The uOttawa Heart Institute is going to the community to find, and treat, people with undiagnosed heart disease.
Up to three times a week, health workers pack mobile equipment and tests into the back of a vehicle and take the uOttawa Heart Institute on the road. The goal? To find people in the community living with undiagnosed heart disease and help them get the treatment they need.
The Heart Institute’s mobile screening program for valvular heart disease is the only one of its kind in Canada and it is beginning to draw attention from across the country, says cardiologist Dr. David Messika-Zeitoun, director of the Centre for Valvular Disease at the Heart Institute, who oversees the program.
This week, nurse specialist Katherine Dagg and others involved with the program, introduced it in the form of a poster presentation at the Canadian Cardiovascular Society annual meeting in Vancouver.
“Despite being the next epidemic in cardiovascular disease, valvular heart disease has a low public awareness, is underdiagnosed, undertreated and referred too late in the disease course,” wrote the authors.
Research has begun to measure the impact of the program. And its organizers are already thinking bigger. Fundraising is underway to purchase and retrofit a bus that could allow the mobile screening program to operate anywhere in the region, with the needed technical equipment already on board, something like a bookmobile, or bloodmobile.
Since it started in 2023, the nurse-led screening program has set up in retirement homes, community centres, malls and residential buildings. Patients are given echocardiograms to test for heart valve issues and other irregularities and blood tests to screen for high cholesterol and diabetes. Program staff also screen for heart disease risk factors such as weight, smoking and high blood pressure. Anyone over 65 can make an appointment or walk in to the clinic, if there is space.
Evening Update
At a recent clinic at an Orléans community centre, patients waited in the hallway for 30-minute appointments. The clinic, operated by a nurse, a sonographer and others, can screen up to 20 people a day.
The novel program serves an unmet need in the community, said Messika-Zeitoun.
Heart valve disease is common, especially as people age, he said. By age 75 it is estimated that 10 per cent of people have valvular heart disease — meaning one or more of their heart valves is not opening and closing properly.
“More critically, we know that patients with valvular heart disease are under-detected and under-treated and present late in the course of the disease,” said Messika-Zeitoun.
“It’s a huge proportion of patients that have some degree of valvular heart disease and are not aware of it.” And Messika-Zeitoun said that being diagnosed late increases the risk for bad outcomes, including death.
Heart valve disease, in its earlier stages, can cause unspecific symptoms such as shortness of breath or few symptoms, allowing it to go undetected without screening.
The clinic also screens for other heart disease risk factors, including obesity, smoking, high blood pressure, diabetes and high cholesterol.
“Since we were doing screening in the population we said, it would be a missed opportunity not to screen for cardiovascular risk factors,” said Messika-Zeitoun.
Since it started, the program has screened more than 1,500 people at about 90 clinics resulting in dozens of diagnoses of previously undetected heart valve disease along with other previously undetected cardiovascular issues.
Between six and seven per cent of people screened in the clinics were diagnosed with valvular heart disease, said Messika-Zeitoun. An additional six to seven per cent of people screened in the clinics were diagnosed with other heart issues. And around 30 per cent were found to have high risk factors for heart disease.
Patients diagnosed with valvular or other heart disease in the clinic are automatically referred to the Heart Institute for further assessment and possible treatment or monitoring. There is no medicine to treat heart valve disease and surgery is often required. Technology has made that surgery significantly less invasive than it once was. In many cases, patients no longer require open heart surgery for valve replacement.
Those with high risk factors are given information, including for help with smoking cessation, and referred to their family doctors for follow up.
In some cases, patients have been sent directly to the hospital after echocardiograms revealed dangerous, and potentially fatal, cardiac abnormalities.
Technology has allowed the mobile screening program to function like a small, portable hospital clinic. Echocardiograms used to diagnose patients are performed using a tablet-based portable machine. Messika-Zeitoun spends evenings and weekends reviewing the images. He says he is not the only one putting in extra time to make the program work.
“It’s really a team effort. You cannot do this without the dedication of the team.”
Those team members believe in the importance of the work, he said.
“We really believe that we can help the population. I think we are paying too much attention to treating (valvular disease) when it’s acute or when it is too late. I think we can be much more efficient at the population level if we are more preventative.”
