I am pleased to report that the Network continues to move aggressively towards the achievement of the goals outlined in our Strategic Plan. The success of CANet is the direct result of many disciplines coming together to collaborate and learn from one another to help propel arrhythmia research in Canada and beyond.
The integration of patient-driven research initiatives and technologies highlighted within VIRTUES will improve the access, quality, and cost of healthcare for all Canadians with an arrhythmia condition. We have partnered with world-class researchers, full engaged patients, academic institutions and industry partners and their participation is a clear example of the confidence that Canadian companies and organizations have in CANet and the community that it has created.
We are committed to world-class patient-focused excellence in research; international collaborations; and solutions-driven outcomes that will impact the lives of the millions of Canadians suffering from Arrhythmia-related illnesses. We look forward to seeing the positive outcomes of the novel, interdisciplinary research that’s happening in our Network.
The Network continues to demonstrate research excellence through the facilitation and funding of multi-disciplinary, multi-provincial, and multi-sectoral collaborative projects that help to position Canada at the forefront as a leader in arrhythmia research and patient engagement.
CANet is committed to empowering patients to manage their health through the development of VIRTUES (Virtual Integrated Reliable Transformative User-Driven E-Health System), a technology that will undoubtedly remodel the structure of care patients receive and allow for appropriate time and place care for arrhythmia patients. VIRTUES is a vital technological building block towards the realization of the transformation of care pathways in the management of arrhythmias.
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. Moving forward, CANet is committed to facilitating the continual invention and implementation of new technologies and strategic solutions.
21,250 Patients Active In Research Programs
VIRTUES provides personalized health care delivery, empowerment, and ownership for each patient to co-manage their health. Resources, including health education, are uniquely tailored to the individual.
VIRTUES is a leading-edge data platform designed by CANet that provides patients a cloud-based electronic health record that is owned by the patient and can be accessed by their healthcare providers. Combining mobile electrocardiographic monitoring, wearable/implantable technology, and digital smartphones and tablets,
VIRTUES will track a patient’s symptoms along with real-time data and medical information into a patient-specific, personalized clinical context for patients and medical professionals. It is constructed with the utmost in privacy and security safeguards.
The implementation of VIRTUES improves the access, quality, and cost of healthcare for all Canadians with an arrhythmia condition.
VIRTUES is the means to transform arrhythmia care to provide effective, efficient and accessible care to all Canadians and is the vehicle by which CANet’s research will be disseminated.
CANet’s innovative research program is designed to ensure excellence through iterative mentorship and growth. These core principles are the foundation upon which the Network’s funding programs and review processes are built.
All proposals considered for CANet-funding must be multidisciplinary (more than one, i.e. medicine, engineering, and social science); multi-centered (more than one institution, from more than one province); and multisectoral (more than one sector, i.e. academia, clinical, industry, government, not-for-profit, general public and patients). Our programs meet the expectations of a true pan-Canadian Network, utilizing the strengths across the country and encouraging the building of national research and development capacity.
SCD is a sudden, unexpected death most commonly caused by a lethal arrhythmia.
A defibrillator shock is the only effective means to terminate the lethal arrhythmia. Currently, the only way to identify an individual at risk of SCD is to measure the heart function – left ventricular ejection fraction (LVEF). Although guidelines recommend LVEF measurement in patients after surviving a myocardial infarction (MI), it is rarely performed. As a result, many patients at-risk of SCD are not identified and are not treated appropriately to avoid SCD.
There are currently 13 national CANet-funded programs associated with SCD. CANet is on schedule to achieve a 10% drop of SCD in at-risk individuals and we continue development and implementation these programs.
AF is the most common heart rhythm disorder and has become an epidemic in the developed and developing world.
AF will affect 1 in 4 Canadians. AF increasing prevalence is due to the aging population, improved detection, and increased risk factors. It leads to impaired quality of life, lost productivity, a 5-fold increase in the risk of disabling stroke, and a doubling in the risk of death.
There are currently 12 CANet-funded AF programs. We are ahead of schedule in achieving a 20% drop of AF hospitalization and ED visits. The (AAF-ED) program has demonstrated >20% reduction of hospitalization in a few centres that have implemented the strategy. Implementing this strategy nationally will result in achieving our clinical goal of 20% reduction in AF related hospitalization.
In addition, the EARLY AF program, the life-style modification program, and the Virtual AF Care program will provide better AF care, thus preventing long-term consequence of AF and reducing ED visits.
Syncope affects ~50% of Canadian, causes 1-3% of ED admissions overall with 43% being due to vasovagal syncope (VVS).
