On behalf of the Cardiac Arrhythmia Network of Canada (CANet) community, I am pleased to report on our progress for the 2017/18 fiscal year of activity. The Network has reached several strategic milestones at this half-way point as we position ourselves not only as the world-leader in arrhythmia research and patient engagement but for Networks of Centres of Excellence (NCE) Network renewal.
CANet is pleased to report that it has projected to achieve the 5-10 year clinical goal set for the syncope track by Network renewal through the implementation of world-class research breakthroughs in the syncope track. Dr. Sheldon’s (Alberta) national team has found what is believed to be the first promising pharmaceutical drug for syncope treatment in the world. Dr. Raj (Alberta) and his team are training and educating clinicians, first-responders, and patients to identify and treat syncope more effectively. The syncope emergency department researcher group lead by Dr. Thiruganasambandamoorthy (Ontario) is implementing the Canadian Syncope Risk Score in 16 clinical practice sites across 4 provinces. We estimate that the economic impact toward achieving the syncope goal will result in a projected annual cost saving of millions of dollars to the Canadian healthcare system.
The patient voice and involvement are both critical to the success of research. In CANet, patients are not merely consulted but are active participating members of the research team. All funded Network projects have a patient co-lead that works collaboratively with the research team to develop protocols, milestones and to engage other patients to be involved. Patients are also part of the review process for the Network’s granting programs. CANet has developed what is aimed to become the Canadian standard for patient involvement in research/scientific review. Patients are active reviewers as part of the International Expert Advisory Committee (IEAC) with their own separate review and ranking procedure. Their reviews help dictate the research funding decisions in the Network.
CANet has achieved and exceeded our matching fund goal of $40M within the first 3 years of the Network. CANet has collectively brought in a committed amount of $45,540,876 of cash and in-kind funds from our industry, institutional and government partners. This is an overall leverage of $3.30 (partner matching) to $1 (NCE). This success is a clear example of the confidence that Canadian companies and organizations have in CANet and the community that it has created. As a prime example of helping to shape the growth of new Canadian companies, CANet has facilitated the hiring of over 180 new jobs at Baylis Medical.
Towards CANet’s HQP goals in the field of arrhythmia, the Networks HQP association has reached 252 registered trainees. CANet’s training programs address the whole arrhythmia ecosystem – it includes basic and clinical trainees, allied health professionals, clinical trial coordinators, junior and mid-career physicians, and also patients and caregivers. To date, 35 trainees have graduated from the program and are now CHAT Alumni with 22 (63% of CHAT graduates) obtaining full-time positions directly after completing the CHAT program.
At the core of the Network’s continued success are our growing connections with the best and brightest arrhythmia researchers in the world, our trainees, our fully engaged patients, and our partners. I hope that this annual report demonstrates our strong fiscal position through the progress we have made and continues to meet the level of excellence expected of the NCE Program.
Such as in previous years, CANet has continued to grow and establish itself as a leader in arrhythmia care research.
In the hope of carrying on the tradition of growth, the network has formed several new collaborative partnerships while maintaining the commitment to advance previously established technologies.
VIRTUES (Virtual Integrated Reliable Transformative User-Driven E-Health System), combines wearable biosensor technology, digital multi-media interfaces and validated analytics and simultaneously integrates system-driven validated physiological data into patient-specific, personalized context; and from this, develops an appropriate care plan. The VIRTUES technology will undoubtedly remodel the structure of care patients receive and allow for appropriate time and place care for those individuals using the technology. VIRTUES is a vital technological building block towards the realization of the transformation of care pathways in the management of arrhythmias.
CANet consists of world-class researchers and collaborative partnerships, but at its core is the inclusion of patients as integral members of all Network committees and councils. Not only does CANet’s model of patient engagement promote the growth of the network but ensures that patients are integrated into the design and implementation evolution of the Network’s strategic plan.
Moving forward, CANet is committed to facilitating the continual invention and implementation of new technologies and strategic solutions for all three research tracks.
Patient partners continue to help direct CANet-funded research projects towards advancements relevant and essential to them. These types of funded research projects have the most significant socioeconomic impact on Canada.
Our patient partners are involved in every aspect of the management and review processes as participants on all of our committees, including the Board of Directors.
Patient partners also participate in the review process for our Network’s research grant programs. In collaboration with the Centre of Excellence for Partnership with Patients and the Public (CEPPP), we have developed what is aimed to become the Canadian standard for patient involvement in research/scientific review. In addition, as part of the International Expert Advisory Committee (IEAC) patient partners participate as active reviewers with separate evaluation and ranking procedures.
