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Sudbury hospital leading the way in writing the guidelines for rare condition

$700,000 grant from NOAMA will help bring experts from across the country to Sudbury
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Dr. Robert Ohle, an emergency physician with HSN, received a grant to adapt and improve current guidelines for Acute Aortic Dissection (AAD). This is a rare, but life-threatening condition that results from a tear in the inner wall of the aorta, the body’s main blood vessel. (Supplied)

Health Sciences North Research Institute and Health Sciences North received a significant boost from the Northern Ontario Academic Medical Association (NOAMA) recently that will put Sudbury's hospital at the forefront of setting the guidelines for Acute Aortic Dissection (AAD).

Physicians have partnered with HSNRI scientists to receive a grant of more than $700,000 from two NOAMA research funds - Alternative Funding Plan (AFP) Innovation Fund, and Clinical Innovation Opportunities Fund.

Dr. Robert Ohle, an emergency physician with HSN, received a grant to adapt and improve current guidelines for Acute Aortic Dissection (AAD). This is a rare, but life-threatening condition that results from a tear in the inner wall of the aorta, the body’s main blood vessel. Acute Aortic Dissection can present with a variety of symptoms that makes it difficult to diagnose.

There are no widely accepted guidelines that are both safe and efficient to help guide physicians. 

"Essentially you have a big blood vessel which comes out of you heart (aorta) which pumps blood into your entire body. You can get a tear in the inner wall of the aorta which allows blood to go into the wall and essentially unzips it," said Ohle

"As you unzip down the aorta you block off all the pipes that come from this main one so you block off blood flow to essentially any organ in the body depending on where the tear is. It can even rupture."

The difficulty in diagnosing AAD comes with the fact that it can block blood flow to a number of different organs and symptoms can mimic those of a number of other, more common conditions.

"Let's say you have blood flow blocked to the heart, it may look like someone is having a heart attack," said Ohle. "The treatment for a heart attack is you give them blood thinners and try to stent open any problems. If you give aortic dissections blood thinners it gets a whole lot worse. It gets really difficult because it masquerades as a whole lot of other conditions."

There are currently two guidelines available to health care practitioners when it comes to AAD, an American guideline and a European guideline. Each has a different set of standards when it comes to risk thresholds as far as who needs to be investigated and who can be discharged. 

The guidelines were developed without collaboration across all disciplines that are involved in the care of a patient with AAD, which ranges from the patient themselves to their physician to the cardiac surgeon, radiologists, to intensivists who care for the patient before and after their surgery.

"What we're doing which is different, is we're developing something with Canadians that is for Canadians. We are developing it with everyone who is involved in the actual care, including the patients and we're doing it with physicians that practice in the north and patients in the north," said Ohle.

National guidelines for treatments tend to be generated at larger centres across the country. Sudbury is a newer academic centre in the health care field, but Ohle is excited by the prospect of developing a more inclusive set of guidelines that can be implemented across Canada and beyond.

Acute Aortic Dissection is quite a rare condition, and occurs in as few as three to five in 1,000 patients (0.3 - 0.5 per cent). While the condition is not extremely common, the concern lies with the high rate of misdiagnosis.

One in three to one in five patients (20 - 33 per cent) with AAD are misdiagnosed on first presentation, according to Ohle.

"One in three or one in five of a very rare condition is still a small number, but to those patients who are misdiagnosed it's a big deal," said Ohle. "This is why it's important to have different voices on the panel - those who have been diagnosed and treated, those that have been misdiagnosed, and those who are at potential of developing it."

The funding from NOAMA will allow HSNRI and HSN to bring people from across Canada to Sudbury for these discussions.

"It's important to have these types of meetings in Sudbury. Traditionally these are held in larger centres like Toronto or Calgary," said Ohle. "This funding allows us to bring everybody here and that's for two reasons; it allows us to show everybody that we are a centre of excellence that is open for business, and that we are an academic centre that has far-reaching research activities and programs."

The guidelines that will help guide physicians in diagnosing AAD that will be established in Sudbury will be the first of their kind, in that they will be developed with the input of community physicians from remote locations.

"I'm excited about this and implementing it and seeing if we get better uptake and a better essential product because we're including all of these experts who aren't traditionally included," said Ohle.

A group will be meeting in Sudbury on Nov. 23 to discuss the guidelines that are to be established. That information will be disseminated over the following two to three months, and Ohle is hoping for publication by spring 2019. 




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