As the stress test is in full swing and the participant is giving it her all on the treadmill, Marie-Ève Piché abruptly stops the exercise: an arrhythmia has just appeared on the electrocardiogram scrolling before her eyes, and there’s no room for error.
Everything stops. The participant lies down on a stretcher to catch her breath. Everything is fine.
“When we reached the peak intensity of the exercise, the heart raised a red flag,” Piché explains to her afterward. Piché is a cardiologist specializing in cardiovascular prevention at l’Institut universitaire de cardiologie et de pneumologie de Québec. “You have truly excellent exercise capacity—it’s a very good test—but given that signal from your heart, I think we need to look into it further. We need to determine exactly what it is.”
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The participant had taken advantage of the mobile cardiometabolic health assessment Unit’s visit to Saint-Siméon, in the Charlevoix region, to come meet Piché and her team.
Doctors always say: the earlier a problem is detected, the sooner the patient can be treated, and the better the prognosis. And that’s exactly what just happened: somewhat by chance, Piché discovered a problem that needs to be addressed before the situation potentially worsens.
The participant, with whom La Presse Canadienne spoke briefly after her consultation with Piché, agrees wholeheartedly.
“It’s a privilege to be part of something like this because these days, you don’t see a cardiologist unless you have a problem and end up in the ER by ambulance,” she said. “It’s a privilege to undergo these exams.”
Second year
The idea for the project took root in Piché’s mind during her medical studies and early in her practice, when she realized that most of the data available to her had been collected from older white men—which is of limited relevance when treating a 40-year-old woman who has just suffered a heart attack.
She therefore worked for years to raise the funds needed to create this mobile cardiology unit, which takes the form of a recreational vehicle whose interior has been converted into a medical clinic. Those who use it go through ten stations, for a visit lasting about two hours.
“For me, there were issues of health equity,” she said. “Even in Quebec, not all regions have access to all this specialized care and these screening tools, even though heart conditions are often much more prevalent in rural areas.”
A situation, she explains, that is largely attributable to the well-documented founder effect in Quebec.
During the first phase of the project last year, 150 people were interviewed in five different communities. Thirty percent of the participants were men, compared to 70 per cent women, with an average age of 48. Just over half of the participants were Indigenous.
Half of the participants received a new diagnosis, which, in 80 per cent of cases, required medical care.
But meeting with participants—and, in some cases, telling them that a health issue has been detected—is just the beginning. We must ensure that the participant then has the necessary support to manage their own care.
“The local teams in the communities we visit help us coordinate activities, but they are involved in the care pathway after the visit,” explained Piché. “They will take over for the follow-up (…) of the people who came to see us and for whom we identified health issues.”
During a follow-up one year later, an improvement in health status was noted in 60 per cent of participants, and a full remission in a quarter of cases.
Piché cites as an example those participants in whom prediabetes or newly diagnosed diabetes was detected.
“People had been prediabetic or diabetic for years; we screened them, we treated them, we mobilized teams, nutritionists, and exercise therapists on the ground… A year later, all of our prediabetics are no longer prediabetic; they’ve all returned to normal,” she said. “So we addressed their health conditions—first, because we detected them while it was still possible to reverse the conditions, and second, because we supported the people and mobilized teams.”
Perhaps the most impressive statistic, however, is this: a change in lifestyle habits was observed in 84 per cent of participants. We’re talking here, in particular, about people who changed their diet, quit smoking, or decided to be more active.
By identifying problems as early as possible and giving participants the tools they need to take charge of their own health, Piché emphasized, we not only enable them to improve their health, but we also—and this is the elephant in the room—allow the healthcare system to save colossal sums of money by avoiding the need to treat much more serious problems in a few years’ time.
Guinea pig
Determined to provide readers with quality information and advance science, La Presse Canadienne reporter accepted the Piché team’s invitation to undergo some of the tests offered at the mobile cardiology clinic.
Nurse Julie Desjardins first measures my blood pressure, and things get off to a bad start. Normally well-controlled by medication for the past fifteen years, my blood pressure decided that morning to take a trip to the stratosphere. A bit embarrassing, but nothing dramatic.
The story would have been entirely different if we had discovered previously undiagnosed hypertension, as that would have been a finding of paramount importance. High blood pressure isn’t nicknamed “the silent killer” for nothing: it wreaks havoc quietly, without really causing any symptoms, over the years… until the day you have to call an ambulance because an artery has just become blocked or burst.
Desjardins then measures the circumference of the neck, waist, and hips. This last measurement, in particular, is increasingly recognized as an important indicator—and a better one than the more well-known body mass index (BMI)—of cardiovascular disease risk, since it can reflect an accumulation of visceral fat (a major source of inflammation) in the abdomen. Fortunately, everything is fine on that front.
The next step is a scale that’s nothing like the ones we have in our bathrooms. In about a minute, this device—straight out of Star Trek—not only measures weight (stable) and BMI (normal), but also reveals that there’s more muscle in the arms than in the legs (time to get back on the bike); that the body fat percentage is normal (but, of course, higher than we would have hoped); that skeletal muscle mass is greater than fat mass (yay!); and that visceral fat levels are low.
The rest of the evaluation is handled by Caroline Samhani, a French endocrinologist who has been working with Piché for two years.
She takes about ten measurements using a device that resembles those used for an ultrasound. This reveals a complete absence of fat in the liver, which likely stems, in terms of diet, from total abstinence from alcohol and moderate (ahem…) sugar consumption.
The most spectacular—and reassuring—result comes at the end of the test. A sensor placed on a finger and another on a toe measure vascular age (essentially, the health of the vascular system and the flexibility of the arteries) and compare it with chronological age. The result: La Presse Canadienne representative’s vascular age is 21 years younger than his chronological age—a result so astonishing that at first we thought it was a joke.
But when you see the number on the screen of Samhani’s device, it’s encouraging to see, in concrete terms, that the efforts made over time are paying off. And that inspires us to keep going.
Sustainability
Piché and her team hope to meet 500 people this year and visit new regions. They have the necessary funding to ensure the project’s survival for another five years.
A project that, incidentally, is starting to inspire others, as a young cardiologist from British Columbia was inspired by the Quebec example to launch a similar initiative.
“We know that we can prevent up to 80 per cent of cardiovascular conditions through early screening,” Piché noted. “With early screening, we can even prevent certain heart attacks, certain strokes, and heart failure… “So that’s what we want to offer with this specialized community care service: we want to provide this screening and then this care with a multidisciplinary team.”
She believes we could even consider expanding screening beyond cardiology by inviting other specialists to join the effort.
“With all the tools we have, with all our technology, we’re able to identify the early signs of the disease before the first symptoms appear,” Piché noted. “This is a very promising window for intervention because the disease hasn’t yet fully taken hold. And often, we’re able to correct it.”
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The mobile cardiometabolic health assessment unit will be visiting the Essipit Innu Reserve from May 11 to 15.
–This report by La Presse Canadienne was translated by CityNews
