheresearchers to bring in cutting-edge technology andtalentedtraineestoadvancetheirworkandmakeaglobalimpactinhealthoutcomes.

“Theresultsarespectacular—afundamentalscientificdiscoverywithenormousclinicalrelevance. It highlights that supporting any part of the CSM enterprise can result in a significant impactinwaysyoumaynotexpect,”saysFedak.“Iamthankfulforthesupportofthesefamiliesforstrengtheningmylaboratoryandallowingmetosuccessfullycollaboratewithaworld-classscientist from the Snyder Institute. We may have inventedanewfieldofresearch—immuno-cardiology!”

This research is supported by the Heart and StrokeFoundationofCanada,theCanadianInstitutesofHealthResearch,theCanadaResearchChairsProgram,theNationalInstitutesof Health.

By Jordanna Heller and Steve Macfarlane, Cumming School of Medicine

Dr. Paul Fedak, Dr. Paul Kubes and Dr. Justin Deniset pose in front of a screen showing the hearts of animal models.


Appendix B

Cardiac Sciences Grand Rounds Speakers

SPEAKER ORIGIN TITLE

Iain Parsons SouthLondonDeanery,Major–BritishArmy

SyncopeintheUKArmedForces

Jacob A. Udell University of Toronto Influenza,RespiratoryInfectionsand Cardiovascular Outcomes - NewEvidenceandRoleofVaccination

Shelley Zieroth University of Manitoba HarnessingSocialMedia:HowTwittermaybeanefficienttoolfor#WIC,knowledgetranslation,collaborationandacademicpromotioninCardiovascularMedicine

KevinBuscheandSarahWeeks University of Calgary Mistreatment in Medical Education-TeachingwiththeMind and the Heart

Andre Diedrich Vanderbilt University

Nashville,TN Postural Tachycardia Syndrome - Neuropathic or Hyperadrenergic

RajatSharma UniversityofBritishColumbia ImprovingoutcomesafterIn-hospital cardiac arrest

Benjamin Hibbert UniversityofOttawa Experimental Medicine in InterventionalCardiology:ClosingtheTranslationGap

RoopinderSandhu University of Alberta MeasuringtheQualityofCareforAtrialFibrillationinCanada:Arewedoingagoodjob?

MarkChandy Stanford University Geneandenvironmentalinteractionsincardiovasculardisease

Meena Madhur VanderbiltInstituteforInfection,Immunology,andInflammation

Hypertension:What'sYourGoal?


JonathanHowlett University of Calgary TheRoleofMiniAVRinanEvolving TAVI World

RahulPotluri AstonMedicalSchool,UnitedKingdom

Big data in Cardiology: Current applicationsandRoadmaptothefuture

RobertCaliff DukeHealth GeneratingandDisseminatingthe Evidence to Improve Cardiovascular Health

Residents University of Calgary Christmas Jeopardy

Carlos Morillo University of Calgary Cardiology2019inReview

Blandine Mondesert Université de Montréal Cardiac Implanted Electronic Devices and Tranvenous Lead ExtractioninAdultCongenitalHeartDiseasepatients

Maria Jose Santana University of Calgary TheRoleofPatient-reportedOutcomes and Experiences in Health and Health Care

AnitaY.M.Chan Toronto Cardiac Amyloidosis: The Unique RoleofNuclearCardiology

BrianClarkee University of Calgary Remotemonitoringinheartfailure:possibilities,pitfalls,andpatientperspectives

Amy B. Bromley University of Calgary NavigatingCareAfterDeathinCalgary

PiotrSlomka Cedars Sinai Translatingartificialintelligencedevelopments into clinical practiceofcardiovascularimaging

RenatoLopes DukeUniversity TreatingpatientswithAFandPCI:Wheredowestandin2020?

Marc Deyell UniversityofBritishColumbia TheLowlyPVC:ImplicationsandTreatmentin2020

GlenSumner University of Calgary AlignmentofIncentiveswithHealth Outcomes: The Future of Physician Payment



Eliano Navarese NicolausCopernicusUniversity,Bydgoszcz,Poland

EvidenceonPCSK9Inhibitorsinhigh-riskpatients

Jagat Narula Mount Sinai Canweeliminatecoronarydiseaseinourlifetime?

