When Dr Heather Ross came within 200 metres of the summit of Mount Vinson in 2006, she suddenly could not breathe.
The Toronto clinical cardiologist was climbing Antarctica’s tallest mountain with Test Your Limits, the organization she founded to raise money for cardiovascular research, when she developed high-altitude pulmonary edema, a life-threatening buildup of fluid in the lungs that causes severe shortness of breath.
“It feels remarkably like heart failure,” Ross says of the condition she experienced on the climb, and the one she has spent her career treating at Toronto’s Peter Munk Cardiac Centre, part of the University Health Network.
“I had what my patients get,” Ross says, “and until that moment I had no clue what it really felt like to not be able to breathe.”
After that experience, Ross says she became focused on improving quality of life for heart failure patients.
“I only had to feel it for hours,” she recalls. “I have patients that live with it for years.”
In the two decades since, Ross has carried that focus into new tools for cardiac patients. Test Your Limits has raised more than $4 million, and Ross recently developed what she calls a “hospital in a Pelican case,” using a hard-shell case to carry portable digital equipment to patients who live far from her downtown Toronto clinic.
Heart failure happens when the heart cannot pump enough blood to fuel the body. One in five Canadians will develop it in their lifetime, cardiovascular disease is the top non-communicable cause of death worldwide, and it costs the health-care system more than $30 billion a year.
Heart failure rates are twice as high in northern Ontario as in the rest of the province. The source text says that is partly because about one-third of Ontario’s Indigenous people live in the north, and Indigenous Canadians face a higher risk of cardiovascular disease because of factors including oppression, racism, health-care biases and social disparity. It also says long travel distances make specialized care harder to access.
Ross, who had just returned from six days running a clinic in Sioux Lookout in northwestern Ontario, says some cardiac patients in northern communities need multiple flights to travel between home and downtown Toronto.
“If you’re a patient in Sandy Lake and you’re told to just pop on down to Toronto to get a test done … that’s two full days of travelling in order to go there and back.”
Ross and her team travel four to six times a year to spend about a week seeing patients in northern communities. But she says they did not previously have access onsite to the same high-end equipment available at UHN, so she started building the Pelican case kit.
It includes Health Canada-approved portable versions of tools used at the Peter Munk Cardiac Centre, including an i-STAT blood analyzer, an Apple Watch and its heart-monitoring apps, a digital stethoscope for remote listening, an electrocardiogram machine the size of a USB key, and a portable ultrasound machine that can send images to a distant doctor to diagnose heart failure.
Ross says the tools have also been vetted for privacy and safety guardrails.
“The goal is to be able to go to a community with my Pelican case and be who I am in Toronto,” Ross says.
She says UHN hopes to start leaving the cases in communities so local nurses can keep using the tools after Toronto doctors leave.
“It’ll help us triage better, make decisions about who needs to be transported out of the community and who can stay. Coupling this with virtual visits and in-person visits, we can provide wraparound care.”
About a decade ago, Ross and other UHN researchers also developed Medly, a smartphone app that lets patients enter their weight, blood pressure and heart rate each day. Based on that information, the app’s algorithm flags patients who need care to a UHN-affiliated nurse or directs patients in immediate danger to their nearest hospital.
Ross says heart-failure patients have traditionally been seen in “episodes of care,” with follow-ups every six months to a year, or when something goes wrong. Medly lets her track patients’ health between appointments.
Ross has used Medly and the Pelican case with the Weeneebayko Area Health Authority, which serves remote communities near James Bay. She and her team visit regularly to run clinics, treat patients in their homes and train WAHA nurses to use different tools.
Sandra Kioke, WAHA’s senior vice-president and chief nurse executive, says the visits and technology have changed how patients experience care.
“patients don’t feel as alone. Instead of a cardiologist in Toronto they see twice a year or once a year, they have an ongoing trusted relationship.”
Kioke says the Pelican case and Medly help keep heart patients at home.
“Without the tools that Heather and her team bring, patients may languish in their community and have to be medevaced out if their health has spiralled to a place where it can no longer be managed [locally],” adds Kioke. “For people that live in remote communities, not having to travel for care is very meaningful, and it could only be made possible through this group, who are 100 percent committed to addressing some of the health inequities that people have experienced up here for decades.”
Ross, who has been a Member of the Order of Canada since 2020, says building more hospitals matters, but it is not possible to have one in every community. She says that is why digital tools that extend the reach of major hospitals matter so much.
“We want to give the best care” she says. “We want to make sure that the access to [it] is equitable across all the different ways we think of equity, and we want to make sure that we are meeting patients where they’re at.”
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