“Getting old isn’t for the faint of heart,” Mae West, died at age 87. A sentiment that rings true when it comes to cardiovascular health.
The notion that aging challenges the physical, mental and emotional wellbeing of a person, demanding resilience, courage and perseverance, is well established. Growing older is tough; it requires self-acceptance, a sense of purpose, social connections, staying active and – importantly – taking care of one’s health.
On the physical side, as the body ages, issues tend to arise. Ranging from mild annoyances to life-threatening diseases, health concerns take centre stage because, after all, what do you have without your health?
A major health concern for all aging people is the heart. Whether at a milestone age (think 40, 50 or 60), facing some level of cardiovascular risk or having experienced a heart event, most people will at some point start to think about their heart health. And it’s no wonder: heart disease is the second leading cause of death in Canada.
Understanding one’s heart health risks is therefore increasingly important as we age. And this is exactly what Heart Fit Clinic offers.
In 2007, Diamond Fernandes founded Heart Fit Clinic as a response to a public healthcare system that fails to address individual cardiovascular risk. A private model that is patient-focused and which assesses and treats individual risk.
“Ignorance is not bliss when it comes to your heart health,” Fernandes says from his clinic in Calgary. Born in London, England, Fernandes moved to Calgary at age 4 and has lived here most of his life. His Calgary clinic is one of five Heart Fit Clinics, and the others are in Vancouver, Edmonton, London, Ontario and Toronto. “A lot of people walk around thinking they’re fine. But you have to be proactive about understanding your risk. Heart disease can happen to any shape and size.”
It was his own father’s experience – a heart attack at age 38 and then bypass surgery at 42 – that inspired Fernandes to get into the field of cardiac rehabilitation. Fresh out of university, he got a job at Total Cardiology in Calgary (formerly the Cardiac Wellness Institute of Calgary) in 1999.
Seeing a need for private cardiovascular disease risk assessments and care, Fernandes was limited in what he could do in Total Cardiology. Frustrated by the lack of personalized cardiovascular care, Fernandes was limited in the Total Cardiology model. “I always thought it should be patient first, looking at the best interests of the patient,” he says. “But in public healthcare it’s about taking care of the staff. It shouldn’t be that way. It should be patient focused.”
His idea was rejected by Total Cardiology, so Fernandes left in 2005. After working in Dubai and Kelowna, he returned to Calgary to launch the first Heart Fit Clinic in a small room at the Trico Centre for Family Wellness.
“Bridging business and healthcare in Canada has always been a challenge,” he reflects. “But people are going to be looking more and more at private options. We’ve had our challenges, no doubt. We opened in 2007 and were an overnight success; we opened our second one in 2018. I kid about the overnight success, but that’s business.”
What makes Heart Fit Clinic unique is its focus on the biology of the artery wall and blood flow – not just blockages. Its 2,500-square-foot Calgary facility bridges the gap between the patient’s family doctor and cardiologist. “We look at the biology of the artery wall and blood flow,” Fernandes says, “because if you go to a cardiologist to prevent a heart attack and just do a stress test, you’ll miss the majority of heart attack risk. It goes beyond even just prescribing cholesterol lowering drugs.
Fernandes, who is not a medical doctor, laments the old school way of looking at arteries as pipes: “It concerns me when physicians oversimplify artery health by saying ‘your pipes are clean.’ It’s the wrong way of treating that disease process. Arteries are not like pipes; they are muscles. They expand and contract in different spots in the body. And when we look at artery disease, there’s a lot of biology that goes on. It’s not just cholesterol that accumulates in the pipe. If we’re trying to prevent or reverse disease, we have to understand the biology.”
“If you go to your family doctor, it’s too basic,” he continues. “When you come to the Heart Fit Clinic, we want to know about where your risk of a heart attack is. We look at the function of the artery wall, the stiffness of the artery wall, the health of the artery wall. We have an ultrasound where we measure artery health. We look at small arteries and big arteries. We do a fitness assessment, like a stress test. And we also do an AI heart scan which allows us to detect small vessel disease.”
Heart Fit Clinics employ physicians, nurses, exercise physiologists and nutritionists, 23 employees in all across the five clinics. “The clinics are mostly run by our nurses,” Fernandes says. “They manage the care of the patient. What I’m very proud of is how all five clinics come together once a week to discuss our most difficult patient cases. The multidisciplinary aspect really comes from sharing case studies amongst all our groups.”
