Canadian Heart Failure Research Articles

The Canadian Heart Failure (CAN-HF) Registry: A Canadian Multicentre, Retrospective Study of Outpatients with Heart Failure

BackgroundGuideline-directed medical therapy (GDMT) reduces events in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Despite this impact, underutilization of GDMT persists. This report sought to describe HF management in Canadian outpatients treated at specialized HF clinics (HFCs). MethodsThe Canadian Heart Failure (CAN-HF) study was retrospective and observational, and it included 1775 patients from 6 Canadian outpatient HFCs, from the period January 2017-April 2020. ResultsWe observed improvement in prescription rates in patients with HFrEF, between their first visit and their most-recent clinic visit, across all GDMT classes, in those who were followed at the HFC for ≥ 6 months. The largest prescription rate increases were observed for angiotensin receptor–neprilysin inhibitors and mineralocorticoid-receptor antagonists. However, more than half of the patients remained on angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers, despite being symptomatic, according to their New York Heart Association class. Most patients (50%) were on triple therapy, as of their most-recent visit, with fewer (36%) on dual therapy, monotherapy (13%), or no GDMT (2%). Our data also suggest that patients who had been managed at the HFC for > 6 months had higher prescription rates of GDMT and were on higher doses of GDMT, compared to those who were new to the clinic. For patients with HF with preserved ejection fraction, few patients were on candesartan and less than half were on a mineralocorticoid-receptor antagonist. ConclusionsOur data from HFCs that in most cases were affiliated with academic centres compare favourably with data from other analyses of ambulatory patients with HFrEF, evidence that supports the use of a specialized patient-care model.

Qualitative Analysis of Patient Decisional Needs for Medications to Treat Heart Failure.

The development of tools to support shared decision-making should be informed by patients' decisional needs and treatment preferences, which are largely unknown for heart failure (HF) with reduced ejection fraction (HFrEF) pharmacotherapy decisions. We aimed to identify patients' decisional needs when considering HFrEF medication options. This was a qualitative study using semi-structured interviews. We recruited patients with HFrEF from 2 Canadian ambulatory HF clinics and clinicians from Canadian HF guideline panels, HF clinics, and Canadian HF Society membership. We identified themes through inductive thematic analysis. Participants included 15 patients and 12 clinicians. Six themes and associated subthemes emerged related to HFrEF pharmacotherapy decision-making: (1) patient decisional needs included lack of awareness of a choice or options, difficult decision timing and stage, information overload, and inadequate motivation, support and resources; (2) patients' decisional conflict varied substantially, driven by unclear trade-offs; (3) treatment attribute preferences-patients focused on both benefits and downsides of treatment, whereas clinicians centered discussion on benefits; (4) quality of life-patients' definition of quality of life depended on pre-HF activity, though most patients demonstrated adaptability in adjusting their daily activities to manage HF; (5) shared decision-making process-clinicians' described a process more akin to informed consent; (6) decision support-multimedia decision aids, virtual appointments, and primary-care comanagement emerged as potential enablers of shared decision-making. Patients with HFrEF have several decisional needs, which are consistent with those that may respond to decision aids. These findings can inform the development of HFrEF pharmacotherapy decision aids to address these decisional needs and facilitate shared decision-making.

Evaluation of Guideline-Directed Medical Therapy for Outpatients Living with Heart Failure with Reduced Ejection Fraction.

Pharmacotherapy is the cornerstone of treatment for heart failure with reduced ejection fraction (HFrEF). The Canadian Cardiovascular Society and Canadian Heart Failure Society have defined guideline-directed medical therapy (GDMT) as 4 foundational medications. Despite strong recommendations for use of GDMT in HFrEF, current practice alignment with guidelines is unknown. The primary objectives were to determine the proportion of patients for whom optimized GDMT for HFrEF was prescribed, to describe the doses of foundational medications achieved, and to describe any documented rationale limiting the optimization of GDMT. The secondary objectives were to describe documented pharmacist activities outside of scheduled multidisciplinary appointments at the heart function clinic (HFC) and to describe heart failure-related hospital encounters in 2021. A retrospective cohort study using medical records of patients with HFrEF who were receiving treatment at the Regina HFC as of December 31, 2021, was conducted. Of the 129 patients included in the study, 61 (47.3%) were prescribed optimized GDMT. Specifically, within the individual foundational medication classes, 82.2% (106/129), 80.6% (104/129), 79.1% (102/129), and 74.4% (96/129) of patients received optimized therapy with a renin-angiotensin system inhibitor, mineralocorticoid receptor antagonist, β-blocker, and sodium-glucose cotransporter 2 inhibitor, respectively. Documented rationale was not available in 35.8% (38/106) of instances of suboptimal utilization of GDMT and in 41.7% (60/144) of instances of suboptimal dosing of GDMT. The most common documented rationale for suboptimal utilization was intolerance to the medication (33.0% [35/106]), and the most common rationale for suboptimal dosing was intolerance to dose increases (57.6% [83/144]). Pharmacists documented a total of 553 patient care activities for 58.9% (76/129) of the patients, outside scheduled multidisciplinary appointments in the HFC. Sixteen patients (12.4%) had heart failure-related hospital encounters a total of 31 times in 2021. Although many patients were receiving the benefits of multidisciplinary care at the Regina HFC, there remained a treatment gap in the use of GDMT for HFrEF. These findings will be used to inform strategies to improve clinic processes, including efficient identification of patients requiring optimization of GDMT, who would benefit the most from multidisciplinary care.

