Province needs coordinated plan for heart attack care, Lethbridge doctor says

A Southern Alberta doctor says it may be time to rethink how advanced cardiac care is provided across the province.

Physician says several Alberta cities could benefit from cardiac catheterization services

Dr. Aaron Low would like to see health officials sit down with experts and draw up a coordinated, provincial plan for roll out of cardiac catheterization labs. (Dr. Aaron Low)

A Southern Alberta doctor says it may be time to rethink how advanced cardiac care is provided across the province.

Physicians in Lethbridge say smaller centres in Alberta have to transport heart attack patients to Calgary and Edmonton for life-saving treatment, and a case could be made for equipping a number of cities with more advanced cardiac services.

We would love a cath lab, absolutely.- Dr. Aaron Low, Chinook Regional Hospital

Last week, a CBC news investigation revealed Central Alberta has been plagued with much higher heart attack mortality rates than Calgary. Red Deer physicians have been calling for a cardiac catheterization lab at their hospital for years.

 "We would love to have access to advanced cardiac services in Lethbridge," said Dr. Aaron Low, internal specialist at Chinook Regional Hospital in Lethbridge, who, like his counterparts in Red Deer, regularly tells sick and dying patients they need to travel far from home for time sensitive procedures such as angioplasty. 

"None of that is good for patients We make do with it and we do the best we can because that's what we have available," said Low.

While heart attack mortality rates in Southern Alberta are not as high as those in the Central zone, Low said a feasibility study shows Lethbridge has the patient volume to sustain a cardiac catheterization lab.

According to Low, Lethbridge has a stronger case for a lab than Red Deer because it's further away from Calgary.

"The longer time you wait before you get restoration of blood flow to your heart the more heart muscle that dies. So time is crucial," he said. 

Provincial framework needed

Low said he understands Alberta Health Services cannot afford to provide everything to everyone. Any move to decentralize cardiac care, he argues, needs to be done in a coordinated way.

He'd like to see AHS and Alberta Health sit down with experts and draw up a provincial plan for introducing catheterization labs to smaller centres.

"Everyone should know, 'okay you've reached this amount of volume, this amount of patients, this distance from a tertiary care centre, then we would consider a cath lab,'" said Low.

Access to care

University of Calgary research shows Canadians have much less immediate access to advanced cardiac services than their American counterparts.

Dr. William Ghali, scientific director at the U of C's O'Brien Institute for Public Health, co-authored a 2010 study that shows there is roughly one cardiac catheterization facility for every 176,000 adults in the United States. In Canada, there is one facility for every 595,000 adults.

The study found adding a lab in Lethbridge would increase the proportion of Albertans able to access the service within 60 minutes from 63.3 per cent to 66.6 per cent — or roughly 50,000 people.

Dr. William Ghali, scientific director of the University of Calgary's O'Brien Institute for Public Health, says decentralizing cardiac services is a complex issue.

"There are societal decisions around whether that's reasonable in terms of a health system financing consideration," said Ghali.

But he warns this is a complicated issue and it isn't just about money.

"It may not be as simple as thinking [a cath lab] is the way to go."

Ghali said research shows places that aren't doing enough procedures tend to have poorer outcomes.

"There needs to be a well operating cath lab in place, that's staffed with experienced personel, that has enough cases in any given year to achieve good results," he said.

"Any slight slippage in the results...could negate any advantage of getting a person to a cath lab right away."

Both Ghali and Low said the right prevention programs, treatment protocols, support services and staffing need to be in place before a cath lab is considered.