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Strategic Intervention

May 14, 2012

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By Alisa Kim

For Dr. Dennis Ko, the occasional sleepless night isn't due to an after-dinner espresso. If he's up at 3 a.m., chances are he's trying to clear a clogged artery or repair a damaged heart.

Ko, who is a scientist in the Schulich Heart Research Program at Sunnybrook Research Institute and an interventional cardiologist at Sunnybrook, says he was drawn to cardiology because of the potential life-changing impact he could have on patients. "You see somebody who's sick—maybe dying from a heart attackyou do a procedure, and they're better afterwards. It's instant gratification," he says.

His research is also aimed at helping patients. The focus is on finding ways to improve the treatment and outcomes of cardiovascular disease. "We want to make informed decisions," he says. "Procedures work, but they're expensive. In an environment with scarce resources, what should we do? The goal of my research is to improve patient outcomes, as well as the efficiency of the health care system."

Ko is this year's recipient of the Dr. Subhash C. Verma Young Investigator Award. The prize recognizes exceptional achievement in the cardiovascular sciences and was established by the Heart and Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research at the University of Toronto.

At the centre's annual Cardiovascular Scientific Day, held on April 19, 2012, Ko spoke about how his research has helped guide health policy in Ontario. One example of this impact is a review of the safety of three standalone angioplasty centres in Ontario. These are clinics that do procedures to open narrowed heart arteries, but do not provide cardiac surgical services on-site. Ko and colleagues looked at the effect of these centres on patients, as well as the mechanisms by which these centres receive back-up surgical support in an emergency. They concluded the centres were safe and effective, and improved timely access to care.

"Our data supported the safety of these centres. Subsequently, the Ontario government announced [the creation of] two more standalone sitesone in Brampton and one in Peterborough," says Ko.

Shedding light on new therapy

He also spoke about his research on the safety of transcatheter aortic valve implantation (TAVI). A fairly new therapy, TAVI is a less invasive alternative to open-heart surgery in which cardiologists use a catheter to implant an artificial heart valve over a diseased valve to restore blood flow to the body. The procedure offers high-risk patientsthose who have aortic stenosis (narrowing of the heart valve) and other medical conditionsthe benefit of valve replacement without the risks of surgery.

"The procedure is very expensive but potentially life-saving in patients who cannot undergo conventional aortic valve surgery," Ko says. "We found that in Ontario, [TAVI] is relatively safe." The provincial government has announced provisional funding for TAVI; details regarding how it will be funded, as well as the number of procedures that will be covered, are being worked out, notes Ko.

He recently received a Heart and Stroke Foundation operating grant to look at knowledge gaps within TAVI. In addition to learning why people with severe aortic stenosis are not having surgery, Ko will work on prediction scores to try and predict a heart patient's risk of dying from other conditions such as cancer or lung disease. "If the risk of dying from a cardiac cause is high but the [risk of dying of] other [diseases] is not, then it's probably reasonable to do these procedures. The reason for needing to understand this is because so many resources are put into these procedures. You want to be certain you're doing it on the right patient population," says Ko.

As a clinician-scientist, Ko's hours are not nine to five. Even with the long hours, he says he is happy. "I want to apply scientific discovery to the real world population so that patients can have as good an outcome as possible. I get a lot of joy in my work, despite the sleepless nights."

Dr. Dennis Ko