The State of Heart Failure Care in Canada: Minimal Improvement in Readmissions Over Time Despite an Increased Number of Evidence-Based Therapies

Poon, Stephanie; Leis, Benjamin; Lambert, Laurie; MacFarlane, Kendra; Anderson, Kim B.; Blais, Claudia; Demers, Catherine; Hawkins, Nathaniel M.; Lee, Douglas S.; Moe, Gordon W.; Sandhu, Roopinder K.; Virani, Sean; Wilton, Stephen B.; Zieroth, Shelley; McKelvie, Robert S.

doi:10.1016/j.cjco.2022.04.011

Cited by 12 publications

(2 citation statements)

References 37 publications

(59 reference statements)

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“…3 4 Given the complexity of HF management, patient-centred, comprehensive and multidisciplinary care is needed. 5 Although there is wide variation in composition and services provided, heart function clinics (HFCs) are outpatient subspecialty centres staffed by a multidisciplinary team, typically offering timely care access to stabilise, optimise and prevent acute decompensation. 6 7 There is compelling evidence supporting reduced all-cause mortality and HF hospitalisations in patients receiving care in HFCs, with even greater benefits seen in patients having a recent emergency department visit or hospital admission.…”

Section: Introductionmentioning

confidence: 99%

Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic’s and referring provider’s perspectives

Mamataz,

Virani,

McDonald

et al. 2024

BMJ Open

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ObjectivesThere are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF clinic inclusion or exclusion criteria and how that related to referring providers' perspectives of ideal criteria.Design, setting and participantsTwo cross-sectional surveys were administered via research electronic data capture to clinic providers and referrers (eg, cardiologists, family physicians and nurse practitioners) across Canada.MeasuresTwenty-seven criteria selected based on the literature and HF guidelines were tested. Respondents were asked to list any additional criteria. The degree of agreement was assessed (eg, Kappa).ResultsResponses were received from providers at 48 clinics (37.5% response rate). The most common actual inclusion criteria were newly diagnosed HF with reduced or preserved ejection fraction, New York Heart Association class IIIB/IV and recent hospitalisation (each endorsed by >74% of respondents). Exclusion criteria included congenital aetiology, intravenous inotropes, a lack of specialists, some non-cardiac comorbidities and logistical factors (eg, rurality and technology access). There was the greatest discordance between actual and ideal criteria for the following: inpatient at the same institution (κ=0.14), congenital heart disease, pulmonary hypertension or genetic cardiomyopathies (all κ=0.36). One-third (n=16) of clinics had changed criteria, often for non-clinical reasons. Seventy-three referring providers completed the survey. Criteria endorsed more by referrers than clinics included low blood pressure with a high heart rate, recurrent defibrillator shocks and intravenous inotropes—criteria also consistent with guidelines.ConclusionsThere is considerable agreement on the main clinic entry criteria, but given some discordance, two levels of clinics may be warranted. Publicising evidence-based criteria and applying them systematically at referral sources could support improved HF patient care journeys and outcomes.

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Section: Introductionmentioning

confidence: 99%

Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic’s and referring provider’s perspectives

Mamataz,

Virani,

McDonald

et al. 2024

BMJ Open

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“…In Canada, more than 100,000 patients with heart failure are diagnosed annually and about 2.6 million adults aged 20 and over are living with this heart disease. Since heart failure is one of the top reasons for hospitalization, the associated healthcare costs have been estimated to reach

2.8 billion by 2030 in this country [ 1 , 2 , 3 , 4 ]. However, it should be pointed out that significant advances have been made for the development of medical therapies, which are used for the treatment of this disease.…”

Section: Introductionmentioning

confidence: 99%

Status of β1-Adrenoceptor Signal Transduction System in Cardiac Hypertrophy and Heart Failure

Dhalla,

Bhullar,

Adameova

et al. 2023

Rev. Cardiovasc. Med.

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Although 1 -adrenoceptor ( 1 -AR) signal transduction, which maintains cardiac function, is downregulated in failing hearts, the mechanisms for such a defect in heart failure are not fully understood. Since cardiac hypertrophy is invariably associated with heart failure, it is possible that the loss of 1 -AR mechanisms in failing heart occurs due to hypertrophic process. In this regard, we have reviewed the information from a rat model of adaptive cardiac hypertrophy and maladaptive hypertrophy at 4 and 24 weeks after inducing pressure overload as well as adaptive cardiac hypertrophy and heart failure at 4 and 24 weeks after inducing volume overload, respectively. Varying degrees of alterations in 1 -AR density as well as isoproterenol-induced increases in cardiac function, intracellular -concentration in cardiomyocytes and adenylyl cyclase activity in crude membranes have been reported under these hypertrophic conditions. Adaptive hypertrophy at 4 weeks of pressure or volume overload showed unaltered or augmented increases in the activities of different components of 1 -AR signaling. On the other hand, maladaptive hypertrophy due to pressure overload and heart failure due to volume overload at 24 weeks revealed depressions in the activities of 1 -AR signal transduction pathway. These observations provide evidence that 1 -AR signal system is either unaltered or upregulated in adaptive cardiac hypertrophy and downregulated in maladaptive cardiac hypertrophy or heart failure. Furthermore, the information presented in this article supports the concept that downregulation of 1 -AR mechanisms in heart failure or maladaptive cardiac hypertrophy is not due to hypertrophic process per se . It is suggested that a complex mechanism involving the autonomic imbalance may be of a critical importance in determining differential alterations in non-failing and failing hearts.

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Comparison of Machine Learning and Conventional Statistical Modeling for Predicting Readmission Following Acute Heart Failure Hospitalization

Abdul-Samad,

Ma,

Austin

et al. 2024

American Heart Journal

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The State of Heart Failure Care in Canada: Minimal Improvement in Readmissions Over Time Despite an Increased Number of Evidence-Based Therapies

Cited by 12 publications

References 37 publications

Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic’s and referring provider’s perspectives

Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic’s and referring provider’s perspectives

Status of β1-Adrenoceptor Signal Transduction System in Cardiac Hypertrophy and Heart Failure

Comparison of Machine Learning and Conventional Statistical Modeling for Predicting Readmission Following Acute Heart Failure Hospitalization

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