In collaboration with CANet’s Patient Advisory Committee (PAC) and the CEPPP, patient partners have designed essential review criteria. As with scientific reviewers, patient reviewers comment and provide scoring based on:
Our patient review procedures and policies have been requested and are currently in the process of being adopted in other research funding networks and patient engagement initiatives across the country.
CANet is in the process of formalizing our standards as the best practice for national and international use.
Researchers have long sought a practical way of identifying individuals at risk for sudden cardiac death. An implantable defibrillator (modified pacemaker) effectively treats sudden death, but is expensive, invasive and reliable identification of patients at risk of sudden death has remained elusive.
In one of the largest clinical trials in the world to address this issue, Dr. Derek Exner (Alberta) is coordinating a multi-national study to definitively determine if an implantable defibrillator can be used to prevent death in patients after a heart attack. The trial has demonstrated that the combination of abnormal repolarization alternans (TWA) and impaired heart rate turbulence (HRT) measured after a myocardial infarction (MI) using a Holter monitor reliably identified patients at risk of cardiac death or cardiac arrest.
The results so far show the utility of these diagnostic tools to discriminate individuals at risk of sudden cardiac death such that of 694 subjects, the odds of death in patients with BOTH abnormal TWA & impaired HRT was 9-fold higher as compared with those patients without these abnormalities. The study will go on to determine if implantation of an ICD will reduce this risk. The world is watching and anxiously awaiting the result of this study as this may be the holy grail to reduce sudden cardiac from ventricular arrhythmia after a myocardial infarction.
Some Canadian hospitals are able to discharge 95% of acute atrial fibrillation (AAF) patients seen and treated in the Emergency Department (ED) whereas others admit up to 40% of similar patients.
Drs. Debra Eagles and Ian Stiell have developed a management strategy that improved the care of patients presenting to the ED with AAF, while decreasing unnecessary hospitalizations.
Piloted implementation of these guidelines at the Ottawa Hospital alone has resulted in a 3.5% admission rate to the ED with similar results from 10 other sites across the country, a significant marked reduction against the 40% historical national admission rate. These guidelines have now been adapted into an ED Best Practice Guideline.
Led by Dr. Venkatesh Thiruganasambandamoorthy (Ontario) and the Canadian syncope research group, the Canadian Syncope Risk Score (CSRS) optimizes the management of syncope patients by providing accurate Emergency Department (ED) risk-stratification for early disposition of the very-low to low-risk patients. This particular patient population is quite large and represents a needless burden on healthcare facilities and resources. Using the CSRS tool, clinicians and EMS can calculate the patient’s risk score electronically and determine the best course of action for response.
The validation study involving 3912 patients is complete, and the CSRS tool has begun implementation in 16 clinical practice sites across four provinces.
This tool when implemented will result in patients discharged quickly from the emergency department (within 2 hours) and is projected to save the healthcare system millions per year. Additionally, patients will be discharged home with cardiac monitoring devices providing a more efficient follow-up treatment plan.
Our investigator, Dr. Venkatesh Thiruganasambandamoorthy has been invited to be 1 of 4 plenary lectures at the Society for Academic Emergency Medicine (SAEM), the largest emergency medicine conference in the world, to disseminate the results of this tool and how to implement it in healthcare systems worldwide.
Healthcare clinics across the United States have also adopted the CSRS tool.
The current standard of practice for patients with symptomatic AF is to be treated with medication. When patients are intolerant or failed trials of several types of medication patients, the AF condition may have progressed further, some patients may be directed to receive an ablation with the intention to abolish AF.
In a national clinical trial involving 21 clinical practice sites across 6 provinces, Drs. Jason Andrade (British Columbia) and Atul Verma (Ontario) and many investigators in Canada are conducting a clinical trial, planning to recruit 300 patients to determine whether first-line treatment with ablation instead of starting with drug therapy will fix AF early in its course. Using this procedure early in a person’s condition could stop AF from reoccurring later in life–preventing premature deaths and saving the healthcare system hundreds of millions of dollars in direct and indirect costs. Patients who have the procedure go home within hours of the procedure and fully recovered within a couple of days.
To achieve this, the promising long-term solution uses a minimally invasive procedure – called cryoballoon ablation – that uses technologies developed and manufactured by Medtronic of Canada at their manufacturing facility in Montreal, along with tools developed and manufactured by Baylis Medical from Ontario.
Helping to foster the collaborative relationship between a mature, large company with a growing small-medium enterprise provides a form of industrial mentorship not typically seen in Canada.
