Affairs of the Heart

Christa Hammons, 66, looks more like a candidate for an active living promo than a participant in a heart disease management study. This slim, energetic Whistler resident is an avid skier and hiker, but there’s no skirting the fact that heart disease runs in her family. Both of her parents died of heart attacks and her younger brother suffered a non fatal one not long ago. Christa herself has four stents in her chest to counteract blockages in her arteries.

Given her family history, you’d think Christa would be less than optimistic about her future, but you’d be wrong. She feels healthier than ever since participating in a study on the impact of a new virtual cardiac prevention and rehab program – a program that’s had a real impact on how Christa lives.

Christa is one of 74 rural heart patients from B.C.’s Sunshine Coast, Whistler and Northern regions who signed on for the research program in August 2009. The goal is to test the effectiveness of a home-based Internet alternative to cardiac rehab programs commonly offered at urban hospitals, but not available to rural patients who live too far away.

The lead on the study is internationally renowned B.C. heart disease researcher Dr. Scott Lear, whose work also includes several high-profile studies demonstrating the disparities in heart disease risk across different ethnic communities.

Now, after an international search, Lear is the inaugural holder of the Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research in the Providence Heart + Lung Institute at St. Paul’s Hospital, established in partnership with Simon Fraser University (SFU). The $4.6-million endowed chair allows Lear to ramp up his investigations into why people get heart disease and what they can do to prevent or manage it. The chair also ensures the benefits Christa has experienced will soon be available to many more heart patients.

United approach

The new chair – the first in Canada to focus on cardiovascular disease prevention rather than biomedical laboratory discoveries or clinical medicine – was made possible through donations from Pfizer Canada Inc., the Heart and Stroke Foundation of BC & Yukon, St. Paul’s Hospital Foundation and SFU (see Strength in Numbers).

“The fact that four very different organizations are involved sends a strong message about just how important this chair is,” says Dr. Bruce McManus, head of St. Paul’s Providence Heart + Lung Institute (HLI). “The position builds on a strong belief within HLI that prevention matters.”

McManus adds that the new chair is also in keeping with the legacy of St. Paul’s provincial Healthy Heart Program, created in 1995, which brought physicians and scientists together to turn cardiac prevention and management knowledge into treatment programs for clinics and communities: “It was out of this environment that the chair was spawned and it’s in this fertile environment that Dr. Lear will be working.”

Paper to practice

While final results on his virtual rehab study aren’t expected until spring 2011, the provincial government is already showing interest, says Lear. “It’s quite possible that before the end of 2011, we could have the necessary infrastructure in place to roll out a similar program provincewide.”

That will be good news for the thousands of heart patients in British Columbia who can’t easily access city-based cardiac rehab programs.

“It’s the people outside the urban areas whose disease rates are higher,” observes Lear. “In fact, rural patients with heart disease are 40 to 50-per-cent more likely than their urban counterparts to be admitted to hospital due to their condition.

“Through our research, we want to deliver care to those people who might not otherwise have access. We want to improve their quality of life, keep them out of hospital and reduce their future risk.”

Home based rehab

Lear has been interested in overcoming geographical obstacles to care delivery since doing his PhD in cardiac rehab at University of British Columbia (UBC) from 1996 to 2001. He helped develop a pilot study based on a website that mimicked proven hospital-based cardiac rehab programs. The results showed that virtual rehab is just as effective as hospital based therapy. In fact, participants’ exercise capacity (a key marker of heart health) improved by more than double that of a control group after 12 weeks, and their cholesterol, blood pressure and body-weight improvements were comparable to those of hospital-based program participants.

The current study involving Christa is much more extensive, with six times the number of participants and more follow-up to test sustainability. The 74 participants are divided into two groups: one group is part of the virtual rehab program; the other is participating in usual care. Christa says she’s grateful she was chosen to test the virtual program: “I can’t say enough about how helpful it was in changing some of my habits. The alternative would have been to go into Vancouver regularly, or to bring home a sheet of exercises and instructions telling me what to eat, which I’ve done before and quickly gave up on.”

After a blood and stress test at St. Paul’s to provide a baseline measurement, Christa was provided with a blood and heart monitor and set up on the cardiac rehab website at home. Every week for four months, she filled out food diaries, followed prescribed exercises while wearing a heart monitor, took her blood pressure and weighed herself, and then uploaded the data onto her computer.

She logged into a chat room each week with other study participants where they had direct access to a nurse, exercise specialist and dietitian. Once a month, Christa enjoyed scheduled one-on-one chat sessions with these specialists, or she checked in with questions as needed.

After four months, Christa underwent a second round of tests, the results of which will be compared to her baseline results. She’ll be reassessed again in August (a year after her baseline tests) to see if she’s managed to stick with the program, maintain her exercise regimen and lower cholesterol levels, blood pressure and weight.

While the relevance of this study and others made possible by the new Pfizer/Heart and Stroke Foundation Chair will be measured in percentages, ratios and other statistics, Christa knows in her heart how valuable it is. She’s living proof of science’s potential for improving the quality of people’s lives. Ultimately, the chair will benefit many more like her.

The new Pfizer/Heart and Stroke Foundation Chair in Cardiovascular Prevention Research was made possible by donations from multiple organizations representing diverse but linked missions. The key contributors are: SFU ($1.5 million); Pfizer Canada Inc. ($1.25 million); St. Paul’s Hospital Foundation

($1.18 million, including $1 million from an anonymous donor); and the Heart and Stroke Foundation of BC & Yukon ($750,000).

Strength in Numbers

The Heart Centre in the Providence Heart + Lung Institute at St. Paul’s Hospital (HLI) is a unique resource for British Columbians, providing comprehensive cardiovascular care through a range of programs. It is also a leading centre for heart education and clinical innovation, led by top cardiologists, cardiovascular surgeons, nurses, radiologists and other health professionals. This clinical work is complemented by leading research into heart, lung and blood vessel diseases in HLI’s UBC James Hogg Research Centre.