Framework – HeartLife Foundation

Heart Failure Policy Framework

A National Action Plan for Change

Overview

Heart Failure (HF) is escalating, resulting in thousands of deaths annually among people in Canada. Despite the availability of diagnostic and management tools for heart failure, significant obstacles hinder the provision of effective, patient-oriented care.

Building on our 2022 Patient & Caregiver Charter, The Heartlife Foundation developed the Framework to give decision makers the tools to improve patient outcomes and reduce costs on our healthcare system.

Why This Matters

HF is on the rise, causing substantial economic burden and reducing patients’ quality of life. Inequities in access to care further impact outcomes.

Huge Economic Costs to Our Healthcare System

▪ Second most expensive health condition in Canada, costing $575.2 million in hospital costs in 2016-2017.

▪ $2.8 billion per year in expected associated HF costs by 2030 associated with heart failure in Canada.

Huge Economic Opportunity With Change

▪ Simple interventions, like better testing implementation, could save $268-$347 million annually based on projected healthcare resource reductions

Three Pillars to Move Forward Change

Diagnosis & Screening

Provide and reimburse natriuretic peptide testing for all patients on first presentation to any healthcare setting with symptoms suggestive of new or worsening heart failure.

Provide timely access to echocardiography (immediately or within two weeks for baseline assessment) (preferred when available) or cardiac magnetic resonance imaging (CMRI) when echocardiographic imaging is non-diagnostic

Management & Care

Patients with heart failure should be on all 4 guideline-directed medications (GDMT), at a maximally tolerated dose for them, within 3 to 6 months from their initial diagnosis.

Use standardized regional or provincial processes and protocols, (e.g., acute admission order sets, discharge protocols, cardiac rehabilitation referral process, continuity of care protocols) to ensure consistency and quality of care.
Provide access to mental health support and psychological services for individuals with heart failure and caregivers upon diagnosis and regularly throughout the care continuum.

Research & Evaluation

Establish national heart failure registry and optimize the Canadian Community Health Survey to guide care delivery, to monitor outcomes and adherence for resource planning.
Engage patients, healthcare practitioners, and health systems to participate in heart failure research.
Define national, healthcare system-level key heart failure performance indicators,
Mandate performance reporting to establish accountability.
Routinely collect and report on patient reported outcome measures and patient-reported experience measures

Impact:

Overall, improving access to NT-pro-BNP testing has shown in multiple studies to both improve patient outcomes and reduce costs on the healthcare system in Canada, via reduced resource utilization, fewer echocardiograms, fewer initial hospitalizations, fewer cardiology admissions, fewer ICU admissions, fewer emergency readmissions and fewer hospital readmissions.
NT-pro-BNP testing implementation in Canada could save $268-$347 million annually based on projected healthcare resource reductions

Impact:

Effective and timely access to GDMT has been proven to improve patient outcomes and quality of life, reducing disease progression, complications and hospitalizations. Using all 4 GDMT medications together could help you live 5 to 8 years longer.

Effective management and multidisciplinary care could save millions through reduced hospitalizations and complications. This is essential as HF is a leading cause of hospitalization only behind COVID-19 and giving birth.  
For every $1 invested in scaled-up treatment for depression and anxiety research estimates a $4 return in better health.

Impact:

Enhanced transparency and accountability in healthcare delivery.
More responsive and tailored healthcare services to meet patient needs.
Accelerated development of medical knowledge and advancements.
Patient perspectives integrated into research priorities, design, and outcomes.
Increased relevance of research outcomes to real-world patient experiences.
Enhanced patient trust and engagement in healthcare research.
Opportunities for patients to contribute to improved treatments and interventions

Funding Requirements

Invest in Diagnostic Infrastructure for acute and primary care: Allocate funding to enhance diagnostic capabilities by updating and expanding medical imaging equipment such as hand held echocardiograms, diagnostic tests such as NTproBnP, and point-of-care testing technologies. This can lead to quicker and more accurate diagnoses, enabling timely interventions.

Subsidize GDMT: Provide equitable access to treatment through funding essential drugs and new effective therapies (including research to address the limited data on pharmacological therapy of heart failure with preserved ejection fraction [HFpEF]). Allocate funding to subsidize or reduce the cost of heart failure medications that are part of evidence-based treatment guidelines for prevalent conditions. This ensures that patients have affordable access to necessary GDMT, increasing adherence to treatment plans.

Expand Funding for Mental Health Services: Allocate funding to increase the availability of mental health services for patients and caregivers living with heart failure, including therapy, counseling, and psychiatry, particularly in underserved areas. This can help address the growing demand for mental health support. 
Fund research: including initiatives that examine new and affordable therapies (e.g., value-based agreements), assess the cost-effectiveness of treatments, evaluate healthcare performance measures, and explore new care delivery pathways (e.g., end-of-life care, advances in hospice care). Study enrollment should consider equity, diversity, and inclusion.

It's time to take action.

It is essential for provincial and federal political and administrative leadership to actively work to implement the framework recommendations, and everyday People in Canada can help. The HeartLife Foundation is advocating for change in Canada, urging participation in advocacy initiatives and donations to support People in Canada with heart failure. By actively participating in initiatives and supporting the foundation, individuals can contribute to substantial improvements in heart failure care and outcomes.