Earlier the better? Intervening to halt the Progression of Atrial Fibrillation

“I am always looking for ways to help patients with atrial fibrillation lead full lives,” says Dr. Jason Andrade, University of British Columbia Cardiology Professor.

He is currently leading a CANet-funded project, ‘Early Invasive vs. Delayed Intervention for Atrial Fibrillation’ which explores the first line of treatment for atrial fibrillation (AF).

AF, a heart rhythm disorder, results in rapid, irregular heartbeats. Patients are at a greater risk for stroke and death.

“We have pretty good information on how to manage atrial fibrillation at its later stages,” Andrade says, “but can we intervene sooner to improve outcomes?”

Andrade’s quest for an improved, more rapid treatment for AF might just come down to a matter of when to intervene.

He has teamed up with CANet’s industry partners Baylis and Medtronic CryoCath.

Medtronic has developed a revolutionary new technology to advance AF treatment, Medtronic’s Cryoablation Catheter freezes and destroys the faulty cardiac tissues.

“This is a major advance in the interventional treatment of AF, and a significant Canadian accomplishment,” Andrade says.

Importantly, it reduces the patient’s dependence on antiarrhythmic drugs (AADs), which are often ineffective, and can have severe side-effects such as organ toxicity.

CANet’s industry partnerships, such as with Medtronic, demonstrate the network’s commitment to commercialize technologies that improve the efficiency, effectiveness, and accessibility of arrhythmia care delivery in Canada and the world.

Andrade’s CANet-funded project is currently evaluating the use of the therapy early in the course of the disease before progressing to an advanced condition with the consequence of further complications, such as heart failure and stroke.

“I hope to determine which approach to the early management of atrial fibrillation will result in optimal improvement patient outcomes and reduce the burden of AF in Canada,” Andrade says.

The research study will ask patients who have undergone the cryoablation procedure to undergo implantation of a cardiac monitoring device that will continuously track the heart rhythm, and determine the amount of AF patients are experiencing per day.

“The combination of implantable rhythm monitors and home monitoring devices will permit us a fairly intense, yet minimally intrusive follow-up. In addition, this combination of monitoring will enable us to definitively determine the best possible treatment for early AF,” Andrade says.

His work is aligned with CANet’s Strategic Goal of achieving a 20 per cent drop in atrial fibrillation hospitalization and emergency department visits.

In fact, a significant portion of AF-related healthcare costs come from hospitalization and acute care.

Andrade is working with healthcare economists to look at the budgetary and cost-savings impact of this treatment strategy.

“More effective treatment also means less healthcare costs, and increased economic productivity because fewer people are missing out on work due to illness,” Andrade says.

The CANet project is also training Highly Qualified Personnel (HQP) like Dr. Christopher Cheung, reflecting its goal to cultivate the next generation of researchers in patient engagement and partnership.

“Research is a great way to learn about gaps in our knowledge, and how we can improve it moving forward,” Cheung says.

Andrade and CANet are also working with the Heart and Stroke Foundation – a non-profit organization – to develop a patient decision support tool.

“As someone who is clinically trained, it is a privilege to work with these patients and hear their stories,” Cheung says.

The decision support tool is an online platform of educational materials, interactive information, and social media. It will empower patients to be more involved in their own healthcare decisions, and improve their quality of life.

“Our patient partners, who have been involved with the project since the very beginning, have been critical in designing the project questionnaires and making sure that the study has a meaningful impact on their healthcare,” Andrade says.

The questionnaires – open to patients and medical professionals (general practitioners, internal medicine specialists, and cardiologists) – will help Andrade and his team capture patient experiences associated with AF and its treatment.

“Eventually, we want to be able to deliver an optimal, tailored treatment strategy for each patient,” he says.

As far as eyes can see: CANet project sees old target in new light

Look once. Look twice. Look again.

Drs. Frank Prato and Allan Skanes are taking no chances when it comes to improving atrial fibrillation (AF) therapies.

The CANet Investigators and professors of Medicine at Western University is putting faulty heart tissues – one of the main culprits of AF – under microscopes, MRIs, X-rays, nuclear medicine procedures and myriad other imaging technologies to develop “a clear, rational approach to selecting the right kind of treatment for AF patients.”

In doing so, they are helping provide effective, efficient and accessible arrhythmia care in Canada and worldwide, all critical CANet targets.

Cardiac tissues called atria generate electric signals that subsequently produce heartbeats. Diseased tissues and/or faulty electric signals result in rapid, irregular heartbeats – or atrial fibrillation – with frequent symptoms of chest pain, shortness of breath, light-headedness, and palpitations.

Their pioneering project Atrial Image-guided Decision to Optimize Treatment of Atrial Fibrillation (AID-AF) scrutinizes diseased atria through a battery of medical imaging techniques utilizing, for example, microscopy, x-rays, and MRI. It also studies, among other things, those faulty electric signals.

In other words, they are looking at AF repeatedly, in a variety of ways.

“This more accurate understanding will help doctors pick the right AF treatment,” Prato says.

Currently, the go-to AF therapy is catheter ablation. The treatment locates and destroys (ablates) faulty cardiac tissues – by either burning or freezing them – restoring normal function.

But the procedure works only 50 to 70 percent of the time. Patients often undergo a second procedure, which may or may not be successful.

“We are unable to accurately predict AF ablation outcomes as the extent of atrial disease is often underestimated,” Skanes says.

So how does one measure the severity of AF prior to ablation? What kind of information would allow patients and their physicians to make better decisions?

Prato’s new imaging tools (along with information on electric signals) will be combined with other patient characteristics such as age and duration of AF to predict accurate outcomes for catheter ablation of AF.

“Our hope is to identify those patients who are both likely and unlikely to benefit from AF ablation, and provide alternative therapies,” Skanes explains.

He continues, “We expect that by identifying patients with severe atrial disease and poor outcomes predicted, other non-ablation treatments, such as pacemakers can be used to maintain a high quality of life without repeated ineffective ablation procedures.”

Canada’s increasing seniors population is one of the leading causes of growing AF cases in the country, with healthcare costs going into millions of dollars per year.

By recommending the correct AF therapy for seniors for example, the CANet-funded research can help achieve the Network’s goal to reduce hospitalizations and emergency department visits by 20 per cent.

“Our work is bringing together Canada’s most skilled heart imaging scientists from multiple centers – Ottawa, London and Calgary – to collaborate on multiple methods of atrial disease imaging,” Prato says. This is unlike most other large, well-known medical centres both in Canada and the US, who work independently and use a single imaging method.

Apart from a multi-disciplinary team of imaging scientists, engineers and clinician scientists, Prato is also working with industry partners such as Siemens, Medtronic, Biosense, St. Jude Medical and CUBE Medical Solutions to develop commercially viable novel imaging technologies.

These industry partnerships will help CANet move forward with its strategic business and capacity development targets.

This CANet-funded project also helps train and mentor Highly Qualified Personnel in arrhythmia research in Canada.

“Trainees in medical imaging and technology, junior clinician-scientists and early-stage research fellows will benefit from multi-disciplinary collaborations, and exposure to state-of-the-art technology,” Prato says.

The project contributes to CANet’s vision of creating highly qualified personnel at the forefront of arrhythmia research and management.