A Canada first, industry competitors have become industry collaborators. Through the networking support of CANet, Dr. Jaimie Manlucu (Ontario) and her team of investigators have brought together Medtronic, Abbott (formally St. Jude Medical) and Baylis Medical to share resources and work collectively in this program to improve and effectively treat heart failure.In patients with heart failure, electrical activation of the heart can become slow and uncoordinated. This often makes heart function worse, which increases the risk of life-threatening heart rhythms, sudden death and hospitalization for heart failure.
“Cardiac Resynchronization Therapy” (CRT) is a special pacemaker-based therapy that has been shown to improve survival and quality of life in patients living with heart failure. However, patients with less severe electrical abnormalities do not seem to benefit as much from this innovative therapy. A modification of the treatment procedure is being piloted by seasoned and junior EP clinicians in over 12 centres across Canada and shows promise in helping these patients respond better to CRT.
This study will help identify the best way to treat heart failure patients so that they can live longer, feel better and stay out of hospital to remain productive members of the community.
With successful results to produce a cutting-edge treatment of vasovagal syncope (VVS) through a first-in-world trial of the experimental drug Atomoxetine, our investigator, Dr. Robert Sheldon (Alberta) has completed his research project.
Syncope affects around 50 percent of Canadians every year with several patients suffering from frequent episodes. It causes 1-3% of emergency department admissions overall with 43% being due to VVS. As of late, there have been no proven medical treatments to treat VVS, and it causes a substantial economic impact on the healthcare system (an estimated 418,000 visits yearly to family physicians and 39,000 – 100,000 visits annually to the emergency room).
The national pilot study (4 clinical practice sites across three provinces) has shown a significant reduction of the occurrence of VVS for patients using Atomoxetine compared to those that received a placebo treatment. This result has shown a strong biomedical and clinical rationale to expand into a larger randomized clinical trial of Atomoxetine for the prevention of VVS.
The physiologic data gained will provide invaluable insight into the mechanism of action of Atomoxetine in preventing Syncope.
Cardiac arrest is often the first symptom of cardiac disease for the victims. Eighty-five percent of victims collapse in their own home and fifty percent collapse in the presence of a family member.
Bystander cardiopulmonary resuscitation (CPR) can improve the chance to survive a cardiac arrest by three to four times but needs to be started quickly. Unfortunately, in most communities, less than 30% of victims receive CPR before the ambulance arrives. Currently, only 8% of cardiac arrest victims leave the hospital alive. So far, the only thing that has increased the initiation of CPR is when 9-1-1 attendants started to give CPR instructions to callers over the phone.
The only problem is that about 25% of cardiac arrest victims gasp for air in the first few minutes and can fool the 9-1-1 callers and attendants into thinking that the victim is still alive.
Dr. Christian Vaillancourt’s (Ontario) team of investigators are helping 9-1-1 attendants save the lives of cardiac arrest victims across Canada by implementing a teaching tool which will allow attendants to recognize abnormal breathing characteristic of cardiac arrest immediately.
Working alongside IBM Watson algorithm specialists, the next step will be to use artificial intelligence technique to listen to 9-1-1 calls involving cardiac arrest victims and learn audio cues from victims revolving around abnormal breathing. In comparing these audio cues to thousands of other victim reactions in real-time, the machine-learned algorithm would be able to substantially reduce the time required for a 9-1-1 attendant to identify and determine abnormal breathing from a cardiac arrest victim and administer an effective first action response.
The Network’s multidisciplinary and multi-sectoral highly qualified personnel (HQP) training programs continue to evolve to match the changing research landscape.
We have basic and clinical trainees, allied health professionals, clinical trial coordinators, junior and mid-career physicians, and also patients and caregivers as part of our growing trainee program.
The Training and Education Committee (TEC), alongside CANet HQP Association for Trainees (CHAT) and the CHAT Executive Committee, has helped to ensure that the Network and its HQP continuously identify gaps and develop solutions to value-add to current University education and professional development programs. Our National Development Program strengthens existing institutional programs by adding elements that cannot be implemented due to either limited resources or the inability to initiate cross-institutional programs.
With 252 registered trainees, 126 represent students whereas the remaining represent Early Investigators and Allied Health Professionals/Research Professionals whom already have obtained employment.
Successfully, 28% have graduated from the trainee program and are now CHAT Alumni.
Our remaining graduates have re-entered the education system and continue with CANet training initiatives to strengthen their skills for employment.
Coinciding with the expansion of network activities our Integrated Knowledge Translation (KT) strategy was modified to meet the needs of our expanding Network.
Working with the Network’s KT consultants, Ms. Pamela Fuselli and Dr. Melanie Barwick, the Integrated KT strategy was enhanced to support the development of implementation strategies. The application of the Network Integrated KT strategy is operationalized through the review process completed by the Research Management Committee (RMC) and the International Expert Advisory Committee (IEAC). Supported by this review process and the Director of Partnerships and KT at CANet, the KT activities outlined in the proposals are integrated into KT milestone tracking and reported as part of the Network Milestone Tracker.
