Ways CCS Promoted Cardiovascular Health and Care of Canadians in 2016

Today the number of cancer survivors is increasing at twice the rate of new cancer diagnoses. Extended follow-up has shown cardiotoxicity is now a leading cause of long-term morbidity and mortality among cancer survivors. In response to this, the CCS collaborated with the Canadian Cardiac Oncology Network to develop The CCS Guidelines for Evaluation and Management of Cardiovascular Complications of Cancer Therapy. These guidelines, co-chaired by Dr. Susan Dent and Dr. Sean Virani are the first of their kind in Canada and cover four key topics: (1) the patient population at highest risk for cardiovascular toxicity related to cancer therapy; (2) strategies for detection and prevention of cardiotoxicity; (3) treatment of cardiotoxicity; and (4) the need for a multi-disciplinary approach in the management of individuals who experience cardiotoxicity related to their cancer therapy. The guidelines highlight the urgent need for collaboration to increase awareness and provide guidance on the management of these complex patients.

Guiding Cardiovascular Care and Surveillance of Canadian Cancer Patients

Measuring and Reporting on the Quality of Cardiovascular Care in Canada

Dr. Paul Dorian, Chair of the CCS Quality Project and Dr. Anita Asgar, Chair of the CCS TAVI Working Group, marked a milestone with the release of the CCS National Quality Report: Transcatheter Aortic Valve Implantation (TAVI). The pan-Canadian report was the first of its kind to measure and report on this new and growing procedure. With 100% participation of TAVI centres, this effort allows for national and regional comparisons of evidence-based quality indicators including mortality, readmissions, and procedural risk. This work has already helped to identify knowledge gaps and opportunities for improvement. This demonstration report is part of the broader CCS Quality Project that is working with provincial registries and the Canadian Institutes of Health Information to provide ongoing pan-Canadian quality measurement and reporting for cardiovascular care.

The Canadian Cardiovascular Society (CCS) is the national voice for cardiovascular clinicians and scientists, promoting cardiovascular health and care excellence through knowledge translation, professional development and leadership in health policy.

Below are ten highlights of the many initiatives that were undertaken in 2016 in support of our mission.

Pediatric syncope is a common problem that peaks in adoles-cence for which there is limited evidence-based consensus on investigation and management. Most cases are benign, yet these patients may undergo unnecessary investigations and consulta- tions that cause undue stress for patients and families. The 2016 CCS/CPCA Position Statement: The Approach to Syncope in the Pediatric Patient, co-chaired by Dr. Shu Sanatani and Dr. Vann Chau presents recommendations to encourage an efficient and cost-effective approach for the many patients with a benign cause, and highlights atypical or concerning clinical findings associated with other causes. For most patients with syncope, medical testing is not required and lifestyle modifi-cations without medications suffice to prevent recurrences. The position paper is the first to propose reducing the use of routine electrocardiograms in all patients with syncope, based on the low diagnostic yield. This has the potential to reduce costs and unnecessary referrals, and represents a significant change in current practice. The position paper represents an important step towards a more efficient approach to this common pediatric problem, and now requires an effort to get the information into the hands of frontline practitioners.

A humorous and thought-provoking debate on the continued relevance of the stethoscope exam that garnered national media coverage; opening session calisthenics; interactive e-posters; and a presentation by the Honourable Minister of Health Jane Philpott, were all part of the 2016 Canadian Cardiovascular Congress in Montréal. The Canadian Cardio-vascular Congress continues to be the national forum on heart health and care, but this year’s format was a significant departure from the traditional scientific meeting. Dr. Michelle Graham, CCS Scientific Program Chair and Dr. Andrew Krahn, CCS Annual Meeting Chair and the CCS committees and staff worked with invited speakers to increase delegate engagement using technology and novel program formats. The 2,800 attendees responded positively to the program, giving it a 96% satisfaction rating at final evaluation. The CCS is committed to evolving the Congress so that it continues to be the principal platform for connection of cardiovascular health and care professionals in Canada.