Importantly, Prato is collaborating with patients who bring with them a variety of experiences.

“Patients will give insight into tolerability, appropriateness, and acceptability of complex imaging studies as well as strategies for efficient patient engagement and enrolment,” he says.

Ultimately, Skanes hopes that the research will empower patients to predict their clinical course, avoid futile procedures, and select alternative therapies more appropriately.

For their part, Prato and Skanes will not stop looking for better solutions.

Baylis-CANet partnership – fruitful, innovative, and going strong

“When our employees see technology being used to help patients, it gives us strong motivation to work harder and stronger,” says Kris Shah, President of Baylis Medical.

A few months ago, CANet investigator and Western University Medicine professor Peter Leong-Sit became the world’s first physician to use a pioneering medical device developed and manufactured by Baylis to make atrial fibrillation (AF) ablation procedures safer and more effective. The procedure was a success.

“That event helped lift the entire company to a new level,” Shah remembers fondly.

For almost three decades, Baylis, located in Mississauga, Ontario, has developed and distributed state-of-the-art medical products in Canada and across the world.

When CANet launched in 2015, it sought out organizations that shared the Network’s vision – to significantly improve the efficiency, effectiveness, and accessibility of arrhythmia care delivery in Canada and around the world.

Baylis fit the bill.

“We are very fortunate to be associated with CANet since inception,” Shah says. “As a result of our strong association with CANet, we feel our company has grown at a much faster rate than we otherwise would have. It created a number of meaningful jobs in Ontario, as well as helped deploy our technology on a worldwide basis.”

When CANet started, Baylis had roughly 350 employees in 2015, To date, the company has almost doubled its number of employees.

“I can honestly say that a big chunk of that has been a direct result of our strong partnership with CANet,” Shah says.

Currently, Baylis is working with CANet on several projects to help reduce atrial fibrillation (AF)-related emergency department visits and hospitalization. AF is the most common heart arrhythmia abnormality and accounts for the majority of arrhythmia-related emergency room visits and hospital admissions.

The collaboration is critical in helping achieve a 20 percent drop in AF hospitalization and emergency department visits, a key strategic goal of the Network.

“There is a critical need for innovative minimally invasive cardiac procedures that improve patient outcomes without increasing healthcare costs and treatment time,” says CANet’s Scientific Director and CEO, Dr. Anthony Tang.

The Baylis-CANet partnership will help improve patient care and allow hospitals to adopt safer and more effective technologies.

“Access to CANet’s leading-edge network of investigators allows us to introduce our therapies to even more hospitals, and bring relief to patients, faster,” Shah says.

For example, in CANet’s Early-AF study, Baylis deployed its tools across Canada at 30 sites.

The study was successful, and Shah hopes it will help Baylis and CANet commercialize and disseminate cutting-edge technologies — another key CANet strategic goal.

Shah also highlights the critical role of CANet members in helping Baylis grow, all the while encouraging the company to develop technologies to help cardiac arrhythmia patients.

“CANet members have been educating us on clinical needs and how our technology can play a meaningful role in their everyday practice,” Shah says. “They have provided clinical input, medical expertise and helped us design and execute clinical trials.”

The Baylis-CANet partnership, according to Tang, is a stellar example of how clinicians and industry partners can work together to improve patient outcomes and enhance productivity in the healthcare system.

AED-equipped drones will decrease response time, saving the lives of cardiac arrest victims

This month, residents of Caledon, Ontario, will continue to see multiple EMS vehicles zip by their streets, responding to 911 calls.

If they happen to look up, they will see something new. Drones equipped with Automated External Defibrillators (AEDs) – racing to the same locations.

Dr. Sheldon Cheskes will be examining the response time and the impact these drones will have in saving the lives of cardiac arrest victims.

“Drones may be able to beat firefighters and paramedics to the scene of a cardiac arrest, and those extra minutes could be life-savers,” says Cheskes, a CANet Investigator, medical director at Sunnybrook Centre for Prehospital Medicine, and Associate professor of Emergency Medicine at The University of Toronto. “Survival chances decrease by 7 to 10 per cent for every minute of cardiac arrest.”

Cheskes’ CANet-funded project, “AED On The Fly” is pioneering how Canada manages cardiac arrest situations, by assessing the potential of dispatching AED-equipped drones – when a 911 call comes in for a cardiac arrest victim, along with the traditional fire and ambulance response. Bystanders will be guided in the use of the AED in the drone by real-time smartphone technology applied to the AED.

“When bystanders provide shocks through defibrillation, survival chances are significantly greater than if we wait for EMS to get there,” Cheskes says.

The challenge with AED deployment is 85% of cardiac arrests occur in private locations while 15% occur in public locations classically accessible for AEDs. Yet historically only 2% of all cardiac arrests have a bystander apply an AED although the number jumps to 15-20% in public locations. Despite this fact, a vast majority of public cardiac arrests have an AED in close proximity that are not being used.

“We lag behind in the area of private access to, and efficient use of AEDs,” he says. “I want to rethink the way we approach this problem and bring a new mindset to cardiac arrest and AED deployment. “

CANet is helping Cheskes demonstrate his new approach in Caledon.

He will initially simulate mock cardiac arrests at six different locations around town, while simultaneously dispatching a drone equipped with an AED and an EMS vehicle. The response time to these mock cardiac arrests when applied in a “real world” scenario will be studied.

“By optimising where we place drones, based on the area’s historical call volume, we can cut down six minutes of response time in urban areas, and almost 10 minutes in rural areas,” Cheskes says.

In fact, cardiac arrest survival rates are worse in rural communities compared to urban areas. Ambulance and fire services have slower response times, and AED’s are not found in close proximity to the majority of cardiac arrests.

Cheskes anticipates that AED-equipped drones will be a great success in rural areas. Remote-controlled drones can safely land in these communities, which mostly consist of large, open spaces, and low-rise buildings.

The current system will likely not work in urban areas like downtown Toronto at this point in time.

“The technology to land drones on a condominium balcony in downtown Toronto, for example, is very difficult – we have to take into account multiple factors such as navigating high-rises, and wind shear,” Cheskes cautions. “It needs to be more specific and safe.” With the advent of rapidly evolving drone technology, this may change.

The U.S. and Europe have tested similar systems, but none has launched a drone as part of a 911 dispatched EMS response. Cheskes’ CANet project hopes to be the first of its kind to implement AED-equipped drones as part of a 911 dispatched EMS response.

To this end, CANet’s Commercialization Grant will play a crucial role in helping Cheskes improve the efficiency, effectiveness, and accessibility of arrhythmia care delivery in Canada and the world.

CANet and Cheskes are working with Drone Delivery Canada (Ontario) and InDro Robotics and Remote Sensing (B.C.) – ‘both leaders in this space’ according to Cheskes. CANet’s industry partnerships help foster economic growth across Canada and fulfill the Network’s strategic and capacity development targets of commercializing new technologies.

“We are extremely grateful to CANet for being such willing collaborators, and funding our work. Without their support, it would be very unlikely that we would be able to continue,” Cheskes says.

His project aligns with an important CANet strategic clinical target – a 10 per cent drop in sudden cardiac death.

Cheskes is already thinking beyond cardiac arrests.

