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Cardiologist sees life-saving changes for heart attack patients

Mon October 29, 2012

Catherine Kells

By EDEN BOUTILIER
Staff writer

Dr. Catherine Kells has seen heart attack patients benefit from the development and refinement of two different treatments during the past two decades.

When she started practicing cardiology in 1990, she witnessed the use of thrombolytic drugs as one of the first systems to drastically reduce the mortality rates after a segment elevation myocardial infarction (STEMI) heart attack.

Dr. Kells said during the 1980s, mortality rates following a STEMI heart attack were about 20 per cent nationally. When thrombolytic drugs were introduced, the rates decreased to 10 to 15 per cent and stayed there – until now.

Currently the division head of cardiology at Capital District Health Authority, Dr. Kells reflected on her experiences in decreasing mortality through thrombolytic drugs to implement and continuously improve a second system that has seen impressive results – the primary Percutaneous Coronary Intervention (PCI) program.

Because of this program, the mortality for patients in Nova Scotia suffering major heart attack has dropped to below 10 per cent, and the average length of stay is now three to four days in hospital.

“These outcomes are now better than the Canadian average,” said Dr. Kells.

The Halifax-born Dr. Kells said she’s proud to offer exceptional services to the community she loves. She graduated from Dalhousie Medical School and did her postgraduate fellowship training in interventional cardiology, followed by a fellowship in heart transplantation at Stanford University Medical Center in California. She returned to Halifax and joined the Dalhousie Medical School faculty where she serves as a staff cardiologist and a professor of medicine. She’s also a consultant cardiologist to the IWK Health Centre.

In 2005, Dr. Kells and her team introduced, on a small scale, the primary (PCI) program in Nova Scotia. This procedure uses a balloon and a stent to open the blocked artery or arteries that caused the heart attack. The program has since expanded to all of Capital Health and, ultimately, to all patients within a 90-minute driving radius of the Halifax Infirmary cardiac catheterization laboratory.

This means, if responding paramedics feel they can be transported within 90 minutes, all patients with major STEMI heart attacks are taken directly to the cardiac catheterization laboratory where they’ll undergo a primary PCI.

Heart attack patients who are outside the 90-minute driving radius are treated with thrombolytic drugs, which can be very effective. However, 30 per cent of patients don’t respond to the drug so, in these cases, the province-wide Rescue PCI program has been implemented.

If the thrombolytic drugs haven’t been effective in stopping the heart attack at 90 minutes, then EHS is activated using LifeFlight and the patient is transported to the cardiac catheterization laboratory for emergency Rescue PCI.

“I had the privilege of witnessing not only the first system to change STEMI heart attack mortality rates through thrombolytic drugs, but playing a large role in introducing the second system, the primary PCI program, here in Nova Scotia,” said Dr. Kells.

A major attribute for the program’s success is province-wide communication among all parties involved. From the paramedics and EHS dispatcher to the on-call Interventional cardiologists and technicians, Dr. Kells said everyone plays a crucial role.

“It is an amazing example of what you can do in a small province when everyone works together,” she said.

As for the future, Dr. Kells and the cardiology division will continue to expand the Primary PCI program to service more Nova Scotians for the best outcomes. As mortality rates continue to decrease Dr. Kells is excited to see what the future may hold.