Patient Eligibility for Established and Novel Guideline-Directed Medical Therapies After Acute Heart Failure Hospitalization

BackgroundAcute heart failure (AHF) hospitalization presents an opportunity to optimize pharmacotherapy to improve outcomes. ObjectivesThis study’s aim was to define eligibility for initiation of guideline-directed medical therapy and newer heart failure (HF) agents from recent clinical trials in the AHF population. MethodsThe authors analyzed patients with an AHF admission within the CAN-HF (Canadian Heart Failure) registry between January 2017 and April 2020. Heart failure with reduced ejection fraction (HFrEF) was defined as left ventricular ejection fraction (LVEF) ≤40% and heart failure with preserved ejection fraction (HFpEF) as LVEF >40%. Eligibility was assessed according to the major society guidelines or enrollment criteria from recent landmark clinical trials. ResultsA total of 809 patients with documented LVEF were discharged alive from hospital: 455 with HFrEF and 354 with HFpEF; of these patients, 284 had a de novo presentation and 525 had chronic HF. In HFrEF patients, eligibility for therapies was 73.6% for angiotensin receptor–neprilysin inhibitors (ARNIs), 94.9% for beta-blockers, 84.4% for mineralocorticoid receptor antagonists (MRAs), 81.1% for sodium-glucose cotransporter-2 (SGLT2) inhibitors, and 15.6% for ivabradine. Additionally, 25.9% and 30.1% met trial criteria for vericiguat and omecamtiv mecarbil, respectively. Overall, 71.6% of patients with HFrEF (75.5% de novo, 69.5% chronic HF) were eligible for foundational quadruple therapy. In the HFpEF population, 37.6% and 59.9% were eligible for ARNIs and SGLT2 inhibitors based on recent trial criteria, respectively. ConclusionsThe majority of patients admitted with AHF are eligible for foundational quadruple therapy and additional novel medications across a spectrum of HF phenotypes.

Guideline-directed medical therapy in heart failure patients with reduced ejection fraction in Oman: utilization, reasons behind non-prescribing, and dose optimization

Background: Objective:To determine the reasons behind guideline-directed medical therapy (GDMT) non-prescribing, drug utilization before and after excluding those intolerable to GDMT, as well as dose optimization in heart failure (HF) patients with reduced ejection fraction (<40%) (HFrEF) in Oman.Methods:The study included HF patients seen at the medical outpatient clinics at Sultan Qaboos University Hospital, Muscat, Oman, between January 2016 and December 2019 and followed up until the end of June 2021. The use of renin-angiotensin-system (RAS) blockers (angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) or angiotensin receptor-neprilysin inhibitors (ARNIs)), beta blockers and mineralocorticoid receptor antagonists (MRAs) were evaluated as per the European, American, and Canadian HF guidelines. Analyses were performed using univariate statistics.Results:A total of 171 HFrEF patients were enrolled for this study, the overall mean age of the cohort was 63 ± 15 years old and 59% were male. Over 65% of the patients had chronic kidney disease. Almost 55% of the patients were intolerable to GDMT. The proportion of patients on beta blockers, RAS blockers/ hydralazine-isosorbide dinitrate combination, and MRAs, before and after excluding those intolerable to GDMT, were 89%, 97%, and 77%, and, 94%, 47% and 85%, respectively, while the proportion of patients on the GDMT combination concomitantly was 41% and 83%, respectively. A total of 61%, 44% and 100% of the patients were prescribed ≥50% of the target dose for beta blockers, RAS blockers/ HYD-ISDN combination and MRAs respectively, while 19%, 8.2% and 94% of the patients attained 100% of the target dose for beta blockers, RAS blockers/ HYD-ISDN combination and MRAs respectively.Conclusions:Reasons behind GDMT non-prescribing were frequent and not clearly obvious in patients’ medical notes. The majority of the patients were prescribed GDMT. However, dose optimization, specifically for beta blockers and RAS blockers/ HYD-ISDN combination, was still suboptimal. The findings should be interpreted in the context of low study power and that future studies, with larger sample sizes, are warranted to minimize this limitation.