“CANet saw incredible potential in our technology, and have given us an opportunity to revolutionize health care not only for cardiac arrest but potentially, for other emergencies,” he says. “What if we use drones to deliver epinephrine for anaphylaxis, or medical kits for trauma victims?”

But even with such high-flying, fast-moving technology, Cheskes is firmly focused on the person on the ground.

“Much of cardiac arrest research is moving away from figuring out ways to merely surviving cardiac arrest but also understanding the patient’s own views and priorities,” he says.

Cheskes and his team will hold town-hall meetings with citizens of Caledon (and other Canadian towns and cities where the project is being conducted) to better understand their thoughts and concerns regarding drones.

“Anything that can improve health outcomes should be viewed favourably, but I don’t live in those communities and don’t know how they feel, their misgivings, or their suggestions to make the system better,” he says. “I am definitely interested in listening to them, help improve access to better care, and increase their confidence in operating AEDs, and saving lives.”

CANet VIRTUES: cutting-edge technology ushers in a bold new era of arrhythmia care

Cardiac Arrhythmia Network of Canada (CANet) leverages cutting edge technology to empower its patients.

Digital innovations like artificial intelligence, blockchain technology, and consumer-grade wearables are now mainstream. Healthcare services must invest in these breakthroughs to deliver better medical care for Canadians.

CANet is currently focusing on solutions – advanced analytics, artificial intelligence, machine learning, and blockchain technology – towards one simple strategic goal – significantly improve the efficiency, effectiveness, and accessibility of arrhythmia care delivery in Canada.

“We are staying ahead of the digital-health curve by bridging the gap between doctors, technologists, and patients,” says CANet Research Data and Systems Manager Dimitri Popolov.

So far, that gap has been a key obstacle in developing advanced healthcare technology.

CANet’s VIRTUES Clinical Platform – a user-driven clinical application – is transforming how CANet works with patients and clinicians to manage arrhythmia. It presents patients with their health data and includes them in the decision-making process aimed at improving health outcomes.

Think of VIRTUES as precision medicine – a bundle of technology and medical breakthroughs wrapped in an online platform seamlessly and securely sharing valuable clinical data among wearable medical devices and databases, doctors and patients, all across the country.

VIRTUES combines super-large volumes of diverse clinical data and applies advanced analytics, machine learning, and artificial intelligence approaches to deliver accurate, patient-centric solutions.

The CANet developed platform is a step ahead of the curve – in most cases, medical records are often incomplete or outdated. For example, some records may have medication with dosages and frequencies, other records only mention daily dose while some others only mention administered drugs without specifying the dose. This picture is even more complex when a whole encounter record or clinical summary needs to be analyzed.

With VIRTUES, doctors can get the most up-to-date medical information at their fingertips.

CANet is currently piloting wearable devices that transmit Electrocardiogram (ECG) data into VIRTUES. The valuable clinical data will help doctors and patients better track important events such as atrial fibrillation episodes and valve regurgitations, potentially predict future episodes and prevent them.

“We want to empower patients and caregivers to be active partners in the management of their care,” says Dr. Anthony Tang, Scientific Director and CEO, CANet.

VIRTUES utilizes the HL7 FHIR (Fast Healthcare Interoperability Resources) standard – a vastly superior system of healthcare information and management, succeeding where others have failed.

“We embraced HL7 FHIR early on and through vital partnerships have access to the latest and highest expertise in areas of advanced analytics and visualization,” Popolov says. “VIRTUES is leveraging multidisciplinary and cross-functional technology innovation.”

Partnerships such as these not only help foster economic growth but also improve the lives of Canadians.

At the heart of CANet’s approach to VIRTUES is the belief that patient-centered and patient-owned personal health records should be designed to easily integrate with virtually all electronic health records and clinical information systems across Canada.

“Patients, researchers, clinicians, and industry partners have all played an active role in the design, development and continuous improvement of VIRTUES,” Tang says.

“Our emphasis is on empowering patients to control sharing of their data with their circle of care,” Tang says.

Now, CANet is leveraging clinical and technical leadership to run a Blockchain pilot project.

“Blockchain uses secure cryptography to ensure privacy and it will be integrated into the VIRTUES Clinical Platform infrastructure,” Popolov says.

With blockchain, an ever-expanding collection of patient-controlled health records (containing a cryptographic hash of the previous block, a timestamp, and transaction data) called blocks, are securely linked using cryptography.

With Canada’s complex regulatory landscape, CANet has taken the necessary measures with Privacy and IT Security in their completion of Privacy Impact Assessments (PIA) for the VIRTUES Clinical Platform infrastructure to ensure compliance.

CANet has also partnered with technology companies to ensure that such records are protected and securely shared.

With multiple VIRTUES projects and clinical trials on the go, and a research paper already accepted for an upcoming major Canadian conference, CANet is, once again, pioneering how technology can transform patient’s lives.

“We are embracing the future now,” Tang says.

Secure and Compliant Cloud-Based Clinical Data Repository (CDR) Jump Starts CANet’s Healthcare Workflow

CANet investigators use data from implanted and wearable cardiac devices to deliver more efficient cardiac arrhythmia care for patients across Canada. Currently, the Network is piloting wearable devices that transmit electrocardiogram (ECG) data into VIRTUES which will help doctors and patients track atrial fibrillation episodes, providing patients with personalized health care delivery, empowerment, and ownership to co-manage their health with easily accessible medical information and personalized care plans at their fingertips.

Typically, healthcare data is generated in silos creating additional workload on clinicians to make their decisions and provide care. When data lives in a lot of different places, that can challenge both the privacy and security of your data.

Now imagine all that data sitting in one central repository.

When CANet needed an efficient, flexible, and secure repository solution to support its complex e-health workflows involving researchers, clinicians, and patients, two Canadian companies stepped up to the plate.

“One of the biggest bottlenecks in healthcare data management is time spent creating research tools rather than research studies,” says Duncan Weatherston, Chief Executive Officer of Toronto-based Simpatico Intelligent Systems. “Our biggest impact is easing the complexity of creating flexible and customizable tools for clinicians,” Weatherston says. “You are limited only by your ideas, not by any software.”

“You can use off-the-shelf technology to build DIY software from scratch, but it will take much longer, it will be more expensive, and researchers and clinicians will lose out on doing real work,” claims Craig McLellan, Chief Executive Officer and Founder of Etobicoke-based ThinkOn Inc.

Simpatico has provided CANet investigators with a robust cloud-based resource called Smile CDR. CDRs are databases that combine health information from numerous medical sources – such as clinical laboratory test results, pharmacy data, and hospital admission, discharge, and transfer dates – to better understand patients.

“When talking about healthcare data, there is often an implicit assumption that data has some value in itself. In our experience, data is only valuable when used in value-generating workflows. Consequently, VIRTUES focuses on the implementation of clinical care and research workflows,” says Dr. Dimitri Popolov, Research Systems and Data Manager, CANet. “However, these workflows are indeed impossible without a robust data layer. Our partnership with Simpatico and ThinkOn has allowed us to progress extremely quickly because the CDR we are using ensures interoperability as well as compliance with the most stringent privacy and security requirements, allowing us to concentrate on creating value,” emphasizes Popolov.

