The University of Alberta Hospital/Stollery Children's Hospital (UAH/SCH) will be the site of the new Mazankowski Alberta Heart Institute. The Institute, which will include four stories to be developed above the existing emergency department and an adjacent tower, will be the new home of the cardiac sciences program at the UAH/SCH site.
This new "hospital within a hospital" will consolidate the site's cardiac services into one area and provide additional capacity for increased volumes and future growth. Following is a brief description of our current programs.
Cardiology Inpatient Units - Cardiology patients may be cared for on one of two inpatient units. Each 18-bed unit has the capacity to monitor up to 8 patients via telemetry, allowing them the freedom of mobility while nurses keep a watchful eye on their heart tracings. The multidisciplinary teams on these units are comprised of cardiologists, cardiology residents, nurse practitioners, registered nurses, clinical pharmacists, social workers, dieticians, physiotherapists and many others, all focused on the well-being of their patients. The cardiology inpatient units care for individuals with various forms of cardiovascular disease including myocardial infarction, unstable angina, congestive heart failure and arrhythmias. In the new Mazankowski Alberta Heart Institute, inpatient cardiology beds will be increased in order to accommodate increased activity and future growth.
Coronary Care Unit (CCU) – The 8-bed Coronary Care Unit provides care to patients with acute and life-threatening cardiac conditions. Patients in the CCU include those who require cardiac, respiratory and/or specific hemodynamic monitoring such as those who suffer from congestive heart failure, myocardial infarction, unstable angina, pulmonary hypertension, or arrhythmias. These patients may be admitted directly to the CCU from the inpatient units, emergency department, or from the cardiac catheterization laboratory. Similar to the cardiology inpatient unit, the CCU is staffed by a multidisciplinary team, with specialized skills necessary to work in this environment. CCU capacity will expand with the move to the Institute.
Cardiac Rehabilitation – The University Hospital offers inpatient cardiac rehabilitation classes to all cardiology inpatients and their families. The program provides initial education related to heart disease, and prepares patients for discharge and subsequent follow-up in the community-based cardiac rehabilitation program. The target population for this program is those patients who have had a myocardial infarction, or who presented to hospital with angina or unstable angina. Patients who have had an angioplasty, coronary artery by-pass surgery, or other cardiac surgery such as valvular or arrhythmia surgery are also candidates for cardiac rehabilitation. The registered nurses that teach in this program are also very active in community activities promoting heart health. Patients are referred to the region's outpatient cardiac rehab programs.
Adult Cardiac Surgery and Transplantation
Cardiac Surgery Unit – The cardiovascular inpatient unit is comprised of 26 beds, 20 designated for standard post-operative care and 6 for observation. The observation beds provide higher intensity care to patients when they are first transferred from the cardiovascular intensive care unit following cardiac surgery, heart transplant surgery, or combined heart-lung transplant surgery. The standard beds provide care to surgical patients both pre and post operatively. Patient care involves a multi-disciplinary team that works together to meet the physical, mental, and social needs of each patient and family. The new Mazankowski Alberta Heart Institute will increase capacity for inpatient post-operative beds on the cardiac surgery unit.
Cardiovascular Intensive Care Unit (CVICU) – The CVICU is comprised of 19 beds. This unit provides immediate post-operative care to adults who have had open-heart surgery, heart or lung transplants, and combined heart and lung transplants. The unit currently accommodates 30 planned adult open-heart cases per week, frequently accommodating 1 to 2 additional emergency or transplant cases as well. Staffed by highly skilled personnel including intensivists, nurse practitioners, critical care nurses, and respiratory therapists and others, this unit supports one of the largest cardiac surgery programs in Canada. In the new Institute, this unit will be expanded.
Surgical Suite – Currently, the UAH/SCH designates three operating theatres per day to adult cardiac surgery and one operating theatre per day to pediatric surgery. The Mazankowski Alberta Heart Institute will increase operating theatres, procedure rooms, and patient and staff support areas.
Pacemaker/Defibrillator Clinic – The clinic provides assessment and on-going follow-up of patients with implanted pacemakers and implantable cardioverter defibrillators (ICD). The clinic focuses on both the clinical condition of the patient and on the implanted devices/leads. In 2001/02, there were 3,059 pacemaker and 726 defibrillator patient visits to the clinic at the UAH. During the same period, there were 326 pacemaker and 96 ICD implants.
Arrhythmia Clinic – Patients attending the Arrhythmia Clinic have histories of abnormal heart rhythm. Due to the number of medications that may be prescribed to these individuals to treat their condition, they must be regularly assessed and monitored.
Heart Function Clinic – The Heart Function Clinic serves patients with chronic congestive heart failure. This is done through clinical evaluation and assessment, education, regular monitoring, quick response, and ongoing liaison with both hospital and community services. In 2001/02, the clinic had 1,050 visits and 2,275 patient contacts.
Pulmonary Hypertension Clinic – This multidisciplinary clinic, one of only a few in North America, started in January 2003. The project, funded for three years by Alberta Health and Wellness (Medical Services Delivery Innovation Fund), is focused both on treating and on leading research into cost-effective management of Pulmonary Hypertension. Pulmonary Hypertension, a disease that affects hundreds of people in Western Canada, is a condition which can cause constriction and hardening of the arteries that connect an individual's heart and lungs. It is often hereditary, particularly affecting women in their mid 30s. Unmanaged, the condition can lead to eventual heart failure and death.
Chest Pain Clinic – This program uses a protocol driven assessment method to stratify patients who present to the emergency department with chest pain. The initiative has been undertaken to reduce the stress of unnecessary admissions to hospital, and to ensure that patients requiring further diagnostic investigations receive them prior to discharge from the emergency room.
