By Dave Yasvinski

Walter Koz had just returned from another camping trip in June 2023 when he noticed something unusual buried beneath the surface of his skin. The avid outdoorsman, a gravedigger by trade, was no stranger to ticks and the deadly risk of Lyme disease they can carry with them. He needed medical attention as soon as possible.

After failing to find the help he required at several walk-in clinics, the 57-year-old thought he would try his luck at Humber River Health, an innovative, patient-centred hospital near his home. While he was checking in, an intake nurse took his vitals and saw something that prompted her to send him for an electrocardiogram (ECG) while he waited for a doctor.

“I very quickly found myself in a bed hooked up to a bunch of different monitors,” Koz recalls. “As the evening progressed, my heart rate was very, very slow. They were concerned that maybe I was going to pass out or have a heart attack or something like that.”

Over the next four days, a battery of tests – overseen by a team of doctors – revealed that Koz did not have Lyme disease but bradycardia, a condition in which the heart beats more slowly than normal. An MRI would soon confirm that he needed a pacemaker to control the rhythm of his heart. He didn’t know it at the time, but he had come to the right place.

PUTTING PATIENTS FIRST

Humber’s cardiology program provides more than 25,000 patients per year – many from marginalized communities – with a full range of diagnostic services. This includes a rapid-assessment clinic that offers expedited assistance to patients who require immediate consultation upon release from the emergency department. Those who require longer-term care or more invasive procedures are sent to the sixth or seventh floors, where they receive state-of-the-art intensive care and 24/7 support.

To better serve patients, the hospital has embarked on a multidimensional strategy that will expand the impressive scope of services it already provides. This plan includes the creation of a cardiac catheterization lab (see sidebar) that will allow doctors to perform more complicated coronary procedures on site, and an expansion of its pacemaker program to incorporate the implantation of defibrillators.

“Our catchment area is full of heart failure patients,” says Dr. Syed (Najaf) Nadeem, Head of Cardiology at Humber. “Transportation is a major issue for many residents because they’re elderly and have comorbidities. Our goal is to bring comprehensive care closer to where they live.”

THE FUTURE IS FRIENDLY

Humber’s cardiology program has already been making waves thanks to the cutting-edge technology it brings to the operating table. This includes the hospital’s use of leadless pacemakers – tiny, self-contained units that are easier to implant inside the heart because they don’t have external components that can be tricky to attach and difficult to access after insertion.

“They work really well for patients who are at risk of infections or don’t have good vascular access,” says Dr. Douglas Ng, a cardiologist and one of the program’s device leads. “It’s certainly something we’ve been ahead of the curve on.”

The hospital has also been an early adopter of TeleVU, a communication tool built on a Smart Glasses platform. If a physician needs an assist during a complicated procedure, they can put on a special pair of glasses that will allow colleagues, trainees or any other vital personnel to easily observe and provide feedback from afar. Soon, a modified version of this technology will travel home with patients, where it will be able to connect with their pacemakers and send vital health information back to doctors.

“If we see there’s no fever, no issue with an ECG and the heart rate looks good, we can reassure the patient that they don’t need to come in,” Dr. Ng says. “It saves them the trip.”

Humber has also started using another type of pacemaker that was specifically designed with younger patients, such as Koz, in mind. Left bundle area pacing (LBAP) uses an advanced type of wiring that allows for a more natural, longer-lasting connection to the heart. Many cardiac centres don’t yet utilize LBAP, which means Koz would have gotten a regular pacemaker elsewhere.

“I know Walter well,” Dr. Ng says. “He’s quite young, but he had a heart block that required a pacemaker. This is one of those situations where he’s going to need decades of pacing. You can’t just put a regular pacemaker in. It won’t be enough for him. Luckily, the procedure was a success, and he continues to thrive.”

THE BEAT GOES ON

With his new pacemaker safely in place, Koz is back to digging graves – without the fear he might soon need one of his own.

“My care was top notch, and it has made a noticeable difference in my life,” he says. “I never thought I’d thank a tick, but that tick really helped me out.”

 

A new cardiac cath lab built for the future

A key component of Humber’s vision for the future is creating an on-site cardiac catheterization laboratory to support the health needs of people in northwest Toronto. The hospital has partnered with Toronto’s University Health Network to create a two-way cardiology corridor to provide training and mentorship to Humber staff.

“Currently, it can take around 60 minutes to send someone with a serious heart issue to another hospital,” explains Jhanvi Solanki, Humber’s Vice-President, Clinical Programs. “Every additional second compromises more of the heart’s myocardial tissue. By the time you get there, there may be irreversible damage.”

Once operational, Humber’s cath lab will provide patients with increased access to numerous vital cardiac interventions – such as angiograms and angioplasties – close to home. It will also attract a new generation of cardiology fellows and residents.

“This will put us in an ideal position to provide enhanced care while addressing any equity issues within our population,” Solanki says.

 

To read our full magazine, Care Closer to Home, click here.