Healing Hurting Hearts
Heart failure is devastating to patients and has a huge impact on the healthcare system. In Alberta, researchers are trying to remedy this problem with a number of solutions.
Story by Connie Bryson/Illustrations by Murray Kimber
They say that home is where the heart is. But it wasn’t his heart that pulled Dr. William Ghali back to his hometown of Calgary in 1996. It was heart research. Dr. Ghali, a specialist in internal medicine, had just completed a Master’s degree in public health at Boston University and was evaluating tantalizing job offers at universities in Canada and the United States. Besides practising medicine, Dr. Ghali wanted to do research on the delivery of cardiovascular health services.
One job offer stood out. A position at the University of Calgary would allow Dr. Ghali to be involved with the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH). This data collection initiative was the brainchild of Alberta cardiologist Dr. Merrill Knudtson. His vision was to capture detailed information on every cardiac procedure performed in Alberta and track those patients over time. “I had just finished training on how to use health data,” says Dr. Ghali. “Here was this incredible infrastructure that would allow me—and many others—to do research that sheds light on very important questions around the most effective ways to deliver cardiac procedures. I took the job at the University of Calgary and my work with APPROACH has shaped my career.”
Since its inception, the APPROACH database has been used to: examine how a wide range of demographic and socioeconomic factors affect cardiac care, assess different models of cardiac care, and look at the costs and benefits of new treatments. One recent study focussed on a new technology called drug-eluting stents. A stent is a metal tube used to keep a clogged artery open once it has been opened during a procedure called angioplasty. But bare metal stents can be prone to reblocking, which happens when the muscle cells that line the artery wall grow over the stent, necessitating a repeat procedure. A drug-eluting stent is a metal stent that has been coated with a drug to prevent cell growth. Healthcare systems around the world have been struggling with whether drug-eluting stents are worth the extra cost. Dr. Ghali’s team, which included his colleagues Dr. Fiona Clement and Dr. Braden Manns, used APPROACH data to perform a detailed cost-effectiveness analysis on these stents. They determined that for some patients the new technology is not necessary because they are not prone to reblocking. However, for patients with diabetes or complex lesions the use of drug-eluting stents is justified.
“Medical research is producing so many wonderful innovations but they all come with a cost,” notes Dr. Ghali. “Decision-makers need better information to make better decisions on what to fund and how best to utilize new technologies like drug-eluting stents. The APPROACH database continues to reveal important insights into outcomes and costs, and show us how we can do an even better job of caring for patients.”