These individuals are at very low risk of adverse events. The challenge is to differentiate those with VVS from patients with causes of syncope at high risk of adverse events.
There are currently 8 CANet-funded national programs associated with syncope propelling CANet ahead of schedule in achieving a 30% drop of syncope-related hospitalization and ED visits. When the Canadian Syncope Risk Score (CSRS) in conjugation with emergency medical services (CASMER) were applied to several ED and regions, hospital admissions were reduced by 16% and ER visits were reduced by 34%.
With the implementation of these programs nationally coupling with the application of Virtual Syncope Care, and the promise of a drug that may greatly reduce VVS, we are confident that syncope related ED visits and hospitalization will be reduced.
To maintain the same multidisciplinary and multi-sectoral approach inherent in the Network’s research excellence, CANet’s education and career development program, known as CHAT (CANet Highly Qualified Personnel Association of Trainees) is collaborative by design. In addition to directed training programs, CHAT facilitates programs designed to bring members of different fields together, promoting cross-disciplinary and cross-sector collaboration. As CANet’s CHAT program matures, the program has come to a stage where the Network has formed the first CHAT Alumni Association for trainees that have graduated. The alumni will play a prominent role in the Network’s training as mentors and facilitators as part of CHAT’s Legacy Program.
The CANet HQP program is constantly shaped by the evolving needs of its trainees, Network members, and partners. A yearly needs assessment is conducted with all other public and private stakeholders in our Network. CANet continually adapts and tailors its educational offerings to address any gaps in qualifications/skillsets of the HQPs. Feedback received assures that our graduating HQP possess the necessary knowledge to be successful in obtaining employment or advancing their education.
At its core, the Network continues to emphasize the importance of nation-wide research collaboration with colleagues, partners, and patients early in HQP development to ensure that this concept is implemented into their future professional careers. Nation-wide collaboration is crucial for the growth of national teams and is in alignment with Canada’s evolving funding environment focusing on multi-disciplinary and multi-sectoral, rather than siloed research.
The Network has 304 HQP trainees enrolled in the CANet HQP association. CANet has committed $6,779,991 in HQP initiatives (salaries, training initiatives and grants) since 2014.
HQP include: 38 undergraduates, 50 graduates, 27 medical residents, 39 PDF/clinical fellows and 135 allied health research professionals.
In addition, CANet supports 15 early career/junior investigators. Out of 304 members, 154 are students (54, 35% have graduated and are HQP Alumni). Upon completing the CANet HQP programs, 38 (70%) have obtained full time positions.
• 300 active members in CHAT
• 34 new careers launched in public and private sector
• 112 courses and workshops held
• 2040 HQP trained
Knowledge Mobilization: Implementation Research
CANet’s integrated KT strategy was developed at its inception, which has served well for the initiation of many research programs. The integrated KT strategy has been enhanced to embrace implementation strategies, including the development of the KT milestone tracking. This process ensures that CANet’s integrated KT strategy supports the ongoing translation activities of the research projects.
Currently, several programs/projects are completing knowledge generation activities and have progressed to knowledge mobilization with implementation research.
Four research projects are currently initiating regional and provincial implementation activities.
The Canadian Syncope Risk Score (CSRS) was developed and is being implemented in 16 sites across 4 provinces. The CSRS is being adopted in clinical practice sites in the United States and is receiving strong support for world-wide implementation. The CSRS project was chosen as 1 of only 4 plenary lectures presented at the 2018 Society of Academic Emergency Medicine Conference.
Ventricular tachycardia/fibrillation (VT/VF) are the lethal arrhythmias leading to SCD. A Canadian-led clinical trial VANISH has demonstrated that catheter ablation is superior than additional antiarrhythmic drug (AAD) therapy to prevent recurrent VT. The results of this study are being incorporated into guidelines of the American Heart Association (AHA), American College of Cardiology (ACC), and the Heart Rhythm Society (HRS). CANet’s implementation strategy was instrumental in developing educational materials resulting in practice change.
The AAF (acute AF)-ED study has developed a management strategy that was demonstrated to improve patient care in the ED and decrease hospitalization. As of March 2018, this management strategy has been adapted into the ED Best Practice Guidelines. The implementation of this strategy into practice in Canada is expected to improve the management of patients in the ED and decrease the need for admission to the hospital.
The CASMER study has adapted the Canadian Syncope Risk Score (CSRS) guidelines to develop a simple checklist for paramedics to determine whether the syncope patient is at low-risk. A training module has been created and is being used by the paramedics in Alberta. This “Treat & Release protocol” will decrease the clinical burden on ED, reduce healthcare costs. The project has progressed to the implementation research phase.
