BC Cardiovascular Community at the Canadian Cardiovascular Congress

Rising Stars – Dr. Martha Mackay

mmackay aug13Dr. Martha Mackay is a clinician-scientist, dividing her time between the roles of Clinical Nurse Specialist (CNS) in Cardiology at St. Paul’s Hospital Heart Centre and Clinical Assistant Professor at the UBC School of Nursing. She has practiced for more than 30 years in critical care and cardiac nursing, with the past 18 as a CNS. Her initial nursing education was at George Brown College in Toronto, and she has since earned a BSN, MSN and PhD at UBC. Mackay’s clinical role focuses on improving the care of acute coronary syndromes and myocardial infarction patients. In 2012, she led the development of nursing decision support tools for Emergency Cardiac Care, which are used by all RNs in British Columbia. She serves on the UBC/Providence Health Care Research Ethics Board, the Heart & Stroke Foundation of Canada Grants-in-Aid review panel; the Executive Committee, Centre for Health Evaluation and Outcome Sciences (CHÉOS); and the Executive Committee, BC Centre for Improved Cardiovascular Health (iCVHealth). As well as being an Editorial Review Board member for Dynamics: Journal of the Canadian Association of Critical Nursing, she is also an associate editor of the Canadian Journal of Cardiovascular Nursing.

Lay summary of program/project:

Factors such as ethnicity, sex/gender or mood may affect susceptibility to heart disease and treatment-seeking behaviour. These factors, individually or in combination, may also influence treatments offered and accepted, and how patients fare after serious heart events. My research focuses on these factors. For example, evidence suggests Canadians of some ethnicities fare worse than those of other ethnicities. Yet biological differences (e.g., extent of disease and risks for heart disease) do not fully explain these differences. My primary study examines how a patient’s ethnicity may affect health professionals’ care of them, specifically that received by patients who come to emergency departments in the critical first hours after heart attack symptoms start. This knowledge will deepen our understanding of how cardiac care is given to Canadians of various ethnicities, and whether this contributes to different health outcomes. From this I will develop and test programs to address identified gaps. I am also exploring whether there are ethnicity-based differences in how patients do after heart procedures, using large British Columbia databases, which will complement the knowledge gained in my primary study. A third project focuses on an innovative treatment for patients who have been hospitalized for a serious heart event, and who also have depression, which has a very negative impact on heart health. I will also examine how patients’ ethnicity and gender may influence this interaction. My other projects also address needs during the discharge transition period, by studying innovative ways to support healthy behaviours. Overall, this program of research goes beyond biological explanations by exploring the complex interplay of social, demographic and behavioural factors that also affect cardiac illness, and intervening to support patients to achieve optimal cardiac health.

Medical summary of program/project:

Cardiovascular disease (CVD) exacts a high death, morbidity and financial toll upon Canadians. Research has identified differences in outcomes from CVD by ethnicity, sex/gender and socio-economic status, yet the reasons for these differences are not fully understood. Building on my previous work exploring sex/gender differences in symptoms and ethnicity-based differences in treatment-seeking of patients with acute coronary syndrome (ACS), my research program seeks to identify the impact of important socio-demographic factors on health behaviour, and access to, and outcomes from cardiovascular care, particularly during critical transition points. My program aims to 1) explicate the relationships between key socio-demographic factors and patients’ behavioural responses to cardiovascular illness, the treatments they receive, and their outcomes; 2) develop and test interventions to mitigate or support relationships observed; and 3) test promising clinical interventions aimed at promoting healthy cardiovascular behaviour in a manner that is sensitive to ethnicity and other social locations. One current CIHR-funded study is exploring whether a patient’s ethnicity is associated with differences in care received during an episode of ACS. Patients are being recruited in Emergency departments and ethnicity-based differences in meeting guideline-directed benchmarks (i.e. door-to ECG time) are measured. We are also collecting data about their experience of care in Emergency. Complementing this, I am investigating the effect of ethnicity on outcomes from cardiac procedures using population-based data. Further, I am evaluating innovative programs for cardiac patients, with a particular focus on differential sex/gender- or ethnicity-based effects. Depression screening/follow-up for hospitalized patients; creative use of technology (e.g., text-messaging) to enhance cardiac health; and shared decision-making about undergoing revascularization procedures are some of the initiatives in progress or development. The knowledge from these inter-related projects will provide a foundation for development and testing of interventions to address gaps where they exist, and enhancement of strengths where they are found.