Major boost to JGH’s cardiovascular program through new Azrieli Heart Centre

Historic donation described as “a true gift from the heart, to the heart”

The recent introduction of special cross-training programs for certain JGH cardiovascular nurses has been instrumental in enabling life-saving treatment to begin more quickly than ever for heart‑attack patients who have just arrived in the Emergency Department.

Naomi Azrieli

This is just one of the dramatic improvements—some already under way, others yet to be implemented—that have become possible through the Azrieli Heart Centre, officially launched at a JGH news conference on September 18 with a remarkable $20 million gift from the Azrieli Foundation.

Along with an additional $5 million for new intensive care facilities in the recently named Azrieli Medical and Surgical Intensive Care Unit, plus $1 million for research, the combined $26 million gift ranks as the most generous acts of philanthropy in the history of the JGH and the single largest in the current JGH campaign.

Gaétan Barrette

Also expressing their thanks were Dr. Lawrence Rudski, JGH Chief of Cardiology and Director of the Azrieli Heart Centre, and Edward Wiltzer, Chair of the JGH Foundation, who expressed pride that the Azrieli name will now be so closely association with the Jewish General Hospital.

According to Dr. Rudski and Serge Cloutier (Associate Director of Nursing – Critical Care and Cardiovascular Units), the new training program that began earlier this year has provided skills to many nurses from the Cardiac Intensive Care Unit to start delivering care in the Cardiac Catheterization Lab. Similarly, Cath Lab nurses are now able to begin providing care in the Cardiac ICU.

As a result, when heart-attack patients arrive in the Emergency Department—often to have a coronary artery or other essential blood vessel repaired or unblocked—they receive much faster treatment than was the case just six months ago. Now that the nurses have completed their basic training, a more sophisticated form of training will be provided. This a reflection of the JGH’s longstanding recognition of the value of collaboration among physicians, nurses and a wide range of allied health professionals.

Dr. Lawrence Rosenberg

Dr. Rudski, who is Director of the hospital’s Integrated Cardiovascular Program and of the Azrieli Heart Centre, explains that when the nurses receive training outside their main area of specialization, a larger pool of professionals is capable of responding more effectively in a wider range of life-threatening circumstances.

The results, which Dr. Rudski describes as “phenomenal”, have enabled the JGH to consistently meet the target of the Ministry of Health and Social Services for the amount of time elapsed before catheter-based interventions, such as an angioplasty, are begun for heart-attack patients.

“The Nursing Department is extremely grateful to the Azrieli Foundation for such a generous donation,” Mr. Cloutier adds. “It will allow us to continue to improve our expertise and the quality of the care that we deliver to our patients.”

The focal point of the Azrieli Heart Centre is the cardiovascular area in Pavilions K and E. However, Dr. Rudski notes, new facilities do not need to be built, nor is a significant capital investment in technology required. This is because the most up-to-date equipment is already in place in Pavilion K, which itself is less than two years old.

Denis Coderre

Rather, he says, the Heart Centre will serve as a resource to further strengthen the Division of Cardiology’s clinical, academic and research programs, which are widely recognized as being among the best in Quebec and Canada. “My philosophy has been to favour programmatic building over physical building,” Dr. Rudski adds.

Although the Azrieli family waited until September 18 for their official announcement about the donation, the Heart Centre and the ICU began receiving some of the funds earlier this year.

Naomi Azrieli says her family is “blessed to have had an opportunity to do a lot of good work with a number of organizations this year, and we wanted each of them to have their time in the spotlight.

“By waiting until now for this announcement, we’ve found the right moment to give the Jewish General Hospital the attention it deserves. We wanted to find the best way to talk about the great work the hospital is doing and how we can support it.”

Dr. Lawrence Rudski

Ms. Azrieli says her family’s foundation decided to back the JGH “because of the excellence of its research, its innovative approach to education, and its focus on patient-centred care. We want to help place the hospital in the strongest position to do what it does best.”

Particularly compelling, she explains, was the proposal for the Heart Centre, which will have “a transformative impact on patient care, with a ripple effect that will be felt throughout the hospital. It will help the institution play an even greater role in Montreal, Canada and the world.”