“Smile CDR, designed around Health Level-7 (HL7) Fast Healthcare Interoperability Resources (FHIR), is a globally accepted standard of rules on how electronic health records are shared and exchanged across different formats and databases,” Weatherston says.

With the importance of protecting patient information, ThinkOn Inc. has collaborated with Simpatico, providing essential tools and resources, for CANet’s development of critical data management plans.

“Our approach towards privacy, in all forms, embraces the law, ethical principles, and societal considerations,” says CANet’s Privacy Officer, Lori Sutherland, “Control of your personal information is one of the key features CANet aims to deliver on,” she adds.

FHIR, according to both Weatherston and McLellan, fits perfectly with the next generation of health data management. Both companies are leveraging cloud computing and big data analytics, to maximize computations, networking and storage resources for CANet.

“One of the biggest challenges to implementation of healthcare systems is interoperability. The problem of ‘silos’ in healthcare when different systems do not interact with each other is notoriously complex in healthcare,” says Dr. Popolov. “By adopting FHIR in all our activities, we are ahead of the state-of-the-art in the industry offering. We integrate clinical and research data, traditional data with device data. Without FHIR, our development and implementation progress would have been much slower. We achieve greater improved interoperability using CDRs.”

ThinkOn has consistently attained and maintained extensive security certifications in the realm of secure data, privacy, and government clearance with its state-of-the-art and ultra-reliable infrastructure.

“If you increase that level of trust and reliability, then more members of the community can come together to share and collaborate,” McLellan says. “We as Canadians are in a unique position – there is so much to learn, so many opportunities to enable others, and most importantly, give back to the community.”

CANet’s partnerships with both companies – two among several – also helps foster economic growth in Canada.

VIRTUES

VIRTUES was designed, developed and implemented with the essential involvement of patients, on-going expertise of healthcare leaders from CANet’s pan-Canadian network of investigators and clinicians, and fundamental support of academic, industry and government partners from provinces and territories across Canada.

Patients with arrhythmia conditions will receive on-demand virtual care using state-of-the-art Canadian-made biosensor driven diagnostics and health informatics, integrated with cutting-edge digital technologies, advanced analytics and wireless connectivity.

VIRTUES delivers the most efficient, effective, and accessible healthcare, on-demand and tailored to the specific needs of each arrhythmia patient.

London, Ontario company plays a big role in the design of CANet’s VIRTUES Clinical Platform

“As product designers, we have to fall in love with the problem instead of the solution,” says Jonathan Kochis, head of Research and Design at the London, Ontario based firm Res.im. “Focus on the solution, and you end up with a narrow view, possibly missing something crucial.”

Res.im has partnered with CANet to design front-end elements of the VIRTUES Clinical Platform – CANet’s user-driven clinical application that will transform how patients and clinicians manage arrhythmia.

VIRTUES will give doctors and patients the most up-to-date medical records at a moment’s notice. It will empower patients and caregivers to be active partners in the management of their health.

Kochis highlights the growing demand by consumers to have everything that they might need at their fingertips, accessible via phone.

Healthcare organizations must move away from traditional ideas of healthcare access, and meet these expectations.

“VIRTUES is meeting that consumer demand,” Kochis says. “It is smart and necessary.”

CANet has also partnered with multiple companies across Canada to leverage world-class expertise in developing cutting-edge healthcare which also helps foster economic growth.

These collaborations will help CANet come closer to its strategic goal of significantly improving the efficiency, effectiveness, and accessibility of arrhythmia care delivery in Canada and the world.

“It is not every day that we have the opportunity to participate in work that has the potential to really improve somebody’s health and quality of life,” Kochis says.

VIRTUES will help clinicians and patients efficiently track cardiac events through device monitoring such as atrial fibrillation episodes. The hope is to eventually predict and prevent future episodes.

“Res.im helps design digital products, and make them easier to use,” Kochis says.

When trying to make VIRTUES more user-friendly, Kochis and his team had to think in terms of what the application required – was it to record something, communicate with healthcare professionals, or get a health status update – or maybe, all of the above?

“These tasks apply to everybody, and it cuts across age and digital experience,” he says. “If somebody needs to record a medical incident, for example, we want to give the user the least number of steps to complete the task in a way that is obvious to both experienced users and novices.”

The outcome, according to Kochis is simplicity. The user should not do anything more than is necessary.

“CANet is excellent at communicating with us, and keeping us in the loop at every stage of the product design and development,” Kochis says. “It has been a great relationship.”

He mentions how VIRTUES has given Res.im the confidence to work on a sophisticated suite of healthcare products. The company hopes to leverage this experience for similar work in the future.

“Even if we are a small part in this really big initiative, and help it move forward, that will be great,” Kochis says.

C-SCAN project builds Canada’s first detailed database of sudden cardiac arrest cases

“It bothers me when I cannot answer a question,” Dr. Paul Dorian says.

A few years ago, a patient, having survived a sudden cardiac arrest asked Dorian
if there were other survivors out there like him.

Dorian didn’t know the answer.

Now, the University of Toronto Medicine professor, along with a group of researchers – all part of the Canadian Resuscitation Outcomes Consortium (CanROC) – has teamed up with CANet to search for answers.

The Canadian Sudden Cardiac Arrest Network Registry (C-SCAN) will be the country’s first comprehensive database of sudden cardiac arrest (SCA) cases.

“We have no idea how many people in Canada get cardiac arrests,” Dorian says.

“Is the number going up or down? How many survive? What’s their average age? Does it affect more men or women? We simply don’t know.”

CANet’s role will go beyond tallying numbers and the details of age and sex.

“With CANet’s help, we will have an idea of patients’ health conditions before and after they suffered from SCA,” Dorian says.

He and his team will get to know the patient’s medical history; what happened in the minutes, hours, and days leading up to a SCA? Did they, for example, have a heart attack last week or were they complaining of chest pain a month ago? How many patients survived SCA? Has there been a follow-up?

So far, most SCA-related research use public reporting, and death certificates to identify and classify SCA cases.

C-SCAN will go beyond these limited sources of information; it will not only use CanROC’s existing database of SCA cases but also include coroner’s reports – a vital trove of health-related information, which are usually buried under slow-moving administrative and bureaucratic procedures.

CANet, Dorian mentions, is critical in establishing relationships with coroner’s offices.
“C-SCAN, a comprehensive, unique registry will help us fully understand the causes and outcomes of SCA,” Dorian says. An increased understanding will help doctors formulate better prediction and prevention strategies.

The C-SCAN initiative will contribute to CANet’s strategic goal of achieving a 10 per cent drop in sudden cardiac death across Canada.

Dorian has plans beyond the registry.

He highlights two potential offshoots of the CANet-funded C-SCAN project – one involves teaching 9-1-1 dispatchers to give better phone instructions to bystanders who call in to report a SCA.

Another is to educate the public to recognize warning signs of an impending SCA, teaching them to use Automated External Defibrillators (AEDs), and strategically placing AEDs in easy-to-find locations throughout buildings, and public spaces.

In his quest to reduce the occurrence of SCAs, Dorian is utilizing a critical pillar of CANet – its patient partners.