Improving Investigation and Management of Syncope in Pediatric Patients

Providing New Recommen- dations for Cholesterol Manage-ment in Canada – “No” to Fasting, “Yes” to Dietary Change

Creating a Canadian Platform for Cardiovascular Education, Research and Engagement

One-third of Canada’s population has high cholesterol. In 2016, the CCS published an important update to the CCS Guidelines for the Management of Dyslipidemia for the Prevention of Car-diovascular Disease in the Adult, co-chaired by Dr. Todd Anderson and Dr. Jean Grégoire. The guideline presents evidence-based recommendations for clinicians and patients regarding screening, risk assessment, and treatment. Major highlights/changes include: new cholesterol drugs for patients at risk, recommendations on dietary pattern style eating com-pared to macronutrient diets, and the role of non-fasting lipid testing. It guides difficult decisions about when to use statin and non-statin therapy to treat cholesterol and when other approaches are possible. The overall goal of the guideline is to present the best available evidence that allows clinicians and patients to make collaborative treatment decisions. The guideline is not absolute, but aims to encourage one-on-one discussion between practitioner and patient.

Putting a Spotlight on Clinical Management of Cardiovascular Disease in the Elderly

Improving Patient Outcomes through a Joint Statement on Open and Endovascular Surgery

Providing Cardiovascular Expert Input to Senate Deliberations on Obesity in Canada

A new position statement on Open and Endovascular Surgery for Thoracic Aortic Disease was developed jointly by the CCS, the Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery and provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. Co-chairs, Dr. Jehangir J. Appoo and Dr. Munir Boodhwani and the writing panel advise that the advent of endovascular technology has improved aortic surgery safety and extends the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery.

With the population aging, there is an exponential increase in the prevalence of cardiovascular patients with multi-morbidities and frailty in Canada. Dr. Stan Nattel, Canadian Journal of Cardiology (CJC) Editor-in-Chief, puts a spotlight on this societal and clinical challenge in the September 2016 focus issue on “Cardiovascular Care in the Elderly”. The issue includes articles ranging from Primary Prevention of Cardiovascular Disease in Older Adults (Dr. Arden Barry et al.) to Considerations in Cardiac Revascularization in the Elderly Patient (Dr. Deirdre O’Neill et al.) to End of Life Decisions and Palliative Care in the Elderly (Dr. Deborah Meyers et al). With availability in every Canadian academic centre and over 7,000 institutions worldwide, the CJC focus issue on “Cardiovascular Care in the Elderly” is widely circulated. The message is clear: this increasingly common patient profile requires a different way of managing and delivering care.

Canada ranks 5th among industrialized countries for prevalence of obesity in its population. In 2015, the Senate Standing Committee on Social Affairs, Science and Technology was tasked to provide an in-depth analysis and recommenda-tions for addressing obesity in Canada. The Senate invited Dr. Heather Ross, CCS Past President, to speak to the committee on behalf of the CCS and provide a cardiovascular perspective on the impact of obesity. Dr. Ross discussed the role of obesity in heart failure, the impact of obesity on patient clinical management and the importance of obesity prevention through education, proper nutrition and active living. The 2016 Senate report was released advocating a national campaign to combat obesity which includes research invest-ments, policy initiatives and education/marketing campaigns.

Canadian Cardiovascular Society 222 Queen Street, Suite 1100 Ottawa, Ontario Canada K1P 5V9 CCS.CA

Moving Evidence into Practice to Improve the Health of Canadians

Enabling Funding for Innovative Cardiovascular Research

We all know that well-developed guidelines have the potential to improve quality of care, patient outcomes and cost-effective-ness but publishing guidelines is only the beginning. The CCS builds on the extraordinary work of our guideline writing panelists through knowledge translation programs and in-teractive contact with Canadian practitioners. Our knowledge translation programs include a variety of activities and resources to help practitioners integrate our guidelines into patient care. The CCS’ accredited, case-based workshops and webinars engage practitioners in interactive education and dialogue. This year, we delivered over 30,000 pocket guides, updated our very popular iCCS guideline app, delivered 17 educational workshops and developed 12 key topic videos for YouTube. Together, we are bridging the gap between evidence and practice to improve the health of Canadians.

The CCS is not a traditional research funding body but it actively works with partners such as BMS/Pfizer Alliance and Bayer Canada to enable additional research funds to be available to the community. This year, $350,000 was awarded to fund six CCS peer-reviewed research proposals. Novel projects such as that of Dr. William McIntyre and Dr. Jeff Healey on Atrial Fibrillation Occurring Transiently with Stress (AFOTS): Understanding the Risks of Recurrent AF in Non-cardiac Surgery and Dr. Tina Zhu regarding Carotid Contrast-Enhanced Ultrasound (CEUS) as a Risk Stratification Tool for Cardiovascular Disease were selected. Funded recipients present their work proposal or the progress of their work at the Canadian Cardio-vascular Congress and are encouraged to publish their results to further new knowledge in Canada.

Thank you to CCS members, our many collaborators, supporters, stakeholders and staff for helping the CCS make a difference.