Daniel Malebranche BernFreiburgstrasseBern,Switzerland

Oneanddone?EvaluatingpatternsofLVassessmentinpatientswithAcuteCoronarySyndromes: ACS Choosing Wisely

AyaazK.Sachedina University of Texas TheGoldilocksConundrum:Finding the mechanical support device that's "just right"


CARDIAC

SURGERY

PRIMARY

CATEGORY

BYTHE

NUMBERS

A pattern of growth

CARDIAC SURGERY PRIMARY CATEGORY

964...--+

_ _.975

723 734

•• 123

125

110

99

94

lifrf 351

346 347

295

l❖:MI 260

204

FY2015 FY2016 FY2017 FY2018 FY2019

INCREASE

OVER THE PAST

5YEARS

35%

-15%

11%

7%

FY2019/2020

•••

ECMO INSERTION

29

•••

VENTRICULAR ASSIST DEVICE

(VA□)

14


CARDIAC

SURGERY

BYTHE

NUMBERS

A pattern of growth

CARDIAC SURGERIES PERFORMED

1900

1850

1800

1750

1700

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1600

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I I

I I

I I

I I

I I

I I

I I

I

1,419

FY2016

I I

I I

I I

I I

I I

I I

I I

I I

FY2017

I

I

INCREASE

OVER THE PAST

5YEARS

25%

.. 1,799 1,B.12 __ _.._.,,,

I I

I I

I I

I I

I I

I I

I I

I I

I I

I I

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FY2018 FY2019

FY2019/2020

***

SURGERIES

PERFORMED

1,802 Cardiovascular

surgeries performed.

including coronary artery bypass grafting aortic

valve repair. mitral valve repair. etc.

***

NEW SURGERY

REFERRALS

2,505 INCREASE OVER

THE PAST 5 YEARS

38%

***


CARDIAC

SURGERY

PRIORITY

BYTHE

NUMBERS

A pattern of growth

CARDIAC SURGERY PRORITIES

Emergent Salvage

1100

1000

900

800

700

� Q) "' 5

(/) 600 0 0 z

500

400

300

200

100

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Annual Report 2019-20 Cardiac Science

Research (RE)38%

Teaching9%

Clinical34%

Admin19%

Cardiac Science

Research (RE)41%

Teaching11%

Clinical32%

Admin16%

Clinical with AARP

2015-16 2016-17 2017-18 2018-19 2019-20 2020-21

CSM

Basic Sciences

Clinical w/out AARP

Clinical w. AARP

181919201719

220218215225222221

162165161157157153

142143141136129126

526526517518508500

ANNUAL FTEs

2015-16 2016-17 2017-18 2018-19 2019-20 2020-21

CSM

Basic Sciences

Clinical with AARP

Clinical wout AARP

6.98.08.17.96.37.3

56.559.257.152.352.551.2

87.289.986.483.881.081.5

80.681.479.672.967.966.8

225.0230.5223.1209.0201.4199.6

ANNUAL REs

2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical w AARP

Clinical w/out AARP

$8.9M$8.3M$9.5M$7.8M$8.8M

$36.4M$34.5M$30.1M$27.6M$24.2M

$66.0M$76.8M$70.1M$62.9M$65.6M

$62.3M$59.7M$52.3M$41.6M$43.7M

$213.8M$213.4M$198.3M$164.0M$167.1M

TOTAL RESEARCH REVENUE2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical with AARP

Clinical without AARP

$1.12M$1.02M$1.20M$1.25M$1.21M

$0.61M$0.60M$0.58M$0.53M$0.47M

$0.73M$0.89M$0.84M$0.78M$0.80M

$0.76M$0.75M$0.72M$0.61M$0.65M

$0.93M$0.96M$0.95M$0.81M$0.84M

RESEARCH REVENUE PER RE

2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical w AARP

Clinical w/out AARP

$0.89M$1.41M$1.07M$1.00M$1.40M

$11.0M$8.3M$7.2M$5.2M$3.3M

$16.3M$19.0M$14.9M$13.1M$12.5M

$19.4M$18.1M$16.6M$14.6M$14.6M

$46.7M$45.3M$38.7M$33.0M$30.4M

TOTAL CIHR REVENUE2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical with AARP