Our process ensures that our Integrated KT strategy supports the ongoing translation activities of all Network research projects.
A key success of our Integrated KT Strategy is demonstrated through the implementation of the Patient Engagement and Empowerment (PE2) Strategy.
The goal of the implementation of the PE2 strategy is the creation of new patient-driven healthcare models.
This novel patient and caregiver strategy is the first to be developed and implemented among the Networks of Centres of Excellence.
Multiple healthcare organizations such as the Ministry of Health and Long-Term Care, CorHealth and Plexxus have approached CANet to support the integration of patient engagement in a provincial implantable cardiac defibrillator and cardioverter resynchronization therapy procurement process.
The PE2 strategy has been shared through presentations across the country and recently presented to other funded NCE’s.
The PE2 strategy has resulted in another network (working with clinical researchers) approaching us to use the Networks patient engagement strategies and tools developed to develop further engagement strategies.
Through funded research projects and Network initiatives, an expansion in the definition of CANet’s knowledge users has been realized. In addition to targeted academic users, the definition of a Network end-user was broadened to include key stakeholders, gatekeepers and knowledge users that will facilitate change in practice.
An important mechanism in the promotion of the adoption of interventions within clinical settings is CANet’s Expert Knowledge Exchange (EKE) initiative.
This provides an opportunity for patients, policy representatives, not-for-profit organizations to learn, collaborate and support the implementation of Network research. Each EKE event is paired with a knowledge translation goal and the outcomes of the event are integrated with the implementation plan for Network research.
This successful event brought together health care professionals and health leaders from seven provincial Ministries of Health to discuss the operationalization of evidence-based practice within healthcare settings.
National implementation would not be possible without this instrumental working group.
This event brought together the following communities of practice: Canadian Foundation for Healthcare Improvement, The Change Foundation, Health Quality Ontario. Cancer Care Ontario, Canadian Institutes of Health Research – Supporting Patient-Oriented Research Unit, Canadian Partnership Against Cancer.
These organizations are actively engaged in supporting patient and caregiver engagement and share common discussion points around remuneration and the demonstration of the impact of patient engagement through evaluation.
CANet has collectively brought in a committed amount of $45,540,876 of cash and in-kind funds from our industry, institutional and government partners. As matching funds are a requirement for several of our funding programs, we expect our matching funds to continue to increase into the end of our first NCE funding term.
Our mature partners including Medtronic, Abbot, Boston Scientific, and IBM, continue to play a significant role in our research programs. Several of our partners (from small to large enterprises) are also participants of our committees. With our partners support, our Network has jump-started world-leading research initiatives such as VIRTUES and Heart-SIGN, as well as, several Network-funded projects.
Our most notable successes have come from the growth of upcoming and new Canadian companies through CANet’s support and networking initiatives.
Through our research partnership, Baylis Medical Inc. has recently announced a new partnership with the Government of Ontario to open a state-of-the-art Baylis Medical Innovation Centre, a new facility that will allow the company to advance its research and development (R&D) efforts, significantly grow its product line (including an innovative radio frequency (RF) needle used in CANet-funded programs such as EARLY-AF and RAFT-LVEndo) and its workforce.
Daniel Gelman (CEO, President of Aufero Medical), a recipient of our pre-investigator grant awards – CHAT Discovery – which provided the funds to initiate his research program during his Ph.D. The results accelerated his timeline and Daniel incorporated in 2017.
Working in collaboration with other CANet investigators, he is now a Co-principal investigator for one of our commercialization grants, contributing matching funds from his company to support additional CANet research initiatives.
Over 200 attendees (clinicians, researchers, trainees, patients, government and industry partners) participated in our Anual Scientific Conference held in Halifax, NS, September 14-15, 2017. With considerable support and sponsorship from our partners including Bayer, Medtronic Canada, Boston Scientific, Abbott (formally St. Jude Medical), Bristol-Myers Squibb Pfizer, Biosense Webster, and Baylis Medical we continue to grow our audience, facilitate essential workshops, and showcase the research advancements and impacts to the arrhythmia community.
With our goals of training and mentoring the future of CANet, our HQP, the conference Awards Dinner Gala continues to engage the entire arrhythmia community with an interactive event featuring presentations from finalists for our CHAT Discovery Program. The CHAT Discovery grant is a program in which trainees are provided experience (with the help of a mentor) in being a principal investigator during their education. During dinner, conference attendees partake in the presentations and vote to determine the winner of the grant competition.
