BC’s Heart Failure Network Rolls out 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 HF and 50,000 new patients being diagnosed each year. (Ross, Howlett, 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. 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%. Accurate and timely diagnosis is critical to initiate treatment that will relieve HF symptoms, reduce hospitalizations, diminish costs and improve survival. A provincial strategy to improve 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 centre has been identified at St. Paul’s Hospital with responsibilities to lead acute HF management, collaborate on 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 (GPs, internists, specialists, other health 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 are 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 plan, five working groups 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 HF diagnosis and management of HF patients, identify gaps in diagnostic imaging and establish provincial protocols for ordering , performing and reporting HF diagnostic tests.

Resource Development Working Group will identify and develop HF quality indicators, create and  standardize HF order sets, protocols, guidelines, develop tools and resources to optimize HF care and facilitate patients to self management their disease.

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.

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.

The number of people with heart failure is increasing throughout BC. To help meet this challenge, BC’s Heart Failure Network generates and shares accurate, current, and relevant heart failure information for health care providers and patients in BC. We will do this primarily through our central, online hub (www.bcheartfailure.ca), which will contain BC  and Canadian specific heart failure information including practice guidelines, expert advice and referral information. We’re also working to improve access to diagnostics and specialized heart failure care throughout the province. We’re called “BC’s network” because we work for the people of BC who are living with heart failure to improve their health and well-being regardless of geography or cultural background.  We are supported by the Provincial Health Services Authority and all of BC’s regional health authorities.

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