History of BC’s Heart Failure Strategy

As in most Western countries, the burden of heart failure (HF) in Canada is increasing, primarily as a result of improved medical management, improved diagnostics, increased survival among patients with hypertension and coronary artery disease and an aging population that are living longer and becoming more susceptible to heart failure. The most recent estimates indicate that there are about 500,000 Canadians living with heart failure and 50,000 new patients being diagnosed each year. (Ross, Howlett and Arnold, 2006).

BC HF prevalence rates are similar to national data and indicate that more than 90,000 patients are living with HF with this prevalence expected to double by 2030 (British Columbia Heart Failure Registry, 2009). HF is also one of the most expensive chronic diseases in BC with an annual estimated cost to the health care system of $590M. HF is also the most common cause of hospitalization of people over 65 years of age and has an average one-year mortality rate of 33% (Ross, Howlet, and Arnold, 2006). Accurate and timely diagnosis is critical to initiate treatment that will relieve HF symptoms, reduce hospitalizations, diminish costs and improve survival.

Phase I of BC HF Strategy

A provincial strategy to improved HF services and care was developed in 2009 with Health Authorities commencing their implementation strategies in 2010. The three-year provincial strategy, led by Cardiac Services BC (CSBC), is based on an investment of $7.58M.

In addition, a provincial center has been identified at St. Paul’s Hospital with responsibilities to collaborate with regional teams in the development of provincial HF quality indicators, HF resources, guideline, tools, patient self management resources, education and research.

The main planning objectives for the provincial HF strategy include:

  • Clear articulation and agreement on the roles and responsibilities of patients and providers (Primary Care Physicians, Internists, Specialists, other Health Care Providers)
  • Development and dissemination of a common understanding of optimal heart failure management for providers and patients
  • Facilitation of active self-management of the disease
  • Promotion of the appropriate use of technologies in consultations and/or (virtual) care
  • Targeting of areas of greatest need
  • Development, implementation, measurement and evaluation of adherence to best practice protocols/treatment algorithms.

To provide coordination of HF services in BC, a conceptual model based on the “hub and spoke” model was proposed whereby there would be  defined services in one location (e.g., spokes) with coordinated access to specialized services in other locations (e.g. regional or provincial hubs). The care model is based on the principles of the “Expanded Chronic Care Model” that functions to ensure integration across the care continuum, creates supportive environments, activates communities, develops and builds self management skills, engages proactive community partners and integrates information systems.

To support the implementation of the Provincial HF strategy, five working groups (with the addition of a 6th in 2013)  have been established that include representation from across the province.

Purpose of each group:

  • Database Working Group will identify a minimum data set, develop tools for data collection and evaluate key HF measures.
  • Diagnostic Imaging Working Group will identify requirements for diagnosis and management of HF patients, assess gaps in imaging services in BC and identify requirements for the establishment of provincial protocols for ordering diagnostic imaging tests.
  • Resource Development Working Group will identify and develop HF quality indicators, standardize HF order sets, protocols, guidelines, develop tools and resources to optimize HF care and create patient education resources that will facilitate patients to co- manage their condition.
  • Special Populations Working Group will identify, develop and implement HF management strategies for specialized populations (specifically, Frail Elderly, South Asians, Chinese, Aboriginal populations).
  • Telecommunications Working Group will identify, develop and implement strategies to improve access and connectivity to promote optimal HF management.
  • HF End of Life Working Group (2013): will identify current pracitce gaps with HF EOL, establish HF EOL symptom management guidelines, develope stratigies to mange HF technology, (specifically ICD deactivation) and outline the roles and responsibilites of specialists in HF EOL care.

Through the vision of BC’s HF stakeholders [those involved with the HF strategy], the Provincial Heart Failure Strategy has moved beyond a strategy to become “BC’s Heart Failure Network”.  The stakeholders within the network will work together at establishing resources, services and infrastructure to deliver quality care and quality services for HF patients across the province.

Phsae II of BC HF Strategy

Building on the success of Phase I of the Provincial HF Strategy, but understanding there was still HF work to be done in BC, it was agreed that the heart failure strategy would transition into Phase II. Cardiac Services BC will continue to fund and lead the Phase II Provinical HF Strategy in partnership with the five health authorities. Formal strategic planning for phase II commenced in spring of 2014 and continued into the late fall. Phase II shifts away from its focus on heart function clinics and established work plans to improve HF care across the care continuum. As well as leveraging the current Phase I work and integrating it into primary and community care, acute, residential and transitional care settings. With the addition of primary and secondary prevention, early identification of HF patients and ensuring all the work is patient centered.

Steering committee membership has expanded to include representation from multiple programs across the care continuum. Those include emergency, medicine, home and community and chronic disease management, as well as the addition of primary care physicians and patients. Phase II planning and infrastructure also aligns with BC’s Ministry of Health Strategic Priorities.

Further planning and infrastructure development is underway and as it unfolds the website will be updated