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People suffering heart attack up-Island are getting substandard care, doctors say

For patients in central and north Island, there is no catheterization laboratory where doctors can perform procedures common since the early 2000s
Part of the cardiac unit at Royal Jubilee Hospital. ADRIAN LAM, TIMES COLONIST

A critical lack of cardiac care in the central and north Island means heart attack patients in Nanaimo are likely to get blood thinners and clot busters instead of highly recommended interventions available in Victoria, says a Nanaimo doctor.

The result is more avoidable deaths and poorer quality life and outcomes, said Dr. David Coupland, a radiologist and president of Nanaimo Regional General Hospital medical staff, who will speak to the issue at a press conference in Nanaimo today.

Nanaimo Regional General Hospital is serving a rapidly growing and aging population. It’s among largest regions in Canada without a cardiology service and a cardiac catheterization lab where doctors can perform life-saving, non-surgical interventions, Coupland said.

“Basically, anyone living north of Duncan … is at a greater risk when a heart attack occurs,” Coupland said in an interview. “We are offering central and north Island patients care that is outdated and not to current standards for a population of our size and burden of cardiac disease.”

Generally speaking, Nanaimo’s hospital can offer big heart attack patients what’s called thrombolysis, medication given intravenously or via a catheter to dissolve clots in arteries — the main cause of heart attacks and ischemic strokes. By contrast, in a catheterization laboratory, commonly called a cath lab, doctors can perform updated procedures — common since the early 2000s — that include opening up blocked ­arteries and inserting a stent, he said.

Given the rapidly growing central Island has the oldest population in Canada, with the 55 and older demographic projected to grow, it also has a greater burden of cardiac disease in every area of cardiology than the south Island, said Coupland.

Heart attacks, heart failure, chest pain due to heart disease, hardening of the arteries and irregular heartbeat are above the provincial average in the central and northern regions, he said.

“Yet, we have one cardiologist at NRGH with a second one coming Aug. 14. We have few cardiac services and no cardiac cath labs versus the south Island with 22 cardiologists, including cardiac services such as electrodiagnostics, two cardiac cath labs, and cardiac surgery,” said Coupland.

Royal Jubilee is the Island’s referral centre for cardiac care.

“I mean, the inequities could not be more obvious. We have more people with heart disease north of the Malahat with very little,” said Coupland.

A cath lab at Nanaimo’s hospital would serve people beyond Nanaimo in communities such as Comox, Campbell River, Ladysmith, Port Alberni, Tahsis. In the medical community, it is well accepted that a person having a serious heart attack should have access to a catheterization lab within 90 minutes, he said.

“These people could not get to Victoria within 90 minutes if they have a big heart attack, so they get substandard care — that’s the bottom line,” said Coupland.

Nanaimo Mayor Leonard Krog, in an interview, said that, for its size, the Nanaimo region is the most underserved — “I can say this without exaggeration” — in the country in terms of not having access to a catherization lab.

“What that means is that if you have a heart attack in Nanaimo, or near Nanaimo, and you can’t get to the cath lab in Victoria … obviously then you have a much higher risk of not surviving a heart attack,” said Krog.

“And even if you do survive the heart attack, if you’d have had access with cath lab, you would also probably have a far better quality of life and be less of a user of the healthcare system in the following years, he said.

The mayor concedes “this issue will cause stress for citizens,” but if such advocacy translates into Nanaimo’s hospital getting needed cardiac services “then that’s the price we have to pay.”

Krog will join Coupland in a press conference at 11 a.m. today at the Millstone Medical Centre, 203 – 1629 Dufferin Cres., calling on the province for improved cardiac care at Nanaimo Regional General Hospital.

They will speak alongside hospital cardiology head Hesam Keshmiri, nephrology head Alison Croome, Regional Hospital District board chair Ian Thorpe and others.

Snuneymuxw Chief Michael Wyse, who is a heart patient, will also be urging the province to act swiftly to bring more timely life-saving interventions to central and north communities. About eighty per cent of the Island’s First Nations communities live north of the Malahat, many in rural and remote regions. In Canada, cardiovascular disease affects 7.1 per cent of Indigenous adults, compared with 5 per cent of non-indigenous Canadians.

“I cannot stress enough the urgency of addressing the critical lack of cardiac care in central and north Island,” said Wyse in a news release. “Lives are at risk due to the absence of a cath lab.”

Island Health said in a statement on that Nanaimo will have a third cardiologist in September. A team of internal medicine physicians also provide and support cardiac care.

“These additional cardiologists will support an increase to diagnostic and outpatient services in the community. Recruitment of additional specialists to support the Central Island region is ongoing.”

The health authority said it recognizes the need to expand and improve cardiac services in Nanaimo (and the central and north Island) and that investment and enhancement of local cardiac care services and infrastructure has been identified as a priority in future capital planning for Nanaimo Regional General Hospital.

In December, the hospital expanded its Heart Function Clinic to a space across the street, doubling patient volumes. The health authority said the clinic improves patient outcomes and reduces the number of patients requiring ER visits and hospitalization from heart failure, but Coupland said much more is needed.

The lack of cardiac services at the hospital also means it struggles to attract and retain young Canadian-trained cardiologists who train at centres with cath labs, he said.

“They are hesitant to come to a centre without a cath lab because they know they will have to do thrombolysis, and they know thrombolysis … it’s better than nothing, but it’s not the standard of care since circa 2004.”

Nanaimo’s Shauna Bergstrom, 43, mother of four, was in Royal Jubilee Hospital in Victoria Feb. 3-20 following triple-bypass surgery but her family couldn’t stay in Victoria. “I had to fight for my life scared and alone,” she said in a news release.

Thorpe, chair of the hospital district board, said planning for the cardiology service and cath lab can’t wait, while Tony Harris, board chair of Nanaimo and District Hospital Foundation, said donors have stepped forward but provincial approval is needed before planning can begin.

In March, cardiologists in Surrey, including Dr. Courtney Young, asked to meet with Health Minister Adrian Dix for a cardiac cath lab at Surrey Memorial Hospital. By early June, a campaign demanding expansion of the hospital was followed by a promise from Dix for immediate and medium-term actions including the addition of two cardiac catheterization labs.

“With respect to Surrey,” said Krog, “the reality is you’re within literally 15 minutes to half an hour of cath labs all over the place in the Lower Mainland.

“In Nanaimo, it’s a long haul over the Malahat to Victoria and if you’re coming from Port Alberni or Courtney or Comox … we have more than half the population north of the Malahat and we don’t have a cath lab — in what world does that make medical sense?”

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