The gift to the Intensive Care Unit is, to a significant degree, an expression of gratitude for the care that was provided in the ICU to Ms. Azrieli’s father shortly before his death in 2014. “Over the years, a number of relatives and friends have been treated there,” Ms. Azrieli says, “and it was a uniformly excellent patient-care experience.”

With the support of the Azrieli Heart Centre, the following initiatives are now under way:

• Michael Goldfarb, a cardiologist, has been recruited to serve as Director of Quality for the Cardiac Intensive Care Unit. Among his duties will be to study how to apply the quality-enhancing activities of ICUs (such as the Azrieli Medical and Surgical ICU) to patients in the Cardiac ICU. Although this approach seems sensible, it has not yet been tested in cardiac patients.

Dr. Goldfarb also has an interest in speeding the recovery of cardiac patients through early mobility—that is, encouraging them to become physically active as quickly as possible. His clinical work will be complemented by research to develop ways of optimizing care among frail cardiac patients.

• The number of patients receiving robot-assisted cardiac surgery is expected to grow substantially, perhaps even to double, in the coming years. The robotic program—under Dr. Emmanuel Moss and in partnership with Jean-François Morin and Dr. Felix Ma—is a team effort that includes operating-room nurses and perfusionists, anesthesiologists and staff of the Cardiac Catheterization Lab. The JGH has the broadest array of robotic and hybrid cardiac surgery procedures of any hospital in Quebec.

• The JGH now has its first fellow in geriatric cardiology. The new fellowship—believed to be the first of its kind in Canada and possibly in North America—was developed by Dr. Jonathan Afilalo, a JGH cardiologist. It offers cardiologists an opportunity to develop a greater expertise in geriatrics, and vice versa, through a combination of research and clinical exposure. Geriatric cardiology is considered to be of critical importance, as the elderly proportion of the population continues to increase, with individuals requiring a greater number of complex medical and surgical treatments.

• An endowment has been provided for a fellow in cardiac imaging. One new fellow will be recruited annually, either to study alongside a physician in echocardiography or to participate in the JGH’s multi-modality imaging fellowship, which is unique in Canada. The fellowship is a reflection of the Division of Cardiology’s long-standing tradition of excellence, its internationally recognized program and its team of physicians, led by Dr. Igal Sebag.

• Funds have been allocated to support the research of Dr. David Langleben, former JGH Chief of Cardiology, who is a leading international expert in pulmonary hypertension. Dr. Langleben’s research extends from basic cellular physiology to cutting-edge clinical trials.

• Since education is critical to ensuring excellence in patient care, an endowment has been created to enable cardiac nurses to attend national and international meetings, and to return and present their findings to the broader group.

Also planned or under discussion:

• The Azrieli Heart Centre hopes to acquire an MRI (magnetic resonance imaging) machine for research purposes, and to share it with researchers in other JGH specialties. MRI imaging is especially useful in cardiology, since it helps in simplifying complex cardiac and vascular anatomy. It can also easily distinguish among tumours, clots and scars—differentiation that would otherwise be possible only with a biopsy. In addition, MRI provides highly accurate information about heart volumes to help measure heart function.

• A simulation centre is envisioned that would train many types of heart-related healthcare professionals to work together more closely as teams. Staff would be placed in demanding situations, such as mock emergencies and other simulations involving cardiac patients who are critically ill.

• The Division of Cardiology, in its role within the Integrated Health and Social Services University Network for West-Central Montreal, would like to develop or strengthen links to community services. These ties are of importance, since in-hospital care is just one element in a cardiovascular patient’s trajectory of care. Among the initiatives that are planned are a heart failure program outside the JGH, a broadly accessible cardiac rehabilitation program, and improved tools to facilitate communication and education with community healthcare professionals.

• Included in the “wish list” is the development of digital tools to improve efficiency and ensure that patients get the most appropriate tests for their specific medical conditions. Also on the list are tools to ensure up-to-date and detailed communication among the professionals involved in patient care.