What makes Heart Fit unique is its ability to serve patients across the full cardiovascular risk spectrum – from prevention to reversal. Patients do not need a referral from their family doctor, though many have one, and generally comprise three groups of people.
The first are people who have reached a milestone age – usually 40 or 50 – and want to be proactive. “They’ve had a friend who’s had a heart attack and they want to make sure they’re not on that path,” Fernandes explains.
The second category of patients are those with elevated risk factors. For example, a family history of heart disease, high blood pressure or cholesterol or sexual disfunction. “A higher risk category of people that are a little bit more motivated to come and see what’s going on,” he says. “Sometimes they are already taking pills from the doctor and want to know if they have to take those for the rest of their life. They come to us to try to navigate all the data and find out where their risk of heart attack or stroke lies so they can reverse it.”
The third category of patients are those who have concerns. “That doesn’t have to be the 80-year-old either,” Fernandes says, “the average ages of that category of people is 62. The ages are across the board – I saw a 37-year-old yesterday. But these people are in the disease process. They have heart disease, artery disease, heart failure. They might have a valve problem, a rhythm problem. They’ve seen a cardiologist, had the testing and are now trying to reverse their disease.”
Heart Fit Clinic sees success with all three categories of patients, though the last can be challenging if the issues are too far gone.
Several years ago, Heart Fit began offering a first free, no obligation assessment. “Just come in and talk to us,” he says. “Just to learn and understand what you can do to help you with your heart health.”
A typical treatment course is about $1,500. “If you have no problem spending a few thousand dollars to fix your car for example, why not spend that to be proactive about your body?” Fernandes asks. “Being proactive is super important.”
Heart assessments look at inflammatory markers on the endothelium (the lining of the artery wall) and cholesterol particle size, among other things. “We’re the only clinic that looks at endothelial markers,” Fernandes notes. “And we look at the consistency (particle size) of cholesterol, rather than just total numbers, which is way more important to look at. There are a lot of biology markers available to us, but not in the public healthcare system, to understand how to prevent or even reverse cardiovascular disease.”
Cardiac rehabilitation programs include exercise, nutrition and getting to the biology of the artery wall. Treatments such as external counter pulsation are used to improve heart function by growing new small blood vessels. “This improves blood flow to the heart, which is healing,” Fernandes says. “We use this treatment for patients that have stable coronary artery disease or are at risk of coronary artery disease.”
Customized heart nutrition programs, based on a person’s biology markers, micronutrient imbalances, food intolerances and gut inflammatory markers are also used to start to heal the gut. “We also get into genetics to determine what you are more likely deficient in so that you can supplement for that,” he says. “We help patients improve their digestive track to absorb nutrients properly.”
Heart Fit also offers corporate health programs for companies who want to assess the risk of their employees having heart disease. “We go into the corporation and educate people as to what they can do,” he explains. “Help them understand about heart health and nutrition factors. Because the cost of a heart attack or stroke to an organization is crazy. It’s mind-boggling as to how much it costs to lose a person to short or long term disability. Our simple assessment is like an insurance policy.”
Sometimes, he continues, it’s simply a matter of getting people to shift their mindset to make lifestyle a priority: sleep better, exercise better, eat better.
Extremely passionate about helping patients, Fernandes’ goal is to grow the business tenfold and help a million hearts in the next 10 years. To date, his clinics have seen around 23,000 patients.
To further spread his message about heart health, Fernandes has written two books on the subject: Beating Heart Disease – 5 Powerful Pillars to Prevent and Reverse Heart Disease and Death of the Stress Test, to be released in September. He suffered his own cardiac event three years ago at the age of 46 when he had valve rupture. He ended up having emergency open heart surgery.
“I tell this story because you never know,” he offers. “And I have clean arteries. My arteries are good. But I still ended up with a problem and a patient in the system. We get all different walks of life that come through and everybody is human in the end.”
It’s the success stories – including his own father’s who is a patient of Heart Fit and has been living with disease longer than without it – that inspire Fernandes to keep going.
“I’m here because I have a family to live for,” he reflects. “Our patients come in for the people that depend on them. The people who will miss them when they’re gone. Everyone has a reason – grandkids, kids, spouse, loved ones. No one ever sits in the hospital in a gurney in the emergency room and says, ‘I wish I didn’t spend that money.’”