42 Health Inc. – A Transcutaneous Physiologic Sensor for Home and Clinical Use (2 patents filed)
42 Health Inc (CANet funded start-up) is developing a small wearable transcutaneous blood pressure (BP) monitor device that weighs a fraction of an ounce. The device measures the BP of every heartbeat, measures blood oxygen levels, can detect when one falls, stores episodes of arrhythmias, and does this wirelessly. The digital data is transmitted to other devices, such as a smart phone. The company has filed 2 patent applications and is currently being incubated at the University of Calgary.
An Accurate Simple Blood Test for Arrhythmogenic Cardiomyopathy (1 patent filed)
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart rhythm disorder which is responsible for 11% of sudden death in adults, 22% in athletes, and 25% in children. ARVC is difficult to diagnose with current clinical or genetic testing. A novel biomarker has been identified and simple, accurate blood test for ARVC has been created. The biomarker is currently undergoing large scale specificity and sensitivity testing.
Aufero Medical Technologies – Catheter Contact-Force Controller for Cardiac Ablation Therapy (1 patent filed)
Aufero Medical (CANet funded start-up) has developed a Catheter Contact-Force Controller (CFC) device that can be used in conjunction with standard catheters to instantaneously adjust the catheter position and control contact force. This technology will greatly improve the ablation procedure for atrial fibrillation and will reduce AF recurrence after ablation. The technology is ready for human use. The company is actively fundraising to advance the device to clinical trials.
Conavi Medical – Catheter-based Imaging Tools for Characterization of Myocardial Ablation Lesions (1 patent filed)
By coupling ablations with state-of-the-art imaging methods, such as high-resolution ultrasound, physicians are able to visualize the site of the catheter ablation in the heart in real-time to improve the outcomes of the procedure by more effectively destroying the abnormal tissue that is causing the heart rhythm problem. The prototype is ready for clinical testing.
Drone-Delivered Automated External Defibrillator (AED)
Drone-delivered AED and drug therapy to improve survival of cardiac arrest victims can save lives. This technology has been developed in collaboration with Drone Delivery Canada. Pilot study for drone-delivered AED to cardiac arrest site is ongoing.
EARLY-AF – Cryo-balloon Technology for Ablation
This CANet research project has enhanced the adoption of two Canadian invention and manufactured tools. The use of cryo-balloon for AF ablation procedure and the utilization of transseptal radiofrequency puncture tool have increased substantially in Canada and internationally, resulting is new manufacturing and marketing jobs created in Canada (~200 new jobs created at Baylis Medical, and > 200 new jobs at CryoCath-Medtronic in Quebec).
CANet has achieved and exceeded our matching fund goal of $40M within the first 4 years of the Network. CANet has brought in $45,540,876 of cash and in-kind funds from our industry and institutional partners: an overall research leverage of 3.30 (partner matching dollars) to 1 (NCE/CANet research dollar). CANet is proud to bring together provincial partnerships including nine provinces and one territory. CANet has grown exponentially in private sector and community (medical institutions, clinics, government, public sector) partnerships. Since the original application for NCE funding, private sector involvement has grown 300% and community involvement (hospitals, government, public sector) has grown 225%.
Through the Network’s investigators and their research accomplishment, there is international awareness, engagement, and collaboration. Our Network reach includes international investigators from USA, Brazil, Columbia, Argentina, Germany, France, Italy, Belgium, Netherlands, Norway, Finland, Sweden, UK, Poland, Spain, Saudi Arabia, India, China, Hong Kong, Australia, New Zealand, Malaysia, Singapore, and Japan.
Driven by the Network vision of a transformed, patient-driven arrhythmia care, CANet embraces patients as partners. While healthcare professions are experts at treating disease, patients are experts at living with their diseases. Combining the expertise from both healthcare professionals and patients is the key to the impactful and imaginative use of healthcare resources and research funding. The voices and involvement of patients are critical to the success of CANet. In CANet, patients are not just consulted but are active partners in every aspect of the Network.
Patients are co-PIs of each research team: All research in CANet must have a patient co-lead to develop protocols, set milestones, and engage other patients. Patients facilitate the direction of research such that the research is relevant and important to them.
Patients are involved in the governance and management of CANet: Patient partners are members on all CANet committees. Patients are an integral part of the review process for CANet funding initiatives as active reviewers with their own separate review and ranking procedure that they have designed.
