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 acrossthe province.

Physicians in Lethbridge say smaller centres in Alberta have to transport heart attack patients to Calgary and Edmontonfor life-saving treatment, and a case could be madeforequipping a number of citieswith 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 muchhigher heart attack mortality rates than Calgary.Red Deer physicians have been calling for a cardiac catheterization lab at their hospital for years.

• Central Alberta heart attack patients up to 70% more likely to die, doctors warn

"We would love to have access to advanced cardiac services inLethbridge," saidDr. Aaron Low, internal specialist at Chinook RegionalHospitalinLethbridge, 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 asangioplasty.

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

• Better cardiac care not coming 'any time soon' to central Alberta, health minister says

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 considera 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 servicewithin 60 minutes from 63.3 per cent to 66.6 per cent or roughly 50,000 people.

"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 saidresearch 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 cathlab is considered.