“Patient partners are very important for us,” Dorian says. “They help us better understand how SCAs and other cardiac rhythm disorders impact patients as well as their families.”

They are also, according to Dorian, powerful advocates who work with city councils and government bodies to promote increased CPR and AED training and raise awareness for inherited cardiac rhythm disorders and SCAs.

“CANet, with its resources, funding and patient partners are helping us apply our knowledge in better, more effective ways,” Dorian says.

Ultimately, the C-SCAN project, with its detailed tally of SCA cases, patient histories, and other details – the location of the SCAs, actions taken by paramedics, patient survival rates, for example – will be critical for implementing effective prediction and prevention strategies.

“You cannot improve what you cannot measure,” Dorian says.

He is hunting for answers. CANet is right there with him.

SADS partnership putting a smile on patient’s faces

Pam Husband has spent 23 tireless years giving a voice to patients and families affected by inherited cardiac rhythm disorders, which often lead to sudden cardiac death.

She is the Executive Director of the Canadian Sudden Arrhythmia Death Syndromes (SADS) Foundation, Canada’s only SADS-specific patient advocacy group.

The registered Canadian charity works with patients and medical professionals to raise awareness about the warning signs of SADS.

An estimated 700 children and young people die from a SADS condition each year in Canada – early diagnosis and proper treatment help patients lead productive lives.

“CANet has been very helpful by including and inviting us to their meetings and conferences,” Husband says.

As a patient-information group, SADS gets to talk to other physicians about SADS, and create opportunities to reach out to their patients.

For years, the organization has brought patients and healthcare professionals closer together through their website, social media, and importantly, their SADS conferences, held across Canada, “It is critical to bring patient voices forward, understand their experiences, and improve their healthcare experience,” Husband says.

In her eyes, patients are not only recipients of healthcare, but also its participants.

Earlier, Husband explains, the physician was the expert, and the patient is merely the receiver.

SADS conferences give patients an opportunity to approach and interact with doctors more proactively.

Physicians, according to Husband, learn to see patients in a different light; they get to discuss patient issues in more personal, informal way, far removed from formal clinical settings.

“The conferences are beneficial for encouraging patients to be more engaged with the healthcare community, and actively invest in healthier lifestyles,” Husband says.

For example, current recommendations of acceptable levels of exercise for patients suffering from inherited cardiac rhythm disorders have come about from a combination of research studies, but also, feedback that physicians have received from patients in these conferences.

Many patients, Husband informs, have become role models to others like themselves, inspiring them to take charge and ownership of their health conditions.

Most importantly, however, the conferences provide patients with a sense of belonging.

“Every patient has gone through a similar experience,” Husband says. “People here are very good at taking each other under their wings.”

A few years ago, Husband lost her 16-year old son to sudden cardiac death – he was initially misdiagnosed with idiopathic epilepsy.

“These inherited diseases are not just affecting one individual but whole families – so the correct diagnosis is very important,” she says.

Shortly after his death, Husband’s daughter was diagnosed with an inherited cardiac rhythm disorder.

“I have strong motivation to prevent these tragedies in other families,” she says.

She looks forward to making progress on that front with CANet, to achieve a 10 per cent drop in sudden cardiac death within the decade.

“We are very excited about our relationship with CANet – there are opportunities on both sides, and we are really thrilled to be included in the organization,” Husband says.

Combining genetic counselling with clinical assessments to tackle sudden cardiac death (SCD)

“The impact of sudden cardiac death is second only to all cancers in terms of life-years lost,” says CANet investigator and professor at University of British Columbia’s Faculty of Medicine, Dr. Andrew Krahn.

He, together with fellow CANet investigator and professor at University of Toronto’s Faculty of Medicine, Dr. Robert Hamilton, is helping better diagnose and treat individuals and family members at-risk for sudden cardiac death by developing a more effective detection and prevention strategy.

The strategy, according to them, is in the genes.

The program focuses explicitly on channelopathies, and hypertrophic and arrhythmogenic cardiomyopathies – all predominant causes of SCD in young adults and children.

Each of these disorders is an inherited heart condition.

“Our current system typically discovers barely ten per cent or less of these individuals,” Dr. Krahn says.

Krahn and Hamilton have received funding with CANet’s Strategic Research Grant for their project “The Canadian Genetic Heart Rhythm Network: Innovative Strategies to Reduce the Risk of Sudden Cardiac Death Using Novel Clinical and Population Approaches” The Canadian Genetic Heart Rhythm Network is a collection of 15 centers – 12 adult and seven pediatric – across seven provinces in Canada.

Patients will work with genetic counselors and cardiac experts. Counselors will help family members understand the benefits, and risks for clinical & genetic assessment.

Patients will also be monitored for arrhythmias or other SCD-related symptoms using implanted cardiac monitors.

The CANet project will develop an “accurate, up-to-date, and reliable list of risk factors, and indicators based on information collected from questionnaires, medical data from clinical visits, and information from caregivers,” Dr. Hamilton says.

Genetic testing and clinical testing together are highly cost-effective in preventing sudden death.

New Zealand and Sweden have already combined both and can now successfully identify more than half of the estimated disease population.

Krahn and Hamilton are working with experts from both countries to help adapt the European success story to Canada.

With this project, CANet is a step closer to reaching its strategic goal of a 10 per cent drop in SCD across Canada, while significantly improving the efficiency, effectiveness, and accessibility of arrhythmia care delivery in Canada and the world.

The Krahn-Hamilton CANet project is also building a highly interactive website with educational materials, interactive multimedia, and links to social media and patient advocacy group platforms.

“We want to deliver accessible and up-to-date information to health professionals and patients,” Dr. Krahn says.

For example, he recently partnered with Heart and Stroke Foundation to create a 75-second video on sudden cardiac death research.

It was viewed more than 11,000 times in the first 24 hours.

“We are also developing communication software and apps for public awareness, to help patients take care of themselves at home,” Dr. Hamilton adds.

Both are working with commercial and industry partners such as Medtronic, AliveCor, and Systemas Genomics to develop such home health and technology platforms. This work also reflects CANet’s commitment and strategic goal of commercializing five to seven new technologies related to arrhythmia care delivery.

Aligned with CANet’s strategic goal to launch of 30-40 new experts in public and private research, Drs. Krahn and Hamilton are also creating a scientific think-tank community for students and researchers to foster communications and connections for ongoing and new projects related to SCD.

The think-tank will help in “our ability to support capacity building in the field in terms of Highly Qualified Personnel, connect graduate students, medical trainees, residents and research fellows with one another, and help with patient recruitment,” Dr. Krahn says.

Help is closer than you think: CANet-funded project brings cutting-edge healthcare nearer to patients

Dr. Ratika Parkash is getting closer to 120,000 patients across Canada.

Parkash’s work is aimed at patients who live with pacemakers or implantable defibrillators – both, cardiac implantable electronic devices or CIEDs. Pacemakers help control abnormal heart rhythm. Implantable defibrillators deliver life-saving shocks to patients who are at risk of irregular and potentially fatal heart rhythms.

“We want to deliver more efficient pacemaker and implantable cardiac device care across Canada, virtually eliminating in-clinic visits for most patients,” Parkash says.

CIEDs, like any other devices, need regular maintenance in order to function properly and detect atrial fibrillation and ventricular arrhythmia more effectively.