VIRTUES was demonstrated in real-time at this year’s conference. During the on-site demonstration, Dr. Allan Skanes in real-time received the ECG of a patient located in London, Ontario. Dr. Skanes communicated with the patient via video teleconference and provided diagnosis and viable treatment options.
The platform is set to be piloted in a multi-centre, multi-provincial study. Three different sites located in Ontario, Nova Scotia, and British Columbia will each conduct a 100 patient pilot study to test the platform and assess patient satisfaction with the care received through the platform.
With our track captains facilitating engagement throughout the conference activities, our Network continues to bring national and international cross-collaboration at our Annual Scientific Conference and Public Forum.
Eager to learn more about arrhythmia research, treatment, and care, over 170 patients participated in the 2nd annual Public Forum. Dr. Sam Sears, an internationally-recognized expert on the psychological care and quality-of-life outcomes of patients with implantable cardioverter defibrillators, presented Making Your Cardiac Comeback. The presentation was an engaging, entertaining and enlightening look at how patients and caregivers cope with life after a severe cardiac event. The Public Forum also featured interactive booths provided by The Heart & Stroke Foundation. Attendees lined up to see the attendants demonstrate how to use an automated external defibrillator and how to perform CPR.
We continue to expand our Annual Scientific Conference and Public Forum as part of our on-going efforts to unite patients across the country and promote Canada as the foremost leader in patient engagement in research.
With our strategic communications goals, we continue to enhance and increase public engagement and recognition, by highlighting our successes through the Network’s impactful communication vehicles.
Over the past year, we have seen a vast uptake in our social media following, online presence at our revised web portals, and response for further inquiries as we continue to deliver frequent updates, stories and a variety of online and offline media including our new ‘On Track’ publication.
For the year ended March 31, 2018, with comparative information for 2017
|Networks of Centres of Excellence (NCE)||Non-funding Agencies||2018||2017|
|Amortization of deferred capital contributions||-||148,630||148,630||148,630|
|Research grants and awards||5,044,912||-||5,044,912||2,461,836|
|Salaries and benefits||832,573||-||832,573||756,079|
|HQP training and awards||449,767||2,400||452,167||435,097|
|Travel, networking and workshop||189,968||37,667||227,635||185,438|
|Annual scientific conference||155,687||-||155,687||137,696|
|Audit and professional fees||29,299||18,055||47,355||26,860|
|Supplies and other||21,419||3,348||24,767||28,196|
|Excess of revenue over expenses||-||204,894||204,894||193,359|
|Net assets, beginning of year||-||372,454||372,454||179,095|
|Excess of revenue over expenses||-||204,894||204,894||193,359|
|Net assets, end of year||-||577,348||577,348||372,454|
Dr. Pierre Boyle (C)
Chair, Board of Directors
Ms. Krista Connell
CEO, Nova Scotia Health Research Foundation
Dr. John Capone
Vice President, Research, Western University
Dr. Shurjeel Choudhri
Senior Vice President, Bayer Canada
Mr. Vincent Dumez
PAC Chair, Co-Director, Office of Collaboration and Patient Partnership, Universite de Montreal
Mr. Neil Fraser
President and CEO,
Medtronic Canada Ltd.
Dr. Paul Morley
Founder & Chief Science Officer,
Dr. François Philippon
Institut Univérsitaire de Cardiologie et de Pneumologie de Québec
Mr. Michael Gilbert
President and CEO, Synergiq Solutions
Dr. Katherine Allan (OBS)
Dr. Anthony Tang
Scientific Director and CEO
Dr. George Wells (OBS)
Associate Scientific Director
Dr. Bryce Pickard (OBS)
Managing Director and COO
Dr. Anthony Tang
Scientific Director and CEO
Dr. George Wells
Associate Scientific Director
Dr. Bryce Pickard
Managing Director and COO
Dr. Kevin O’Neil
Director of Research and Training
Dr. Natalie Szudy
Director of Partnerships and Knowledge Mobilization
Fabian A. Folias
Director of Digital Marketing and Communications
Director of Finance
Dr. Dimitri Popolov
Research Data and Systems Manager
The Cardiac Arrhythmia Network of Canada (CANet) is a not-for-profit organization dedicated to transforming Canada’s arrhythmia health care system through integrated trans-disciplinary research and development. The network’s strategy is to invent, prove, and implement innovative solutions to enable patients to take ownership and co-manage their arrhythmia health.
CANet is funded by the federal government’s Networks of Centres of Excellence (NCE), Canada’s flagship science and technology program and housed at the Schulich School of Medicine & Dentistry at Western University.