$0.11M$0.17M$0.14M$0.16M$0.19M

$0.19M$0.15M$0.14M$0.10M$0.06M

$0.18M$0.22M$0.18M$0.16M$0.15M

$0.24M$0.23M$0.23M$0.22M$0.22M

$0.20M$0.20M$0.19M$0.16M$0.15M

CIHR REVENUE PER RE

2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical w AARP

Clinical w/out AARP

$4.97M$4.72M$5.73M$4.59M$2.00M

$11.7M$14.2M$13.7M$16.9M$3.9M

$30.8M$45.2M$44.3M$34.9M$16.1M

$4.6M$6.7M$8.8M$6.7M$1.8M

$47.9M$67.3M$68.0M$58.9M$23.2M

TOTAL CLINICAL RESEARCH REVENUE2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical with AARP


$0.62M$0.58M$0.72M$0.73M$0.28M

$0.20M$0.25M$0.26M$0.32M$0.08M

$0.34M$0.52M$0.53M$0.43M$0.20M

$0.06M$0.08M$0.12M$0.10M$0.03M

$0.21M$0.30M$0.33M$0.29M$0.12M

CLINICAL RESEARCH REVENUE PER RE

2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical with AARP

Clinical w/out AARP

RSF Cardiac Science $0.14M$0.15M$0.17M$0.16M$0.14M

$1.18M$1.02M$0.87M$0.75M$0.62M

$2.18M$2.06M$1.92M$1.69M$1.40M

$2.97M$2.93M$3.04M$3.10M$2.89M

$6.34M$6.04M$5.85M$5.56M$4.92M

RESEARCH SUPPORT FUND2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical with AARP

Clinical w/out AARP

SUM([RSF Cardiac Scie.. $17.8K$18.0K$20.9K$26.0K$19.8K

$19.9K$18.5K$17.2K$14.6K$12.4K

$39.9K$39.2K$37.4K$33.5K$27.5K

$36,421$36,844$41,632$45,710$43,200

$32.5K$32.2K$33.4K$32.8K$29.3K

RESEARCH SUPPORT FUND per RE

1.1

²

³

⁴

⁵

⁶

Cardiac Science

Cardiac Science

Cardiac Science

Cardiac Science

Cardiac Science Cardiac Science

Cardiac Science

Cardiac Science

4.1

5.1

6.1

3.1

3.1

Cardiac Science

Cardiac Science

14 14.1


NOTES and Definitions

Year 2020-21Snapshot of Faculty Counts, as of June 30 2020. This is the definition used by HR Systems and Reporting and the OIA Fact Books.

FTEsFull-time Academic Staff with Ranks of Professor, Associate Professor or Assistant Professor, Instructor, Senior Instructor, as of June 30of the previous year (e.g. 2020 FTEs are as of June 30 2019)Department Groups Defined as Follows:a) Basic Sciences (Biochemistry & Molecular Biology, Cell Biology & Anatomy, Community Health Sciences, Microbiology Immunology &Infectious Diseases, Physiology & Pharmacology)b) Clinical with AARP (Cardiac Sciences, Clinical Neurosciences, Family Medicine, Medicine, Paediatrics)c) Clinical without AARP (Anaesthesia, Critical Care Medicine, Emergency Medicine, Medical Genetics, Obstetrics & Gynaecology,Oncology, Pathology & Laboratory Medicine, Psychiatry, Radiology, Surgery)

Source:Annual Factbook by the UCalgary Office of Institutional Analysis

REsAverage Research Time Allocation, divided by 100 and multiplied by the number of FTE faculty (see Note 2).Note: To account for CSM Academic Staff members with no time allocations reported in the ARO, the previous year's time allocation isused. If the previous year's time allocation is also blank, then the department average is assigned.

