New Research Evaluates Which Factors May Contribute to Congestive Heart Failure in the Indigenous Population 

The CCS/Pfizer/Canadian Heart Function Alliance Research Fellowship Award in First Nations, Inuit and Métis (FNIM) Communities Experiencing Heart Function (HF) Inequities aims to support early career Canadian researchers who are dedicated to investigating and addressing disparities in heart function among First Nations, Inuit, and Métis populations. This award focuses on enhancing understanding and improving care for these communities, both in general health and specifically in heart function care. 

As this year’s recipient of the award, Dr. Miles Marchand is a proud member of the Syilx First Nation, Okanagan Indian Band, whose traditional territories surround the Okanagan Lake in interior B.C. He grew up in Kamloops, B.C. and completed medical school, Internal Medicine and Cardiology residencies at UBC, and served as the lead resident for both Internal Medicine and Cardiology. Dr. Marchand is currently completing a fellowship in Cardiac Rehabilitation and Cardiovascular Prevention at UBC with a focus on Indigenous cardiovascular health, which includes outreach programs to remote and reserve-based communities around British Columbia. He is passionate about the advancement of cardiovascular health in Indigenous communities, including improvement to access to care, Indigenizing current models of healthcare delivery and pathways to optimize primary and secondary prevention of cardiovascular disease. 

Q: What attracted you to this area of research? 

A: As a First Nations cardiologist, I have seen huge inequities in Indigenous communities’ cardiovascular care and outcomes. Indigenous communities have a unique historic, geographic, sociopolitical and cultural context that greatly impacts their cardiovascular health and wellness. There is also a real paucity of Indigenous-led research to guide how we can best support communities’ heart health. In particular, there are almost no studies at all evaluating congestive heart failure in Indigenous populations, and our research will be one of the first to begin to understand CHF in the unique Indigenous context. 

Q: How did this project get started? 

A: With the partnership of 8 First Nations communities around the country, Dr. Sonia Anand has led the Canadian Alliance of Healthy Hearts and Minds First Nations cohort study since 2013, which has become one of the largest studies of Indigenous people worldwide. This rich resource includes clinical, community-level, social, biochemical and radiographic data that will allow us to understand which clinical and community factors contribute to the development of heart failure in First Nations Canadians. 

Q: When do you expect this study to be completed? 

A: I expect our initial study to be completed in 1 year, but we will hopefully be able to use the results of this study to inform future prospective evaluations for models of care that can help Indigenous Canadians improve access, diagnosis and treatment of heart failure. 

Q: Can you walk us through what your project entails? 

A: NT-pro-BNP is an important, readily accessible, clinically useful biomarker that is closely associated with clinical congestive heart failure, and is also associated with subsequent decline in ventricular function. Indigenous Canadians, who often face geographic and structural barriers to more advanced cardiodiagnostics, such as echocardiograms, cardiac catheterizations and cardiac MRIs, may benefit from the use of NT-pro-BNP as a screening tool for congestive heart failure, to guide downstream diagnostic and therapeutic approaches. 

In this study, we will evaluate the relationship between NT-pro-BNP and ventricular dysfunction on MRI, an association that has never been evaluated in an Indigenous cohort. We will then evaluate the relationship between clinical, sociocultural and community factors with the NT-pro-BNP to determine what factors may be contributing to congestive heart failure in this unique population. 

Q: What does this fellowship award mean to you, personally? 

A: I am so honoured to have received this award. The growing recognition of the importance of Indigenous cardiovascular health makes me very optimistic for our communities’ future. It is through the dedication of resources, such as this fellowship, that we really have an opportunity to work with Indigenous partners to make a difference in the current inequities faced by Indigenous Canadians.  

Q: Tell us about your research team. 

A: Our research team will be an important collaboration between Indigenous and non-Indigenous researchers, community members and healthcare providers between UBC, McMaster and institutions across the country. We will use a Two-Eyed Seeing approach to perform Indigenous-led, meaningful and ethical research. I will be under the primary supervision of Dr. Sonia Anand, a national leader in cardiovascular health research with over 25 years of partnership with Indigenous communities.