Patients often visit specialized device clinics at least twice a year, sometimes more frequently.

For 19 per cent of Canadians living in rural communities, they have to travel long distances to reach these clinics and healthcare facilities.

Dr. Paul MacDonald, a cardiologist at Cape Breton Regional Hospital says, “We are over 400 km away from the teaching centre where these devices are implanted. If they do need to be checked or monitored, it can mean, for example, a five-hour drive, or an overnight stay. Often patients’ families have to go, or patients are admitted to hospital and require ambulance service to transport them back and forth.”

The problem needs to be solved quickly – Canada has a growing aging population, many of whom will require CIEDs.

Dr. MacDonald continues, “It can get very expensive for the healthcare system, certainly expensive and challenging for families to manage. New technology and better communications services will help us manage these patients locally.”

Currently, barely five per cent of the 120,000 patients who live with CIEDs have any form of remote monitoring, which usually involves patients communicating with clinics through landlines or mobile phones.

CANet and Parkash are working towards integrating with CANet’s digital health platform, VIRTUES – Virtual Integrated Reliable Transformative User-driven E-health System.

By monitoring the status of a CIED, VIRTUES will inform patients with what the device is doing, and allow clinics, patients, family physicians, and cardiologists to talk to one another regarding the device status

Importantly, the CANet-funded project removes the need for patients to travel outside of their local community to receive care from a highly specialized device center.

“The project will also help free up the time in specialized centers to focus exclusively on more problematic cases by removing the need for routine device checks,” Parkash says.

These partnerships continue to propel CANet with its strategic business and capacity development targets by commercializing new technologies.

“The main factors that will contribute to the success of this program are ongoing collaborations within CANet, and developing technologies that will assist patients with their CIEDs,” Parkash says.

The CANet-funded RPM-CIED project will also help train two early career cardiac electro-physiologists dedicated to the remote monitoring strategy.

Parkash’s work is contributing to a critical CANet goal of creating highly qualified personnel at the forefront of arrhythmia research and management.

Parkash is also working on implementing the novel remote patient management system in the most effective, efficient and accessible way across the “diversity of healthcare systems and patients in Canada.” In doing so, she is helping decrease the rates of arrhythmia, syncope and sudden cardiac death in Canada and worldwide, all critical CANet targets.

Ultimately, it is all about the patients, she notes.

Working the project’s Patient Leader (a patient at Kingston General Hospital), in consultation with nine other CIED patients across Canada, will help ensure that the CANet-funded project puts patients concerns first and foremost, providing patient-centered CIED care.

One of the key surveys in the project, for example, asks patients how they accommodate cardiac devices in their daily lives, encourages them to share any device-related distress that they face, and bring forth any body image concerns related to having a device implanted.

“Rather than have patients be passive recipients of treatment, we want them to active partners in directing and taking responsibility for their healthcare,” Parkash says.

Closing the distance key to managing advanced heart failure

At the heart of CANet’s quest to combat sudden cardiac death lies a few millimeters of cardiac muscle.

For Dr. Jamie Manlucu, it will be enough.

With CANet’s help, she is refining a groundbreaking technology that may give 40 per cent of Canadians suffering from advanced heart failure a second lease of life.

The project is a crucial step towards CANet’s strategic goal to reduce sudden cardiac death cases in Canada by 10 per cent.

Manlucu, a CANet Early Career Investigator, and professor at the Schulich School of Medicine & Dentistry, recently received CANet’s Major Industry-Partnered Research Grant totaling $400,000, for her project, ‘Resynchronization For Ambulatory Heart Failure Trial – LV Endocardial Approach (RAFT-LVendo)’ .

Advanced heart failure often results from impaired electrical activation of cardiac muscles.

In the conventional approach – Cardiac Resynchronization Therapy (CRT) – doctors place pacemaker wires at specific areas of the heart to deliver precisely timed electric shocks that restore normal cardiac rhythm.

CRT has been a success story for patients with acute heart abnormalities.

For those with less severe cases – who count among Canada’s most vulnerable populations at risk for ventricular arrhythmias and sudden cardiac death – it has not worked.

Enter LVendocardial CRT.

LVendo CRT uses a larger surface area of the heart to place the wires, unlike conventional CRT, which is limited to small specific areas.

Those extra few millimeters make a world of difference.

Recently completed, in a first-of-its-kind pilot study, patients were recruited and showed that the technique is safe and feasible – compared to conventional treatments for mild heart abnormalities, LVendo CRT stimulates cardiac muscles more efficiently, and helps in better blood flow.

Now, CANet is helping her make a good thing even better.

Over the past few months, Manlucu and her team have expanded the project at 11 cardiac centres across Canada.

They will treat at-risk patients with LVendo CRT and track their progress for a year using a series of extensive tests, interviews, and surveys.

The study will help improve the efficiency and safety of LVendo CRT, introduce it to a wider community of doctors and patients, and make it more cost-effective.

Manlucu has partnered with Baylis Medical and Medtronic of Canada to advance the LVendo CRT tools that both companies have created for the pilot study.

This key industry-partnered research project has also contributed towards CANet’s strategic business and capacity development targets by commercializing new technology.

“This project is a collaboration between experts from the fields of heart failure management, arrhythmia, implantable cardiac devices and cardiac imaging across the country,” Manlucu says, adding that they are mentoring medical trainees and junior engineers working on the project.

With this, CANet continues to grow its highly qualified personnel to tackle sudden cardiac death in Canada and worldwide. Manlucu is also working with CANet’s Patient Engagement and Empowerment team to better understand and incorporate the patient’s perspective.

“Most clinicians are relatively new at collaborating with patients in research,” Manlucu says. “Identifying appropriate patient partners may be challenging in this potentially fragile patient population.”

Through CANet’s Patient Engagement and Empowerment Strategy, support for the identification inclusion and education of patient partners within the research team as well as education for clinicians and highly qualified personnel is being provided. This support is instrumental in ensuring patient engagement is embedded across funded research projects.

AED-equipped drones will decrease response time, saving the lives of cardiac arrest victims

Next month, residents of Caledon, Ontario, will continue to see multiple EMS vehicles zip by their streets, responding to 911 calls.

If they happen to look up, they will see something new. Drones equipped with Automated External Defibrillators (AEDs) – racing to the same locations.

Who will be faster? Who will have shorter response times?

Dr. Sheldon Cheskes is rooting for the drones.

“Drones can beat fire trucks and ambulances to the scene of a cardiac arrest, and those extra minutes could be life-savers,” says Cheskes, a CANet Investigator, medical director at Sunnybrook Centre for Prehospital Medicine, and Professor of Medicine at The University of Toronto. “Survival chances decrease by 7 to 10 per cent for every minute of cardiac arrest.”

Cheskes’ CANet-funded project, “AED On The Fly” is pioneering how Canada manages cardiac arrest situations, by providing ambulance stations with AED-equipped drones – when a 911 call comes in for a cardiac arrest victim, an AED-equipped drone is dispatched, along with ambulance and fire crews. Bystanders follow pre-recorded instructions to use the AED to help save lives.

“When bystanders provide shocks through defibrillation, survival chances are almost four times more than if we wait for EMS to get there,” Cheskes says.