Outcomes of guideline-based medical therapy in patients with acute heart failure and reduced left ventricular ejection fraction: Observations from the Gulf acute heart failure registry (Gulf CARE).

This study aimed to report on the use, predictors and outcomes of guideline-based medical therapy (GBMT) in patients with acute heart failure (HF) with reduced ejection fraction of <40% (HFrEF), from seven countries in the Arabian Gulf.Patients with acute HFrEF (N = 2680), aged 18 years or older, and hospitalized February–November 2012 were recruited and data were collected post discharge at 3 months (n = 2477) and 1 year (n = 2418). The use and doses of GBMT were evaluated as per European, American and Canadian HF guidelines. Analyses were performed using multivariate logistic regression. This study was registered at clinicaltrials.gov (NCT01467973).The majority of patients were on dual (39%) and triple (39%) GBMT modalities, 14% received one GBMT medication, while 7.2% were not on any GBMT medications. On admission, 80% of patients were on renin-angiotensin system (RAS) blockers, 75% on b-blockers and 56% on mineralocorticoid receptor antagonists (MRAs), with a small proportion of these patients were taking target doses (RAS blockers 13%, b-blockers 7.3%, MRAs 14%). Patients taking triple GBMT were younger (P < .001), less likely to have comorbidities such as diabetes mellitus (P < .001) and CKD/dialysis (P < .001), less likely to receive in-hospital invasive treatments (P < .001), and more likely to be treated by a cardiologist (P < .001), than patients on a single medication. Patients taking triple GBMT showed significantly reduced all-cause mortality both at 3-months (P = .048), and at 12-months (P = .003), compared to patients taking no GBMT.Triple GBMT prescribing and dosing in patients with HFrEF were suboptimal in the Arabian Gulf. Further studies are required to investigate GBMT utilization and dosing in the outpatient setting.

The Canadian Heart Failure (CAN-HF) Registry: A Canadian Multicentre, Retrospective Study of Inpatients With Heart Failure

BackgroundDespite recent advances in the management of patients with heart failure (HF), national data regarding the quality of care provided are lacking. The Canadian Heart Failure (CAN-HF) Registry was designed to obtain contemporary, real-world data describing the management of patients with HF. MethodsQuality of care in patients admitted for acute HF (AHF), in relation to guidelines and national HF quality indicators, was assessed as part of the CAN-HF Registry study. ResultsA total of 943 patients admitted to the hospital with AHF were included in this analysis. Patient weight was not recorded on admission for 26% of patients, with daily weight being captured in only 61% of patients. Only 54% of inpatients received left ventricular ejection fraction assessment while hospitalized. Patient education was documented in 31% of patients prior to discharge, with 51% receiving instructions to follow up with a specialist upon discharge, and 2% being referred to a cardiac rehabilitation program. Although use of guideline-directed medical therapy increased during hospitalization, the proportions of patients receiving renin-angiotensin-aldosterone inhibition (63%), beta-blockade (80%), and mineralocorticoid receptor antagonist (40%) upon discharge indicate that potential room for improvement exists. ConclusionsThe CAN-HF Registry study demonstrated a potential quality-of-care gap in the management of patients admitted with AHF.

AMBULATORY PULMONARY ARTERY PRESSURE MONITORING REDUCES COSTS AND IMPROVES OUTCOMES IN SYMPTOMATIC HEART FAILURE: A SINGLE-CENTER CANADIAN EXPERIENCE