Source:Academic Report Online

Total Research Revenue Annual Research Revenue for Projects assigned to CSM- Revenue is assigned to a Department/Comparator Group based on the Project Department.- CSM total includes Project Departments not part of the 20 CSM Departments (e.g. Dean's Department - Operations)* Of the ~$34 million dollar increase in CSM Research Revenue from 2016-17 to 2017-18, ~$21.5 million is grant revenue and ~$10.5 millionis donation related.

Source:Enterprise Reporting\Research & Trust Accounting datamart

CIHR RevenueResearch revenue export (see Note 4), where:IF Account Description = ("CIHR Grants" OR "CIHR Authorized Transfers")

ORTri-Council Source = "CIHR" AND Account Description ("CIHR Grants" OR "CIHR Authorized Transfers")

Clinical Research RevenueResearch revenue export (see Note 4), where" Purpose of Funds = "Clinical Trials" OR "Clinical Research"- In 2016-17, all revenue assigned to projects involving 'Grant Sponsored Clinical Trials' was classified as 'Clinical Research'. In 2015-16,only 47% of revenue assigned to projects involving 'Grant Sponsored Clinical Trials' was classified as 'Clinical Research'. This led to a largeincrease in 'Clinical Research' revenue in 2016-17 from 2015-16

5.1 CIHR Revenue per REAnnual CIHR Research Revenue (See note 5) divided by the number of Research Equivalents in the same year (See note 3)* For the CSM Total, CIHR Revenue assigned to Project Departments not part of the 20 CSM Departments is excluded (e.g. Dean'sDepartment - Operations revenue is excluded)

3.1

Research Revenue per REAnnual Research Revenue (See note 4) divided by the number of Research Equivalents in the same year (See note 3)* For the CSM Total, Revenue assigned to Project Departments not part of the 20 CSM Departments is excluded (e.g. Dean's Department -Operations revenue is excluded)

1.1

2

3

4

5

6

Time AllocationAverage Time Allocation (as reported in ARO) for FTE faculty (see Note 2).Note: To account for CSM Academic Staff members with no time allocations reported in the ARO, the previous year's time allocation isused. If the previous year's time allocation is also blank, then the department average is assigned.

Source:Academic Report Online

4.1

1201920 Cardiac Science Annual ReportThis is the Department annual report, where Citations for 2019 have only been added for Cardiac Science. The rest of CSM will beadded on a later date.


2015-19 FTE BIBLIOMETRICS Cardiac Science

2015-16 2016-17 2017-18 2018-19 2019-200.0K

0.5K

1.0K

1.5K

2.0K

CSM


Clinical with AARP

Basic Sciences

78 68 107 108 107

PUBLICATIONS2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical with AARP


5.65.75.44.04.1

4.94.53.83.83.6

5.45.04.84.54.2

4.34.14.14.04.2

4.34.13.83.63.5

PUBLICATIONS PER FTE

2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Science

Clinical w AARP

Clinical wout AARP

13.413.313.510.810.8

13.612.711.411.310.7

13.012.513.012.211.3

7.57.37.77.67.9

9.99.69.49.18.9

PUBLICATIONS PER RE

2015-16 2016-17 2017-18 2018-190K

50K

100K


Clinical with AARP

CSM

Basic Sciences

ANNUAL CITATIONS

0 2 3 4 5 6 7 9 10-12 13-15 15-20

# PUBLICATIONS BY 2019/20 FTE FACULTY IN 2019

2015-16 2016-17 2017-18 2018-19 2019-20

CSM

Basic Sciences

Clinical with AARP


462439410362332

5217190198176

46348302280251

6325305276236

21267241225204

ANNUAL CITATIONS per FTE

2014-15 2015-16 2016-17 2017-18 2019-20

CSM

Basic Sciences


00000

00000

00000

00000

HOT PAPERS

2015-16 2016-17 2017-18 2018-19 2019-20

8

10

12

14 Clinical wout AARP

Clinical w AARP

Basic Science

CSM

Cardiac Science

PUBLICATIONS PER RE

⁷ ⁸

⁹

¹¹

¹² ¹³

Cardiac Science

Cardiac Science

Cardiac Science

Cardiac Science

⁹

1

25

2015-16 2016-17 2017-18 2018-19 2019-20

6.31K 6.16K 8.20K 8.34K 8.79K

ANNUAL CITATIONS ¹⁰


NOTES and Definitions Cont'd

10 CitationsThe number of times that unique publications by FTE Faculty of a given year have been cited in the same year(e.g. 2018-19 refers to the number of times unique papers published by 2018/19 FTE Faculty were cited in 2018)