Barely 15 per cent of AEDs in Canada are located in public places such as airports, health clubs, and casinos (the rest are in private locations). When someone goes into cardiac arrest, Cheskes notes, 80 per cent fail to find and apply AEDs successfully.

“We lag behind in the area of public access to, and efficient use of AEDs,” he says. “I want to rethink the way we approach this problem and bring a new mindset to cardiac arrest survival. “

CANet is helping Cheskes demonstrate his new approach in Caledon.

He will simulate mock cardiac arrests at six different locations around town, issuing 911 calls to the town’s emergency services.

“By optimising where we place drones, based on the area’s historical call volume, we can cut down six minutes of response time in urban areas, and almost 10 minutes in rural areas,” Cheskes says.

In fact, cardiac arrest survival rates are worse in rural communities compared to urban areas. Ambulance and fire services have slower response times, and the public remains largely unaware of AEDs.

Cheskes anticipates that AED-equipped drones will be a great success in rural areas. Remote-controlled drones can safely land in these communities, which mostly consist of large, open spaces, and low-rise buildings.

The current system will not work in urban areas like downtown Toronto, however.

“The technology to land drones on a condominium balcony in downtown Toronto, for example, is very difficult – we have to take into account multiple factors such as navigating high-rises, and wind shear,” Cheskes cautions. “It needs to be more specific and safe.”

The U.S. and Europe have unsuccessfully tried similar systems; Cheskes’ CANet project is the first of its kind to implement AED-equipped drones as part of an EMS response.

He did have to seek approval for using drones, eventually obtaining clearances from Nav Canada, which operates Canada’s civil air navigation service, and Transport Canada.

To this end, CANet’s Commercialization Grant will play a crucial role in helping Cheskes improve the efficiency, effectiveness, and accessibility of arrhythmia care delivery in Canada and the world.

CANet and Cheskes are working with Drone Delivery Canada (Ontario) and InDro Robotics and Remote Sensing (B.C.) – ‘both leaders in this space’ according to Cheskes. CANet’s industry partnerships help foster economic growth across Canada and fulfill the Network’s strategic and capacity development targets of commercializing new technologies.

“We are extremely grateful to CANet for being such willing collaborators, and funding our work. Without their support, it would be very unlikely that we would be able to continue,” Cheskes says.

His project aligns with an important CANet strategic clinical target – a 10 per cent drop in sudden cardiac death.

Cheskes is already thinking beyond cardiac arrests.

“The grant saw incredible potential in our technology, and gave us a chance to revolutionize health care not only for cardiac arrest but potentially, for other emergencies,” he says. “What if we use drones to deliver epinephrine for anaphylaxis, or medical kits for trauma victims?”

But even with such high-flying, fast-moving technology, Cheskes is firmly focused on the person on the ground.

“Much of cardiac arrest research is moving away from figuring out ways to merely surviving the ordeal to understanding the patient’s own views and priorities,” he says.

Cheskes and his team will hold town-hall meetings with citizens of Caledon (and other Canadian towns and cities where the project is being conducted) to better understand their thoughts and concerns regarding drones.

“Anything that can improve health outcomes should be viewed favourably, but I don’t live in those communities and don’t know how they feel, their misgivings, or their suggestions to make the system better,” he says. “I am definitely interested in listening to them, help improve access to better care, and increase their confidence in operating AEDs, and saving lives.”

Patients play a critical role in developing novel syncope treatments

Syncope research pioneer Dr. Robert Sheldon has teamed up with patients across Canada to produce cutting-edge treatments through the execution of a first-in-world trial.

Sheldon, a CANet Investigator, and professor at University of Calgary’s Faculty of Medicine received a CANet Strategic Research Grant totaling $249,929 for his project, ‘Assessment of Norepinephrine Transport Inhibition to Prevent Recurrent Vasovagal Syncope.’

The CANet-funded project has helped doctors and researchers answer critical yet often over-looked questions such as – what is the acceptable threshold of side effects and discomfort for patients in exchange for them taking drugs for the treatment of syncope? How often and when are patients willing to take pills?

Currently, there are no proven medical treatments for syncope.

“We have to make it worthwhile for them to take the drug,” Sheldon says. “What drives us is patient involvement. It’s a complete eye-opener and the experience has been overwhelmingly positive.”

The answers to these questions are critical in shaping and defining the way Sheldon and his teams conduct clinical trials of Atomoxetine, and increase the chances of a successful trial.

Atomoxetine is an experimental drug projected to reduce the occurrence and suffering of syncope in Canada, decrease emergency room visit and empower patients to manage their care.

Syncope affects around 50 percent of Canadians every year. People suffer from decreased quality of life, trauma, and loss of employment.

“What drives us is patient involvement,” Sheldon says. “It is a complete eye-opener and the experience has been overwhelmingly positive.”

The project has used the information gained from patient-surveys and the trial itself to create educational websites and decision-aids for patients and physicians dealing with syncope.

Sheldon and his team are collaborating with the global non-profit organization, Syncope Trust & Reflex Anoxic Seizures (STARS), to develop these critical resources.

“CANet has played an important role in advancing syncope research in Canada,” he says. “CANet organized a ‘patient day’ at Alberta Health Services long before this study. At that event, patients shared with us what was essential for them, and what their priorities were.”

Those inputs, according to Sheldon, have guided and driven forward CANet’s commitment to engage and empower patients, and together with them, revolutionize syncope research in Canada.

“When you hear what’s important to patients and when you figure out how to address it successfully, that is an amazing feeling,” Sheldon says.

‘CASMER’ Launched in Alberta – Reducing Canadian Healthcare Costs by Eliminating Syncope Hospitalizations

Paramedics in Calgary and surrounding areas are now able to increase capacity in the Emergency Medical Services (EMS) system, thanks to the CANet-funded project, CASMER, Community Alternatives for Syncope Management in the Emergency Room.

CANet investigator, CASMER project lead and professor at University of Calgary’s Faculty of Medicine Dr. Satish Raj, together with a team of medical researchers, doctors, and paramedics, recently launched CASMER in Calgary and surrounding areas within a radius of 45-60 minutes.

“Most patients with low-risk syncope, otherwise known as a temporary loss of consciousness
or fainting, have excellent outcomes because the diagnoses – vasovagal syncope and initial orthostatic hypotension – are non-life threatening and thus, do not merit a trip to the hospital,” Dr. Raj says.

Both, however, are continually recurring features of low-risk syncope, and alarm patients to such a degree that it often prompts unnecessary trips to emergency departments where tests and costs rapidly escalate. Even worse, often patients inconveniently have to wait several hours to be seen, adding to the overcrowding in the emergency departments.

With CASMER, paramedics are now using simple checklists to determine whether syncope patients are low-risk or not.

If they are low-risk, paramedics treat and refer patients on-site. Severe cases are transported to a hospital.

“CASMER allows us to provide better care for our patients while freeing up ambulances to be available for the next 9-1-1 call,” says Ryan Lee, paramedic, and CASMER research coordinator.

Within Canada, studies estimate about a hundred thousand syncope-related visits to emergency departments occur yearly.

