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BC's Heart Failure Strategy & Network

Heart failure (HF) is a growing epidemic across all provinces in Canada. Accurate and timely diagnosis and access to care is vital to establishment treatments to relieve symptoms and reduce hospitalizations, mortality and health care costs.
Heart failure, the most common cause of hospitalization of people over 65, is one of the province’s most expensive chronic diseases, costing the health care system an estimated $1 billion each year. 

Although a chronic condition, developing after the heart becomes damaged, medical intervention and lifestyle changes can help patients live longer and improve their quality of life. In BC, 114,000 people are living with heart failure – with prevalence expected to double by 2030 (British Columbia Heart Failure Registry, 2016).  

Cardiac Services BC invited provincial HF stakeholders to a one-day planning session back in April 2009 to understand the local and provincial system of care used to address this growing epidemic. Participants decided to establish a provincial HF program to build structures and strategies aimed at improving heart failure care, knowledge and care efficiencies. 

Phase I: the early years
A Provincial Heart Failure Strategy was launched in 2010, anticipating that the provincial work would last three years. 

Led by Cardiac Services BC, with an initial investment of $7.58M, the Heart Failure Strategy set out to establish provincial standardization of HF care, improve access to HF care, and standardize patient education resources. 

Collaborative partnerships to improve heart failure management across BC were established between health authority HF teams, patients and educational institutions. Outcomes ranged from the establishment of provincial practice and patient self-management resources, standardizing HF care pathways, improving access to HF care and diagnostics, establishing the first Canadian HF End of Life program and building BC HF website to locate resources in one central repository. 

To ensure ongoing provincial connectivity after the provincial HF program was launched the HF teams established BC’s Heart Failure Network.  

BC’s Heart Failure Network works to improve the health and well-being of BC people who are living with heart failure. It is supported by all of BC’s regional health authorities.

BC’s Heart Failure Network is

1. A collaborative, interprofessional team from across BC.
Supported by BC’s health authorities, we are a BC wide network of cardiac specialists, nurses, family physicians, and allied health care professionals. This team, along with Cardiac Services BC, created BC’s heart failure network.

2. Committed to broad education & knowledge sharing.
We provide comprehensive and current information, guidelines, and practice tools for BC health professionals. We also provide accessible, culturally sensitive resources to ensure all patients and families have the opportunity to co-manage their heart failure care.

3. Working with health practitioners to standardize quolity care in BC.
We provide the latest evidence based heart failure literature and evidence-based tools to ensure all practitioners have the information they need to deliver the best quality care no matter where they practice in BC.

4. Working with BC health authorities to ensure equitable access to heart failure care. 
Together, we are increasing human resource capacity and creating supports to ensure all patients in BC have timely access to heart failure diagnostics and specialty care.

5. Committed to improving health outcomes of British Columbians with heart failure.
Guided by the BC heart failure strategy, we seek to improve the health and quality of life of all heart failure patients living in BC.                                                                                

Phase II: building success
By early 2014 it was clear that BC’s HF program was successful in standardizing health and improving carer and patient access to evidence-based HF resources. 

It was also apparent that the provincial HF strategy would extend well beyond three years, as there was still work to be done across the care continuum, specifically at end of life.

In 2014, Cardiac Services BC coordinated a one-day session with provincial palliative and HF experts to understand the current state care for patients with HF at end of life. What was identified was we needed to do a better job of caring for these patients by improving knowledge and structures within the current system, and understanding the roles of responsibilities of HF specialists as patient’s progress to end of life.  

Cardiac Services in collaboration with the regional health authorities, HF and palliative care experts established the HF End of Life arm of the BC HF strategy/program. 

Outcomes of this work were ground-breaking - the establishment of first-ever Canadian provincial resources:
  1. Planned and urgent ICD deactivation protocol*
  2. Health care profession HF End of Life symptom management practice resources*
  3. HF End of Life Appropriate Prescribing Guideline*
  4. Consensus Framework outlining the roles and responsibilities of Specialist/Specialist Team during End of Life*
  5. Advanced Heart Failure Personal Action Plan
The second phase built on previous work with a specific focus on integrating phase I practice resources into the current acute and community care paths, improving heart failure service provision across the care continuum, and partnering with local and national HF advocacy organizations. The Outcomes remain patient-centred, with ongoing improvement in secondary prevention, and early identification and treatment of heart failure patients. 

Results are being seen across all levels of the care continuum and improving partnerships with Heart & Stroke Foundation and Canadian Cardiovascular Society.

Phase II planning and infrastructure also aligns with BC’s Ministry of Health Strategic Priorities, and steering committee membership has expanded to include representation from programs across the care continuum. These include emergency, medicine, home and community and chronic disease management. 

Cardiac Services BC
  • Provincial Heart Failure Steering Committee
Regional Health Authority Heart Failure Leads:
  • Fraser Health: Ashifa Ahmed, Dr. Amit Khosla
  • Interior Health:  Jeannine Costigan, Dr. Sandy Baker
  • Northern Health: Jessica Place, Dr. Firas Mansour
  • Vancouver Coastal Health: Suzanne Nixon, Janis McGladrey, Dr. Nat Hawkins 
  • Vancouver Island Health: Tasha Mckelvey , Dr. Elizabeth Swiggum

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SOURCE: BC's Heart Failure Strategy & Network ( )
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