Anticoagulation Management Clinic – This clinic is a physician supervised, pharmacist managed service for patients requiring warfarin therapy. This therapy is only effective when blood "thinness" is maintained within a narrow range. Inadequate thinning may precipitate a thromboembolic event (e.g., stroke), and excessive anticoagulation puts the patient at risk for bleeding. Proper management also reduces the risk of hospitalization for this patient population.
Cardiovascular Risk Reduction Clinic – This clinic is a collaborative effort between Medicine and Cardiology where patients are both screened, treated and followed-up for cardiovascular risk factors. The clinic is specifically focused on the prevention of cardiac disease and patient education. The multidisciplinary team (endocrinologist, internist, cardiologist, pharmacist, and dietician) provides a comprehensive program comprised of educational counseling, behavioral intervention and pharmacotherapy.
Adult Congenital Heart Disease Clinic – With an estimated 10,000 adults living in Alberta with congenital heart defects, experts in the field believe that health risks can be reduced and outcomes improved if coordinated care by qualified and informed health care professionals were available. In the new Heart Institute, a dedicated Congenital Heart Disease Clinic will be established to meet the specific needs of adult patients.
Boost Your Heart Program – Works with patients to improve their nutrition, increase their activity, manage stress and stop smoking. This 4 to 5 week program is available at various intervals throughout the year.
Currently cardiac clinics are held in various locations in the UAH, therefore, patients travel significant distances in the Walter C Mackenzie Centre to access required services. The Mazankowski Alberta Heart Institute will provide outpatient Clinic Suite where all Cardiac Sciences clinics will be held. Continuing the focus on patient centered care, Satellite Laboratory and Pharmacy services are also included in the Clinic suite to minimize distances patients must travel.
Diagnostic/Interventional Cardiac Services
ECG/EKG Laboratory – Electrocardiography is a non-invasive procedure that records electrical changes in the heart. The record, which is called an electrocardiogram (ECG or EKG), shows the series of waves that relate to the electrical impulses that occur during each beat of the heart. Results are printed on paper or displayed on a monitor. In 2001/02 the UAH conducted 52,573 of these tests.
Exercise Stress Testing Laboratories – Stress testing has become an integral part of the evaluation of patients to determine cardiopulmonary function and detect coronary artery disease. It uses exercise and/or pharmacological induction, along with the monitoring of heart activity and other indicators to detect specific types and severity of heart disease. Nuclear Stress Testing combines the exercise test, with an intravenous radiopharmaceutical and nuclear scan to provide more information than a regular stress test may provide. At the UAH, the regular exercise tolerance testing is supervised by Nurse Practitioners. In 2001/02, 3,465 of these tests were performed.
Cardiac Catheterization Laboratories – The UAH currently houses two cardiac catheterization laboratories, one single plane room, and one recently renovated bi-plane room boasting state of the art equipment. The service offers a range of diagnostic cardiac catheterization and therapeutic interventional procedures for both adults and children including diagnostic catheterizations, percutaneous transluminal coronary angioplasties (PTCA), stent insertions, atrial septal defect (ASD), ventricular septal defect (VSD), and patent ductus arteriosis (PDA) closures. In 2001/02, 3,779 procedures were performed in the cardiac catheterization laboratories. The Mazankowski Alberta Heart Institute will house three cardiac cath labs adding another regional lab specifically for pediatric use.
Holter Monitoring Service – Holter monitoring is the continuous monitoring of the electrical activity of an individual's heart muscle for 24 – 48 hours, using a portable device called a Holter monitor. Patients wear the Holter monitor while carrying out their normal daily activities. The laboratory connects/disconnects the monitor, downloads, evaluates and interprets its data. In 2001/02, there were 1507 Holter monitor procedures performed at the UAH.
Echocardiography Service – Echocardiograpy (ECHO) is an ultrasound of the heart. It can be performed either transthoracically (over the surface of the skin), or transesophageal (via the esophagus). This test uses ultrasound technology to visualize the structure of the heart and evaluate the blood flow dynamics associated with cardiac function. At the UAH, we also perform ECHO Stress Tests where the patient's heart function is evaluated both during and following an exercise stress test In 2001/02, the UAH performed 4,435 of these tests.
Electrophysiology Laboratory – The UAH currently housesone1 electrophysiology laboratory (EP Lab). The service provides a range of diagnostic and interventional procedures for both adults and children including electrophysiology studies, catheter ablations, and intra-cardiac defibrillator insertions. In 2001/02, there were 726 visits to the EP/Defibrillator Clinic. In the new institute, there will be more EP Labs and a procedure room.
Currently, diagnostic programs are located throughout the Walter C Mackenzie Centre in less than optimal space. The Mazankowski Alberta Heart Institute will centralize diagnostic programs in one area improving efficiencies and making it easier for patients to access programs.
CardiacEASE – CardiacEASE (Ensuring Access and Speedy Evaluation) is a new initiative, funded for three years from a Medical Services Delivery Innovation Fund (MSDIF) grant. It is aimed at expediting the referral process from family physicians and referring specialists to UAH cardiology. CardiacEASE has two linked components. First, a single point of entry, intake and triage service in the form of a toll-free number. The second component of the program, a rapid response cardiology clinic, will be equipped to fast-track necessary diagnostic tests for ambulatory cardiology consultations. Furthermore, the clinic will house telemedicine equipment, thereby facilitating consultation "on-line" under appropriate circumstances – this will be particularly useful for patients requiring follow-up consultation. This is an interdisciplinary effort including cardiologists, a nurse practitioner, a doctoral-level pharmacist, and a social worker. With this program, a single phone call will provide referring physicians with user-friendly access to cardiology consultative services, ensuring that patients are seen in a timely and appropriate manner.