Dr. Stephanie Poon
Cardiologist & Medical Director,
Heart Function Clinic at Sunnybrook Health Sciences Centre
Dr. Simone Cowan
Cardiologist & Director,
Heart Function Clinic, St. Paul’s Hospital
Many Canadians are unaware that heart failure is a serious condition. Greater awareness plus access to timely diagnostics and care are needed.
Heart failure is a chronic condition in which the heart is unable to function optimally. “It can occur if the heart is too weak but also if the heart is strong, but too stiff, and unable to fill properly with blood,” says Dr. Stephanie Poon, a cardiologist specializing in heart failure and Medical Director of the Heart Function Clinic at Sunnybrook Health Sciences Centre in Toronto, Canada. “This can lead to fluid backing up in the lungs causing symptoms of shortness of breath, coughing, and leg swelling,” she says. The most common cause is coronary artery disease, which can lead to blockages in the heart arteries or heart attacks.
Approximately 750,000 Canadians are currently living with heart failure, and an additional 100,000 new cases are diagnosed each year, putting increased strain on our healthcare system. For example, in 2019 alone, there were more than 71,000 hospitalizations, costing billions of dollars. By 2040, those hospitalization costs are projected to reach approximately $19.5 billion. While these patients may experience high-quality hospital care, they may face a very different situation when they return home. Fragmented community support and limited access to effective treatment can lead to repeated hospital visits. In fact, 1 in 5 patients are readmitted within 30 days of discharge.
Canada’s fastest growing coronary condition
Cardiovascular disease is Canada’s fastest rising coronary condition due to our aging population, earlier diagnosis in young patients, and people with other heart conditions. Despite its prevalence, only 4 out of 10 Canadians know what heart failure is. Given the seriousness of this condition, this lack of awareness is concerning. Heart failure is one of the most common reasons why Canadians end up in hospital and can be more deadly than some cancers. “We know that the mortality rate for heart failure is higher than that for breast cancer in women and prostate cancer in men,” says Dr. Poon.
While there is no cure for heart disease, complications and deaths can be prevented through different treatment options to help patients manage their condition, strengthen their hearts, and avoid hospitalization. These can include both lifestyle modifications, such as reducing excess fluid and salt intake and not smoking, and new medical therapies. Among the new evidence-based therapies are drugs targeting different biochemical and hormonal pathways implicated in heart failure, which are helping to improve quality of life, extend survival, and reduce hospitalizations.
Unequal access to life-saving therapies add to disease burden
Unfortunately, fewer than 70% of eligible patients receive these therapies, and fewer than 30% receive target doses. This gap may be due to physician or patient-related factors, but is largely related to how heart failure drugs are covered across provinces. Recent research from the Canadian Cardiovascular Society (CCS) shows that provincial differences in drug reimbursement criteria, prior-use requirements, and prescriber restrictions that don’t align with current evidence make it harder for clinicians to deliver the best possible care. Quebec, for example, is one of four provinces that does not impose prescriber-related restrictions for sacubitril-valsartan through its drug benefit program (RAMQ). However, it is the only province that has restrictions on its coverage of dapagliflozin, a life-saving heart failure medication. Similarly, the heart failure beta-blocker carvedilol, which reduces the combined risk of death and hospitalization, is covered without restrictions in all provinces except Ontario and British Columbia.
The result of this patchwork approach to essential heart failure medication is avoidable suffering, preventable deaths, and higher long-term costs. But this doesn’t have to be the case. Modeling data show multiple tangible benefits could be achieved if eligible patients were treated with guideline-direct medical therapies, including:
- 4,699 fewer cardiovascular deaths or first heart failure hospitalizations
- 3,698 fewer 30-day readmission
- >$40 million reduction in hospitalization expenditures
“There is strong evidence that heart failure medications save lives and reduce health care costs. It’s time to erase health inequities by providing universal coverage without restrictions for heart failure medications across Canada,” says Dr. Simone Cowan, Director of the Heart Function Clinic at St. Paul’s Hospital in Vancouver.
Important test needed to diagnose heart failure
Another area of health inequity is in the ability for many Canadians living with heart failure to get a prompt diagnosis. A simple but critical blood test to diagnose heart failure, N-Terminal proBNP (NT-proBNP), is available. However, until 2021, the $80 cost for the test was borne by patients. Ontario Health started to fund NT-pro BNP following the findings of a health technology assessment report by Health Quality Ontario, demonstrating its effectiveness and potential to reduce healthcare costs. However, the test is not yet covered through core OHIP funding in Ontario, nor is it covered uniformly across Canada.
To fully benefit from the available heart failure diagnostics and treatments, Canadians need equal access, regardless of where they live. Because when it comes to heart failure, where you live should never decide how long you live.
Learn more about heart failure and how to advocate for free access to diagnostic tests for all Canadians by visiting heartfailure.ca.
