Staff Scientist / Director, Research Toronto General Hospital Toronto, Ontario, Canada
Background: Heart failure (HF) is a leading and growing cause of cardiovascular morbidity, mortality, and health care use in Canada. In the James and Hudson’s Bay region of Ontario, a recent ICES analysis of the potential prevalence of heart failure by Weeneebayko Area Health Authority (WAHA), University Health Network (UHN) and ICES estimated that nearly 11% (1,088 individuals) of people in the region have confirmed or possible heart failure (HF), highlighting a pressing need for screening and early detection.
METHODS AND RESULTS: As part of their collaborative model of HF care, WAHA and UHN co-developed a HF screening pathway to detect, diagnose and treat patients earlier. This pathway adhered to Canadian Cardiovascular Society Guidelines and was integrated into WAHA primary care workflows. It was piloted over eight months from January 1 to August 31, 2024. Results were documented in hospital EMRs. Data were extracted for analysis from EMRs in July 2024, with subsequent extractions to capture diagnostic testing results and health system utilization.
A total of 122 patients from WAHA communities were referred as part of the screening program. All referred patients (100%) were triaged and assessed for criticality, with 87 (71.3%) seen in-person or virtually through the Ontario Telemedicine Network (OTN) by UHN clinicians in the pilot timeframe, with all others scheduled or seen subsequently. Cardiovascular risk factors were highly prevalent. Among the 87 patients seen, 80.5% had hypertension, 52.9% had diabetes, 49.4% had dyslipidemia, and 37.9% were current or former smokers and 27.6% reported a family history of cardiovascular disease. More than 50% had three or more risk factors. Only 18 (20.7%) patients had BNP or NT-pro BNP testing prior to their first clinical appointment despite its importance in HF diagnosis and inclusion in the screening protocol. Clinical assessments led to new or refined diagnoses, notably HF diagnoses rose from 13.8% to 27.6%. A total of 24 patients (27.6%) were diagnosed with HF and further characterized with cardiac testing: HF with preserved ejection fraction (HFpEF) was identified in 6 patients (6.8%), HF with reduced ejection fraction (HFrEF) identified in 18 patients (20.6%).
Conclusion: A HF screening pathway grounded in a strengths-based approach and local capacity, and responsive to the realities of northern and remote communities, successfully detected heart failure in 18.9% to 27.6% of potential cases in the JHB, facilitating high-quality care. The value and importance of access to natriuretic peptide testing in HF diagnosis was reinforced.
