By Tanya Kavcic
July 3, 2012

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According to the Heart and Stroke Foundation, heart failure is a common medical condition that affects more than 500,000 Canadians. Since opening in 2006, St. Joseph's Health Centre's Heart Failure Clinic has grown substantially into a resource our patients rely on. Through our Clinic, we are able to provide patients with the tools they need to better manage their heart condition, improve their quality of life and help them avoid multiple trips to the Emergency Department.

After 40 years of caring for patients as an otolaryngologist (an ear, nose and throat surgeon) Dr. Robert MacDonald became a patient himself and has been coming to the Heart Failure Clinic since September 2011. Despite a successful open heart surgery, he developed atrial fibrillation triggering congestive heart failure.

"When I was sick I came here (to the Heart Failure Clinic) every three or four weeks. Now I come every three or four months. Every time I go I feel so much better and I've stayed on track with the regime they've provided me," said Robert. "I just can't say enough good things about it (the Clinic). It saved my life. I'm driving again and my big hope is I might be able to play golf this summer."

Dr. Mark Fisher is the Chief of Cardiology at St. Joseph's and works in the Heart Failure Clinic. "Our Clinic focuses on frequent flyer patients – people who have had recurrent heart failure and have made multiple trips to Emergency," he said. "We try to improve patients' quality of life through education to keep them out of the hospital."

Anyone can be referred to our Heart Failure Clinic. An initial assessment is conducted and if patients are appropriate candidates, they continue to work with the interprofessional team at the clinic. Patients are seen by a team of cardiologists, pharmacists, nurses, dieticians, physiotherapists and social workers.

"There is a lot of teaching that happens at the beginning and sometimes just that teaching makes a big difference," said Dr. Fisher. "Once the patient starts following the dietary advice they sometimes can lose a few kilograms up to 10 kilograms of edema (swelling) simply by being more conscious of their diet."

The Clinic's interprofessional team works to help patients and their families better understand and manage their condition. "When patients come to the Clinic we have four or five rooms for each patient. We (the care team) will rotate rooms and see each patient," said Dr. Fisher. "After we've all had a chance to see the patients we'll have group rounds and discuss each case. Some patients will be a brief discussion if they're doing well. In more complicated patients everyone on the team has an opportunity to give their input to modify the care plan."

Patients are taught how to detect early warning signs which might go unnoticed until their health conditions become unstable and they end up in the Emergency Department. If patients and their family members have concerns they can contact the Clinic and speak with the nurse clinician. For example, some patients who have issues with fluid retention will weigh themselves daily and if their weight increases, they are told to call the Clinic for medical advice. In more severe cases, hospitalization is required.

"The nurse clinician, Beata Pszczolkowski, is important in the Clinic because she's the person patients connect with by phone saying they're not doing well," said Dr. Anjali Anselm, a cardiologist at St. Joe's. "We try to keep space in our schedules so we can bring patients in immediately if needed in order to prevent them from having to go to Emergency. We try to do what we can to avoid hospitalization, if possible."

Roy Costa began receiving his followup treatment at the Clinic after undergoing open heart surgery to repair a blockage in the main artery of his heart. During his recovery, he discovered almost half of his father's side of the family had suffered from heart trouble.

As a realtor for 33 years, Roy has grown accustomed to working in a stressful environment. With the help of the Clinic, Roy is managing his heart problems through diet modifications, increased exercise and taking medication regularly. "I enjoy cooking and make a lot of my meals at home. I also quit smoking, which was one of the easiest things I've ever done," he said. "This is a second chance for me because I thought I was going to die. I think I cherish life a little bit more than the average person."

Heart failure usually develops gradually. It is a condition where the heart does not pump as strongly and/or does not relax as well as it should and the body does not get sufficient blood and oxygen to work properly. The weakened pumping action can cause a backup of fluid (congestion) in the lungs and other parts of the body. Without a proper oxygen supply and with congestion, people can feel tired and short of breath, develop swollen ankles and legs, experience sudden weight gain, loss or change in appetite and fluid buildup in the lungs.

"The number one goal for me is to make sure our patients' symptoms are controlled. A lot of our patients are elderly seniors and there's nothing that can be done for them in terms of surgery. We adjust their medications and encourage lifestyle modifications such as diet and exercise to minimize their symptoms," said Dr. Anselm. "We want to keep patients out of the hospital and prevent them from being admitted. Every day or month that they aren't admitted to hospital is an achievement for me."

For more information on St. Joseph's Heart Failure Clinic please speak to your family physician or contact St. Joseph's Ambulatory Care Centre at 416-530-6045.

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Page last updated: March 25, 2011