Canada Is Failing Our Heart Failure Patients, report says

Heart failure is a chronic, incurable condition that places a growing burden on hundreds of thousands of Canadians, the Heart and Stroke Foundation says in a new report.

In heart failure, the heart muscle is damaged or weakened. Survivors are left breathless and fatigued. Some may develop swelling in the ankles and feet or chest pain.

The 2016 Heart and Stroke Foundation Report on the Health of Canadians takes a hard look at the significant and growing burden of heart failure. Hundreds of thousands of Canadians are living with this complicated, fatal and misunderstood condition that leaves them and their families exhausted and overwhelmed, and puts serious strain on the healthcare system. Despite progress in care and some promising research on the horizon, the country has a long way to go to improve the outlook for heart failure patients.

“The number of Canadians living with cardiovascular disease and its devastating effects is increasing, and this includes heart failure,” says David Sculthorpe, CEO, Heart and Stroke Foundation. “There is so much we need to do as more Canadians develop this chronic, incurable condition — from earlier diagnosis to better end-of-life care, and ultimately finding ways to help heal these damaged hearts.”

Heart failure is often misunderstood by the public. According to a new Heart and Stroke Foundation poll*, more than one-quarter of Canadians believe that heart failure means your heart has completely stopped beating. In fact, heart failure means that the heart muscle is not pumping blood as well as it should because of damage from heart disease such as a heart attack.

“Heart failure is the end result of all cardiac disease,” explains Dr. Paul Fedak, a cardiac surgeon at the University of Calgary and Heart and Stroke Foundation researcher and spokesperson. “You get heart failure from everything that goes wrong with your heart — all roads lead to heart failure.”

Heart failure is a chronic, incurable condition that gets worse over time. Almost half of Canadians think it can be cured, according to our poll — yet currently there is no cure. Depending on the symptoms, half of heart failure patients will die within five years, and most will die within 10 years.

“Revolving door condition” burdens an already taxed healthcare system

Because of long and frequent hospital visits, heart failure is referred to as a “revolving door condition.” Leaving out childbirth, heart failure is the third most common reason for hospitalization according to the Canadian Institute for Health Information — trailing only respiratory disease and heart attack, both of which are associated with heart failure. The average length of stay for heart failure patients is long — eight days — as these patients are usually complex, often managing other health issues.

“There is a huge economic cost associated with heart failure,” says Dr. Justin Ezekowitz, director of the Heart Function Clinic at the University of Alberta and Heart and Stroke Foundation researcher and spokesperson. “The biggest driver of costs is hospitalization and emergency room visits.”

It is estimated that heart failure results in direct costs of more than $2.8 billion per year in Canada.

Hospital visits due to heart failure have gone up every year for the past several years. There are currently 600,000 Canadians living with heart failure, with another 50,000 diagnosed each year, and these numbers are only expected to increase as the population ages and more people are living with cardiovascular disease.

Heart failure costs everyone

Heart failure is a strain on Canadian families. According to our poll, almost half of Canadians have been touched by heart failure — either diagnosed with it themselves or having a family member or close friend with the condition.

The challenges facing heart failure patients can be overwhelming: inability to carry out daily living activities fully, multiple appointments, many medications to manage, and complex health information to process. Around 30 per cent of heart failure patients experience depression. Many caregivers are stressed by the realities of supporting a loved one with a condition that is complicated to manage and whose deterioration is difficult to predict.

Sue MacDonald was one of several family caregivers, along with her mother, who cared for her father until he died at 76 from heart failure and multiple health issues. “It was a hard job taking care of my dad — the sheer number of appointments and trying to coordinate care,” she says. “There were different systems and different specialists. He fell a lot before he went into extended care and there were lots of ambulance calls. He was in and out of the hospital.”

Challenges and gaps

Although heart failure can be difficult to diagnose for various reasons — including that symptoms can be similar to those of other conditions — diagnosis is an area where progress has been made. However, there is still room for improvement, especially around diagnosing patients earlier.

Heart failure can be treated and managed with changes to lifestyle and medications, and devices can help failing hearts. Still, the healthcare system is difficult for patients and their families to navigate and it is riddled with gaps. There are not enough heart failure specialists or heart failure clinics, and family physicians who are often the care providers for these patients can lack the specialized knowledge and training to deal with complicated cases. There is a lack of continuity of care from the hospital to the community with enormous gaps in home care support. Palliative and end-of-life care for heart failure patients is almost non-existent.

Hope for the future

New research is providing hope by looking at ways to stop heart failure in its tracks or to replace damaged tissue. Research is underway to test whether genes can be turned “off” and “on” to improve heart function after a heart attack. Regenerative medicine repairs or replaces human cells to help the body self-heal, and has the potential to heal damaged tissues and organs — such as hearts.

“There are lots of ways to aid a failing heart, either through prevention, medical therapeutics, artificial pumps, or tissue engineering or regenerative medicine,” says Dr. Fedak. “It is a fixable problem if we could turn scar back into muscle or if we could grow someone a new heart.”

Heart failure statistics

600,000 Canadians are living with heart failure.
50,000 new cases of heart failure are currently diagnosed each year.
Heart failure results in direct costs of more than $2.8 billion per year in Canada.
Hospital visits due to heart failure have gone up every year for the past six years, with 60,000 reported in 2013-2014, a relative increase of 13%.
Heart failure is a leading cause of hospitalization. Leaving out childbirth, heart failure is the third most common reason for hospitalization trailing only respiratory disease and heart attack, both of which are associated with heart failure.
Various sources estimate that one in every five heart failure patients find themselves back in the hospital within 30 days either for heart failure specifically (in about half of those cases) or for another related cause.
Around 30 per cent of heart failure patients experience depression.

Agencies/Canadajournal