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DONATIONS MAKE THE HEART GROW FONDER

PHILANTHROPY HELPS TO DRIVE MAJOR ADVANCEMENTS AT UNIVERSITY HEALTH NETWORK

Cardiac care has come a long way since Dr. RJ Cusimano, a cardiovascular surgeon at University Health Network’s (UHN’s) Peter Munk Cardiac Centre and holder of the David & Stacey Cynamon Professorship in Cardiovascular Surgery Innovation and Education, started practicing 30 years ago. And philanthropy has played a major role in advancing that care, through research and education.

For many patients with end stage heart failure, the option of either a mechanical heart or a heart transplant are the last options when all other therapies have been exhausted. This can extend longevity and provide a better quality of life for these patients, who are typically between the ages of 50 and 64.

“Many newer technologies that can be life-saving are made possible by philanthropic funds,” says Dr. Cusimano, who is also part of the Sprott Department of Surgery at UHN.

Today, the Peter Munk Cardiac Centre together with the the Ajmera Transplant Centre at UHN, offers the largest transplant program in North America and is one of only three centres in Ontario that perform heart transplants. UHN also handles the most complex cases that require innovation in surgical procedures, such as operations to repair aortic aneurysms.

Through improvements in surgical and postsurgery therapies—many of them developed at the Peter Munk Cardiac Centre—the survival rate for transplant recipients has improved considerably.

These days, a virtual cross-match—where the antibodies in the recipient’s blood are crossmatched virtually with the donor’s antibodies— can determine ahead of time if a donor heart will be a safe match. This has significantly improved outcomes, by reducing rejection from circulating antibodies.

However, “even if everything looks great, sometimes when we put a new heart into someone, it doesn’t start or it feebly starts, but not enough to sustain life,” says Dr. Cusimano. But that’s no longer a death sentence. Thanks to advancements in technology, patients can be put on temporary mechanical circulatory support. “It takes the heart out of the equation and allows the heart to recover,” he says.

And, if a patient is deteriorating while on the transplant list and no other surgical options are available, often the medical team can surgically implant a mechanical support device called a left ventricular assist device (LVAD). This helps to support the patient until a donor heart becomes available.

These devices used to be completely donor funded by UHN Foundation donors. Now, after a decade of proven results in the field, they’re funded by the Ministry of Health in Ontario. However, donor funding is still imperative to advance research and to assist with the costs of equipment updates, such as battery replacement as well as medications.

That’s critical for patients like Michelle Rambarran, a two-time heart transplant recipient and patient of Dr. Cusimano. At 47 years old, Rambarran is living a healthy life because of the groundbreaking research, innovation and care at UHN.

Aside from advancements in technology, there have also been advancements in care, such as Medly—a 24/7 remote cardiac care platform cocreated by Dr. Joe Cafazzo, Executive Director of eHealth Innovation at UHN, and Dr. Heather Ross, Head of the Division of Cardiology at the Peter Munk Cardiac Centre and Scientific Lead for the Ted Rogers Centre for Heart Research and Loretta A. Rogers Chair in Heart Function.

The Medly program—also supported by philanthropy —is a heart failure management program providing remote cardiac care to more than 1,500 patients, allowing them to better manage their health with guidance and support from the UHN clinical team.

“Medly patients transmit their health data through a secure mobile app to Medly’s interactive platform. Medly gives direct feedback and our care team reviews and also helps guide care. In essence you’re getting feedback on a daily basis from the app and your care team,” says Stella Kozuszko, nurse practitioner and cardiac care nurse at the Peter Munk Cardiac Centre.

The platform encourages patients to take control of their heart health with self-care guidance and the ability to monitor symptoms; it also provides direct access to their care team. Patients submit daily readings and receive instant, actionable feedback via the in-app Medly algorithm.

If a patient has a question or concern, there’s a cardiac nurse at the other end of the app who can provide customized care—which could mean avoiding a trip to the emergency department if it’s not necessary. Or, a patient might be directed to a rapid cardiac assessment clinic, run by nurse practitioners.

Medly provides cardiac patients with a sense of security, says Kozuszko, and creates a circle of trust with their care team. “Our ultimate goal is to get them on the right mix of medications to help improve their cardiac function,” she says. “Medly allows us to titrate medication more effectively and efficiently reducing in-clinic visits. Reaching the optimal therapeutic dosage of medication as soon as possible improves outcomes for patients.”

Kozuszko, who started her nursing career in 1987, has seen how advancements in care have progressed over the years, thanks to research and innovation.

She’s always had a passion for cardiac care, getting a start in her career in the transplant program. Over the years, this has allowed her to meet “amazing patients like Michelle who inspired me every single day and who really put life into perspective,” she says. More recently, Kozuszko made the move to the Medly program—where patients who are Medly users are 50 per cent less likely to be re-hospitalized for their condition. And it can give them peace of mind from virtually anywhere, since they’re always connected to their care team, and their care team can intervene if necessary, in real time.

The use of Medly has cut down on the number of emergency visits, as well as the length of stay when patients are admitted. That’s because patients would often wait until their condition was much more serious before seeking help. With Medly, as soon as data is submitted, a patient can be assessed and triaged in real time.

A product development team is always optimizing the program based on patient feedback, so it continues to evolve to best serve the needs of patients. “The program is geared at keeping patients safe and ensuring that the patient is always the centre of their care team,” says Kozuszko.

Philanthropy is behind Medly—and behind many world-first achievements at UHN that are changing patients’ lives for the better.

When Dr. Cusimano looks back over the past 30 years, he sees how dramatically patient outcomes have changed, thanks to advancements in research, technology and innovative care methods—many of which have been developed by internationally renowned clinicians and scientists at the Peter Munk Cardiac Centre at UHN. And many of which thanks to ongoing donor support. “Compared to where we were before, it’s a completely different world,” he says.

To learn more about how you can make an impact for patients today and in the future, visit UHNfoundation.ca/givingtuesday.

“These are fighters, these are patients who will do anything to live another day.”

Stella Kozuszko, nurse practitioner and cardiac care nurse at the Peter Munk Cardiac Centre at UHN

GIVING TUESDAY

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2022-11-29T08:00:00.0000000Z

2022-11-29T08:00:00.0000000Z

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