McMaster University

McMaster University

The Future is Today

"The future is today." ~ Sir William Osler, Dundas-raised Physician and Icon of Modern Medicine (1849 - 1919)

Sweeping developments over the past twenty years have transformed McMaster Cardiology from a respectable program to the recognized, world-class institution which it is today.

Population Health Research Institute

The Population Health Research Institute has figured prominently in this change. For many people, PHRI is McMaster's face to the world. Under Dr. Yusuf's leadership,the annual research budget increased from $1 million per year to over $100 million per year. This interdisciplinary group of leading researchers is currently the largest and most cited academic cardiovascular research group in Canada, and one of the top three in the world.  PHRI researchers conduct large simple studies to address questions of international importance and relevance, and their groundbreaking research has had global impact, changing medical practice worldwide. PHRI research is underway in over 80 countries, collaborating with over 1000 hospitals. PHRI research has contributed significantly to the development of evidence-based cardiology theory and practice. Evidence-Based Cardiology, by Drs. Yusuf, Cairns, Camm, Fallen and Gersh, was the first textbook of cardiology edited by Canadians, and considered to be one of the most important and comprehensive references for cardiology practice.

Hospital sites in Hamilton Niagara Haldimand Brant LHIN
Hospital sites in Hamilton Niagara Haldimand Brant LHIN

Cardiac services have grown exponentially, as McMaster has established itself as a quaternary-care medical centre. Cardiac catheterizations, percutaneous coronary interventions, and cardiac surgeries are currently at the highest volumes of all centres in Ontario, with over 6000 caths, 2200 PCIs, and 1400 surgeries in 2008-2009. Dr. Holder, Dr. Madhu Natarajan and Dr. James Velianou developed a Primary PCI program serving the Hamilton cachement area in 2003, offering 24 hr access to interventional cardiologists for ST-elevation myocardial infarctions. Currently 83% of all STEMIs in the region are treated with primary PCI. An electrophysiology programme developed by Dr. Stuart Connolly and Dr. Carlos Morillo and a team of electrophysiologists perform complex ablation procedures, insert devices such as ICDs, and contribute to ongoing registry development and the study of the role of new therapies such as dabigatran in atrial fibrillation. A longitudinal heart function clinic, powered by cardiologists and nurse practitioners, lends a hybrid model to the management of complex patients with heart failure. A prevention program, headed up by vascular biology and prevention specialists Dr. Sonia Anand and Dr. Patrick Magloire, seeks to address primary risk factors such as smoking, obesity and dyslipidemia, in at-risk patients and those who have already had cardiac events. Dr. P.J. Devereaux heads up a peri-operative programme seeking to reduce cardiac events in high-risk patients undergoing surgery. Patients who have had cardiac events are referred to a comprehensive cardiac rehabilitation program with social workers, exercise physiologists, physiotherapists and cardiologists.

David Braley Stroke and Vascular Rehabilitation Unit
David Braley Stroke and Vascular Rehabilitation Unit

External infrastructure has been constructed to keep pace with these exciting changes, such as state-of-the-art cardiac catheterization and electrophysiology labs and the new David Braley Stroke and Vascular Rehabilitation Unit with 200,000 square feet dedicated to cardiovascular research.

World-class faculty has helped McMaster stabilize the academic endeavour. Seven Endowed Chairs in or related to cardiovascular sciences have been established, including the first endowed chair at McMaster for research (Heart and Stroke Foundation of Ontario Chair in Cardiovascular Disease, Dr. Salim Yusuf) and the Salim Yusuf Chair in Cardiology (Dr. Stuart Connolly). The cardiology faculty has been reorganized, with the predominant faculty having geographical full-time salaried appointments, and thus more committed to a group approach, building the academic structure with a long-term view. The faculty has also bolstered the postgraduate program, and helped it move forward from a provisional Royal College approval in 1992, to its current stature as one of the strongest internal medicine and cardiology programs in the country, under the leadership of Dr. Alison Montgomery. Capacity-building has also permitted growth of super-specialty training for cardiology trainees to pursue advanced echo (contact: Dr. Eva Lonn), electrophysiology (contact: Dr. Carlos Morillo), and interventional cardiology (contact:Dr. Shamir Mehta) fellowships within the McMaster institution.

In just thirty years, the McMaster cardiology program has undergone transformational change. It has emerged with a consolidated system which differs tremendously from the humble beginnings with which the Four Horsemen and Two Fellows started out in 1978. This was not by accident. The building of cardiology has been a steady succession underlined by key values, the connections between research and education, a culture of innovation, and a commitment to learning in teaching, research, and scholarship. It is a tribute to those who worked very hard to create this dream from nothing. This past and the bright future belongs to them.

Osler's words ring true, "The future is today."

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