- Only publications of Document Types "Article", "Review", "Editorial", "Case Report", "Clinical Trial" and "Book" are included;- Papers co-authored by more than 1 FTE faculty member will be counted once within the same Group.

Source:Web of Science; - CVs from Authors sent to Office of Faculty Analysis (OFA) in 2015-20

11 Citations per FTETotal citations in a year for all unique career publications by FTE faculty (see note 10) divided by the number of FTE Faculty in the sameyear (see note 3)

12 # of Publications by 2019-20 Faculty in 2019Histogram of the number of papers published by 2019-20 FTE Faculty in 2019

13 Immediate Impact PapersUnique publications cited > 49 times in a 5 year publication date window(e.g. For 2018-19, sum of unique publications published between 2014-18 by 2018/19 FTE Faculty that were cited in 2014-18 greater than49 times)

7 PublicationsThe number of unique papers published by FTE Faculty (see note 2) in the same publication year. (e.g. 2019-20 refers to the number ofunique papers published by 2019/20 FTE faculty in the 2019 publication year)

- Only publications of Document Types "Article", "Review", "Editorial", "Case Report", "Clinical Trial" and "Book" are included;- Papers co-authored by more than 1 FTE faculty member will be counted once within the same Group.

Source:Web of Science; - CV from Authors sent to Office of Faculty Analysis (OFA) in 2015-20

8 Publications per FTEAnnual number of Unique Publications (see note 7) divided by the number of FTEs in the same year (see note 2)

9 Annual Publications per RE- Annual number of unique Publications (see note 7) divided by the number of Research Equivalents in the same year (see note 3)

Clinical Revenue per REAnnual Clinical Research Revenue (See note 6) divided by the number of Research Equivalents in the same year (See note 3)* For the CSM Total, Revenue assigned to Project Departments not part of the 20 CSM Departments is excluded (e.g. Dean's Department -Operations revenue is excluded)

6.1

14

Research Support Fund

2016-20 UCalgary Research Support Fund Contribution(Portion of Credits) / (Total UCalgary Credits) * (Annual UCalgary RSF)

- RSF is credited to a Faculty/Department based on the the Primary Appointment of June 2020 UCalgary Faculty, or the oldest start dateof UCalgary Faculty who only have multiple Secondary Appointments

Background:In 2019-20 the University of Calgary was awarded a total of $13,581,364 in Research Support Funds. Research Support Funds (RSF) areawarded annually by the Tri-council Agencies to cover a portion of the indirect costs of research incurred by the University of Calgary (UC).The RSF amount awarded is based on the amount of CIHR/NSERC/SSHRC funding received by UC researchers. This dashboard showsthe total RSF dollars given to the University for grants awarded to the named researchers in comparison to the RSF generated by otherdepartment/institute researchers. The table shows the awarding Tri-Council Agency and what role the researcher has on the grant. Theinformation provided demonstrates that RSF earnings are generated for both the role of Principal Investigator and the role ofCo-Investigator and highlights the benefit of being included as Co-Investigators on grant applications where the PI is external to the UC(because of the RSF dollars that will flow to UC) as well as being selective about who to include as Co-Investigators (if Co-Investigators arefrom the UC, the associated RSF dollars will remain at the UC; if Co-Investigators are from other institutions, a portion of the RSF dollarsassociated with the grant will be shared with these institutions).

14.1Research Support Fund per RE

2016-20 Research Support Fund (see note 14) divided by the annual sum of Research Equivalents (see note 3)

cardiac sciences annual report 1 department of cardiac

Documents