ACCESS TO HEART FAILURE SERVICES IN CANADA: FINDINGS OF THE HEART & STROKE NATIONAL HEART FAILURE RESOURCES AND SERVICES INVENTORY.

Abstract

The rising incidence of Heart Failure (HF) in Canada necessitates commensurate resources dedicated to its management. Several health system partners launched a HF Action Plan to understand the current state of HF care in Canada and address inequities in access and resources. A national Heart Failure Resources and Services Inventory (HF-RaSI) was conducted between 2020-2021 of all 629 acute care hospitals and 20 urgent care centres in Canada. The HF-RaSI consisted of 44 questions on available resources, services and processes across acute care hospitals and related ambulatory settings. HF-RaSIs was completed by 501 acute care hospitals and urgent care centers, representing 94.7% of all HF hospitalizations across Canada. Only 12.2% of HF care was provided by hospitals with HF expertise and resources, and 50.9% of HF admissions were in centers with minimal outpatient or inpatient HF capabilities. Across all Canadian hospitals, 28.7% did not have access to brain natriuretic peptide testing, and only 48.1% had access to on-site echocardiography. Designated HF medical directors were present in 108 sites (21.6%), and 81 sites (16.2%) had dedicated inpatient interdisciplinary HF teams. There were 141 HF clinics (28.1% of all sites); of these, 57 (40.4%) had average wait times from referral to first appointment of > 2 weeks. Significant gaps and geographic variation in delivery and access to HF services exist in Canada. This study highlights the need for provincial and national health systems changes and quality improvement initiatives to ensure equitable access to the appropriate evidence-based HF care.