Barely a quarter of patients are admitted – about 0.1% of patients benefit from CT scans, head MRI, EEG, or ultrasounds which significantly increases healthcare costs.

According to Dr. Gerald Lazarenko, Medical Director for Research for the Alberta Health Services Emergency Medical Services (AHS EMS) system, and CASMER co-investigator, AHS EMS transports approximately 2000 syncope patients a year to emergency departments.

“Most of them could stay at home safely,” he says.

“Paramedics are unable to look after more serious cases like heart attacks if they are looking after low-risk syncope patients,” adds Dr. Raj.

“We want to provide a cost-effective, efficient, and exemplary healthcare system that improves the lives of syncope patients and lessens the burden on Canada’s healthcare system, its doctors, and its paramedics,” says Dr. Anthony Tang, Scientific Director and CEO of CANet.

The CANet-funded CASMER project has also empowered patients with support groups, information resources and website to help them better understand syncope and manage their health.

CANet is committed to reducing syncope hospitalization and emergency department visits across Canada, and lower syncope-related health service expenses by 30 per cent.

After Alberta, CASMER will be launched in various cities across the country.

“We are excited for its outcomes in Calgary and nationally in the future,” Dr. Tang says.

Patient expertise is fundamental to an understanding of the patient experience

Sometimes, all it takes to make a difference is a handshake, a smile and the words ‘tell me about yourself.’

Mary Runte is reaching out to arrhythmia patients – including families and support groups – to document and share their experiences of living and dealing with the illness.

Runte, a CANet Investigator, Chair of the CANet Patient Advisory Committee, and professor at University of Lethbridge’s Faculty of Management, recently received CANet’s dedicated Social Sciences Grant totaling $240,000, for her project, ‘Mapping the Arrhythmia Patient Journey’ which documents the social, emotional and psychological impact of arrhythmia in patients.

Her research will provide Canada’s first in-depth and comprehensive record of the patient experience of arrhythmia through the perspective of the patients themselves.

From this information, doctors will be able to design more efficient, effective and holistic interventions that will take into account patient priorities.

It is also essential to take into account the economic, social, and psychological impacts of the illness in patients suffering from arrhythmias. For example, doctors are often unaware of arrhythmia’s effect on a patient’s employment situation, family responsibilities, and lifestyle choices.

“Real world measures are important when real-life problems are being investigated,” Runte says.

She is an arrhythmia patient herself.

Runte, who is the Chair of the Patient Advisory Committee of CANet, will lead an interdisciplinary team of experts in medicine, policy, economics, and psychology.

She and her team will ask the participants – arrhythmia patients and their family members, and support groups – to share their personal narratives and stories of their illness.

“This will give us a broader understanding of the complexity and diversity of experiences,” Runte says.

Using this data, Runte and her team will develop a survey to help patients identify and prioritize social, psychological, and economic factors that are most impacted by their illnesses.

Doctors can refer to this information to design interventions around them.

Runte will eventually extend this CANet research, currently based in southwest Ontario, all across Canada.

“I want to document the similarities and differences in the cardiac care experience of Canadians across different provinces and territories,” Runte says.

Runte’s research builds on CANet’s previous interdisciplinary research across atrial fibrillation (AF), sudden cardiac death (SCD) and syncope in Canada.

Importantly, it extends CANet’s objective to put patients on the forefront and empowering them to manage their conditions while providing them with a sustainable health system.

The work will train at least five Highly Qualified Personnel (HQP), and expose them to the multidisciplinary CHAT (CANet HQP Association for Trainees) program, keeping in mind CANet’s goal to train the next generation of researchers in patient engagement and partnership.

Runte is working with five patient-partners – people currently suffering from AF or syncope, and in one case, a SCD survivor – who will share their experiences and expertise with the team, and will also help in recruiting patients.

“This project will be patient co-led through all phases,” Runte says, adding, “Patient expertise is fundamental to an understanding of the patient experience.”

CANet Investigator Dr. Drangova pioneers groundbreaking atrial fibrillation treatment

For some of the best minds in cardiac care, the successful treatment of atrial fibrillation has been a moving target.

Until now.

CANet’s Commercialization grant is funding the development of the Catheter Contact-Force Controller (CFC), a pioneering device that will result in more effective atrial fibrillation (AF) treatments, fewer repeat procedures, and lower healthcare costs.

Dr. Drangova, a scientist at the Robarts Research Institute and a professor in the Department of Medical Biophysics in the Schulich School of Medicine and Dentistry at Western University, recently received CANet’s Commercialization Grant totaling $300,000, for her project, ‘Catheter Contact-Force Controller for Cardiac Ablation Therapy.’

Daniel Gelman, a CANet Highly Qualified Personnel (HQP) Trainee, is an electrical and computer engineer who invented and continues to enhance the CFC with Drangova. He first presented his research at the Heart Rhythm Society in San Francisco – the leading conference in cardiac electrophysiology, where he received an overwhelming amount of attention from the academic, clinical and industry arenas. His research poster received top prizes at the Imaging Network Ontario Symposium, London Health Research Day, and CANet annual meeting. He previously received a CANet Discovery Grant totaling $25,000.

“I greatly benefited from CANet’s HQP-trainee program,” Gelman says. “It provided valuable resources and opportunities for me to help strengthen my research and career development.”

AF is typically treated by inserting tiny tubes (‘catheters’) into the heart and delivering precise amounts of high-energy beams to ‘burn’ away faulty heart tissues responsible for arrhythmia.

But precision comes at a cost.

For example, due to a patient’s heartbeat and breathing, the distance between a catheter tip and the faulty heart tissue changes constantly, making it difficult to aim and get rid of it accurately. As a result, AF treatments are often incomplete and patients have to come back for a repeat treatment.

Enter the CANet-funded Catheter Contact-Force Controller (CFC) – a device the size of your smartphone.

Gelman’s device updates doctors on the precise location of the catheter tip with respect to the faulty heart tissue in real-time.

Doctors pick targets more efficiently and get rid of them more quickly.

So far, due to the lack of proper technology, patients return for a second “re-do” procedure nearly half the time. In the case of chronic AF – the most common form of cardiac arrhythmia, recurrence rates in Canada remain as high as 50%. The Canadian taxpayer pays over ~$170M per year for repeated treatments; these figures are expected to increase 2-4 fold by 2050.

Not anymore.

With CANet’s Commercialization Grant, Drangova and her team just got one step closer to improving the lives of approximately 350,000 Canadians suffering from AF every year. This work will also help to reduce AF hospitalization and emergency department visits by 20%, one of CANe’ts clinical goals.

CFC’s pre-clinical results have been received extraordinarily well by doctors across North America and Europe.

CANet’s Commercialization Grant will give Drangova and her team the resources to take the device from CANet’s extensive network to the clinic.

“At the project’s end, we will develop a production-ready CFC system that will be evaluated by our CANet colleagues and physicians in patients with AF,” she says.

The grant will also provide critical assistance to Drangova and her team in commercializing CFC – the team recently established Aufero Medical, a medical device start-up in London, Ontario, to manufacture the CFC, creating jobs and benefiting the Canadian economy in the process.

 “Our ultimate goal is to put the CFC from the lab bench directly into the hands of doctors here in Canada and worldwide to better treat patients,” Drangova says.