Hearts in the right place

New risk reduction clinic points patients to healthier path

Story and photo by Greg Kennedy

EDMONTON — “I’d never seen a cardiologist in my life, or any doctor about my heart, until the day I went to the hospital with chest pains,” says Margaretha Salamon, a busy retiree and “Super Oma” to her grandchildren.

The 78-year-old Edmontonian was seen at the Chest Pain Clinic at Mazankowski Alberta Heart institute, and within hours was introduced to nurse practitioner Jissy Thomas, who helps to manage a new Alberta Health Services (AHS) clinic that aims to prevent heart attacks by identifying at-risk individuals early and helping them adopt a more heart-friendly lifestyle.

The Cardiovascular Risk Reduction Clinic, located at the Mazankowski Alberta Heart Institute, employs a nurse practitioner who identifies, treats and counsels adults who may need to cut cholesterol, ease high blood pressure, control diabetes, lose weight, quit smoking, eat better or beat depression. Without pre-emptive interventions, these individuals would be considered likely to have a heart attack in the future.

For Salamon, Thomas ran a battery of tests to assess her heart health and found her to be at high risk for a heart attack. She then gave Salamon the resources to manage her blood pressure, cholesterol, weight and blood sugar.

“These days, I feel really, really good,” says Salamon. “I’m just tickled pink with Jissy’s care. I followed her plan and today she tells me I’m her healthiest patient.”

Thomas conceived the idea for the risk-reduction clinic while working on an intensive care unit (ICU) earlier in her career.

“I kept seeing patients who kept coming into the ICU with major life events that could have been delayed or prevented if somebody had addressed their cardiovascular risk factors sooner,” says Thomas. “Work needs to start at the grassroots level to prevent heart attacks and, with this clinic, we aim to start at the beginning, before heart attacks happen.”

The clinic, piloted less than two years ago with a nurse practitioner, is now a permanent service at the Mazankowski Alberta Heart Institute, helping more than 200 patients to date.

Thomas says the clinic is likely to reduce capacity pressures, especially in emergency departments and operating rooms, down the road.

“With primary prevention, it’s hard to see tangible returns immediately.” she says. “It’s kind of like investing in mutual funds. It takes time but you eventually get some return. Communities become healthy because of the work that we do.”

Improving access to acute-care services, and increasing the involvement of nurse practitioners in the delivery of primary health care, are among the goals outlined in the 5-Year Health Action Plan, jointly developed by the Government of Alberta and AHS, and supported by the province’s stable, 5-year funding.

Nurse practitioners are highly qualified nurse specialists who are able to diagnose, order diagnostic tests, prescribe treatments and medications as they manage independent clinics and carry their own patient caseload.

Patients are typically referred to the clinic by emergency departments, the Mazankowski Chest Pain Program, cardiologists and family physicians. Thomas says many of these patients do not know they’re at risk of having a heart attack.

At the clinic, patients are diagnosed and their risk factors identified. An individualized care plan is developed that requires patients to become more involved in managing their health.

Clinic director Dr. Sean McMurtry says Thomas plays an integral role in the delivery of care at the Mazankowski Alberta Heart Institute.

“Having Jissy co-manage patients with risk factors enables our group to see many more patients than we could otherwise,” he says. “She helps us bring more care to more people, in order to keep more Albertans well.”