Patient partnership is at the core of CANet’s strategic plan: CANet created the Patient Engagement and Empowerment (PE2) strategy, facilitated by the Patient Advisory Committee (PAC). The PAC is composed entirely of patients with AF, syncope, or are at risk of SCD. CANet has been approached by other healthcare organizations such as the Ontario Ministry of Health and Long-Term Care to integrate our patient engagement strategy into the Ontario provincial implantable cardiac defibrillator and cardioverter resynchronization therapy procurement process.
In partnership with patients and in accordance with CANet’s vision, the Network has created a patient-driven healthcare model – VIRTUES (Virtual Integrated Reliable Transformative User‐Driven E‐Health System) (see Section 3C for more details).
Provincial Government Partners – Provincial government leaders from seven provinces (BC, AB, SK, MB, ON, QC, NS) were consulted at the inception of CANet. Provincial representatives are continually informed of all the R&D of the Network through a bi-annual provincial round table forum. The key outcomes have been the identification of implementation strategies necessary for the translation of CANet research into practice and the development of terms of reference to guide the implementation of best practices. These sessions also facilitate communication across provinces through the identification of connections between provincial mandates. CANet is proud to report that this provincial partner involvement has now expanded to nine provinces (NB, NL) and one territory (NU).
The traditional approach to industry partnerships is either “industry-initiated” research in which researchers agree to participate and include their patients, or “investigator-initiated” research projects that industry would agree to fund. CANet set out to replace this traditional approach with a more collaborative R&D environment. At CANet, industry partners are engaged in the early stages of research conception and are integral to the development of proposals. R&D is co-developed with our partners. This approach facilitates not only achieving CANet strategic goals, but also in expanding the R&D goals of Small and Medium Enterprises (SME’s). An example is the expansion of Baylis Medical, a Canadian SME to open a state-of-the-art Medical Innovation Centre. The new facility will allow Baylis Medical to advance its R&D efforts and significantly expand its product line and workforce. Through our partnership, Baylis Medical has hired over 180 new employees. By promoting a collaborative research environment, traditional industry competitors have become industry collaborators in the medical device field. Through the networking support of CANet, Abbott, Boston Scientific, Medtronic, and Baylis Medical share resources and work collectively on several CANet research projects.
Annual Scientific Conference
It was another successful Annual Scientific Conference held in Ottawa, Ontario, September 2018, documenting a growing turnout of attendees including patient, industry and provincial partners, network investigators, trainees and members of our board.
Hosted by Adrian Harewood (CBC News, Ottawa), our Public Forum featured a very impactful armchair discussion which included panelists Emile Therien and Stephen Blais describing how arrhythmia has personally touched their lives. New this year, the forum was live streamed allowing online viewing and participation. Members of the community joined us on site for the interactive session which was a significant lead into conference day one.
André Picard, the award-winning national-health writer for the Globe & Mail, was the opening keynote speaker of the ASC and provided a compelling perspective on Canadian healthcare. Our panel discussion informed attendees of unmet challenges of cardiac implantable electrical devices. Conference host, Dr. Calum Redpath (Cardiologist, University of Ottawa Heart Institute) was joined by patients partners to provide a demonstration of VIRTUES displaying the interaction between mobile devices and the cloud-based platform. Dr. Phillip Cuculich (Cardiologist, Washington University) captured the attention of the audience with his in-depth presentation on arrhythmia-related innovation. Cuculich presented some of the research and findings he developed collaboratively with radiation oncologists that resulted in a noninvasive method to map and treat heart rhythm disorders using technology typically used for treating certain forms of cancer.
For the year ended March 31, 2019, with comparative information for 2018
|Networks of Centres of Excellence (NCE)||Non-funding Agencies||2019||2018|
|Amortization of deferred capital contributions||-||148,630||148,630||148,630|
|Research grants and awards||2,756,686||-||2,756,686||5,044,912|
|Salaries and benefits||864,036||-||864,036||832,573|
|HQP training and awards||420,988||2,200||423,188||452,167|
|Travel, networking and workshop||525,303||14,790||540,094||227,635|
|Annual scientific conference||156,073||-||156,073||155,687|
|Audit and professional fees||37,788||8,226||46,014||47,355|
|Supplies and other||19,075||7,208||26,283||24,767|
|Excess of revenue over expenses||-||160,959||160,959||204,894|
|Net assets, beginning of year||-||577,348||577,348||372,454|
|Excess of revenue over expenses||-||160,959||160,959||204,894|
|Net assets, end of year||-||738,306||738,306||577,348|
Board of Directors
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.