Robert Welsh, MD FRCPC FACC

Robert Welsh is an Associate Professor and academic Interventional Cardiologist at the University of Alberta Hospital in Edmonton.

Dr. Welsh received his Medical Doctorate from the University of Saskatchewan in 1993 where he subsequently trained in Internal Medicine (1993-1996). He undertook Cardiology training and an Interventional Cardiology fellowship at the University of Alberta in Edmonton, Alberta, Canada (1996-2000).

He is the Director of Adult Cardiac Catheterization and Interventional Cardiology. He is also the Co-Director of the University of Alberta Chest Pain Program, which he initiated and designed in collaboration with Dr. Brian Holroyd (Chief, Emergency Medicine). He is Director of the University of Alberta Cardiology Residency Training Program.

He is chair of Vital Heart Response; a regional reperfusion program for early treatment of STEMI patients.

Pre-hospital management of STEMI and the interaction of pharmacological (antithrombotic and fibrinolytic) and mechanical interventions (primary and rescue angioplasty) are the focus of his clinical research. Further research interests include:

• – investigation, assessment and management of ‘chest pain’ patients in the Emergency Department
• – cardiac risk stratification of diabetic patients prior to renal and islet transplantation
• – the impact of prolonged strenuous exercise on myocardial function.

He has approximately 100 peer reviewed publications, journal reviews and abstracts.

Systems Approach to STEMI

Sunday, March 16, 2008
5:00 PM

Download Dr. Welsh’s slide set [957 KB PDF].

Despite the burgeoning knowledge and multi-pronged investments in both the content and process of STEMI care, important care gaps remain, including:

• a significant proportion of patients untreated with reperfusion therapy
• inadequate patient triage
• delayed time to reperfusion
• suboptimal utilization of appropriate adjunctive medical therapy
• subsequent under utilization of cardiac rehabilitation programs, and
• failure to incorporate life style modifications.

To address these issues national and international guidelines continue to emphasize and recognize the importance of systematic approach to treatment of acute myocardial infarction.

Regions implementing guideline recommendations are required to assess their unique regional expertise and incorporate realistic expectations of time to treatment with both types of reperfusion therapy incorporating realistic PCI related reperfusion delay.

Rich–and often unrealized–opportunities exist prior to arrival to hospital to limit STEMI patient morbidity and mortality by enhancing early management via the pre-hospital emergency medical system. It is essential that prehospital STEMI treatment protocols operate within an integrated system wide region reperfusion program which includes continuous quality and improvement to optimize patient care.

Establishing clear guidelines and empowering experienced decision makers to implement ‘best care’ for individual patients provides the foundation of a regional reperfusion program. This should include identifying high-risk patient populations with early reperfusion to facilitating triage to tertiary care centers for interventional management as appropriate. Dedicated assessment of the success of reperfusion following pharmacological therapies with risk stratification and appropriate rescue PCI will enhance patient outcomes.

Within the Canadian health care environment, the unique aspects of these issues and success of such programs will be discussed to provide various models for implementation of STEMI programs within our unique health care system recognizing geographic and economic constraints.