<h3>BACKGROUND</h3> Pulmonary artery pressure (PAP) monitoring with the CardioMEMS device reduces heart failure (HF) hospitalizations and improves quality of life in NYHA Class III HF. The aim of this study was to evaluate the CardioMEMS device in a real-world Canadian HF cohort and explore its economic impact. <h3>METHODS AND RESULTS</h3> 21 patients with NYHA Class III HF underwent CardioMEMS implantation at Foothills Medical Centre, Calgary, Alberta. Baseline, 3, 6, 9, and 12-month assessments of laboratory parameters, hemodynamics, 6-minute walk test (6-MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ12) scores were prospectively collected. Healthcare costs for the 1-year pre and post-implant were collected from administrative databases. Of 21 patients, 19 patients had useable data (1 unsuccessful implant, 1 pressure dampening due to small implant artery). There were no procedural complications. Mean age was 68.9 years, 45% were female, 10% HFpEF. Of those with HFrEF, mean LVEF at baseline was 31%. Over a mean follow-up of 10 months, there was an 85% reduction in HF ER visits (p=0.0003), 83% reduction in HF hospitalizations (p < 0.001), 79% decrease in all-cause hospitalizations (p=0.0006), 41% decrease in HF clinic visits (p=0.034), and a 151% increase in nurse clinician calls (p < 0.0001) observed. KCCQ-12 scores and 6-MWT at baseline vs. last follow-up were 45.7 vs. 47.1 (p=0.76) and 364.4 vs. 402.3 m (p=0.59), respectively. NT-proBNP and mean PAP at baseline vs. last follow-up were 2277.2 vs. 1509.9 pg/mL (p=0.28) and 31.5 vs. 24.4 mmHg (p=0.0024), respectively. NYHA class improved at least one class in 74% of patients. Fourteen patients have completed 1 year of follow-up. Table 1 outlines healthcare utilization costs 1-year pre and post-implant (n=14). Total measurable HF-related spending pre-implantation was $324 795. The cost of measurable HF spending in the year post-implantation was $108 763. When considering device cost, the net cost at 1-year was $386 558, equating to an additional $4 412 per patient. <h3>CONCLUSION</h3> CardioMEMS remote monitoring demonstrated reductions in PA pressures, hospitalizations, ER visits, clinic visits and improvement in NYHA class in NYHA III HF. There was no significant difference in KCCQ12 scores, 6MWT or NT-proBNP limited by short duration of follow up. Cost-parity was nearly achieved at 1-year post-implantation, driven predominantly by a significant reduction in hospitalization costs. Though further economic evaluation is needed, these results support the use of ambulatory PA pressure monitoring as a cost-effective method of HF management in a publicly funded healthcare system.

Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese

In this document, we propose a universal definition of heart failure (HF) as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. We also propose revised stages of HF as: At risk for HF (Stage A), Pre-HF (Stage B), Symptomatic HF (Stage C) and Advanced HF (Stage D). Finally, we propose a new and revised classification of HF according to left ventricular ejection fraction (LVEF). This includes HF with reduced ejection fraction (HFrEF): symptomatic HF with LVEF ≤40%; HF with mildly reduced ejection fraction (HFmrEF): symptomatic HF with LVEF 41-49%; HF with preserved ejection fraction (HFpEF): symptomatic HF with LVEF ≥50%; and HF with improved ejection fraction (HFimpEF): symptomatic HF with a baseline LVEF ≤40%, a ≥10 point increase from baseline LVEF, and a second measurement of LVEF > 40%.

Evaluation of guideline-based cardiovascular medications and their respective doses in heart failure patients in Oman.

Background Significant gaps exist between guidelines and practice in the management of heart failure, not only in Oman but the Arabian Gulf region in general. Currently, only limited research exists on the use of these guideline-based cardiovascular medications and their corresponding target doses in the region. Objective To evaluate the use of guideline-based cardiovascular medications and their corresponding target doses in heart failure patients with reduced (< 40%) and mid-range (40-49%) ejection fraction in Oman. Setting Cardiology clinics at Sultan Qaboos University Hospital, Muscat, Oman. Methods The study included heart failure patients seen at the clinics between January 2016 and December 2019. The use of angiotensin-converting-enzyme inhibitors (captopril, lisinopril) or angiotensin II receptor blockers (irbesartan, valsartan), β-blockers (bisoprolol, carvedilol) and spironolactone along with their respective target doses were evaluated as per the European, American, and Canadian heart failure guidelines. Analyses were performed using univariate statistics. Main outcome measure The proportion of patients that was prescribed guideline-based heart failure medications along with their target doses as per guidelines. Results The overall mean age of the cohort (N = 249) was 63 ± 15years and 61% (n = 151) were males. Seventy-one percent (n = 177) of the patients had heart failure with reduced ejection fraction while 29% (n = 72) had heart failure with mid-range ejection fraction. A total of 87% (n = 216), 62% (n = 154) and 39% (n = 96) of the patients were on β-blockers, angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers and spironolactone, respectively. Only 33% (n = 81) of the patients were on the triple guideline-based cardiovascular medication classes concurrently. Patients with reduced ejection fraction were more likely to be prescribed the triple guideline-based cardiovascular medication classes concurrently than those that had heart failure with mid-range ejection fraction (37% vs 22%; p = 0.027). A total of 100% (96/96), 56% (121/216) and 42% (64/153) of the patients were prescribed ≥ 50% of target dose for spironolactone, β-blockers and angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers, respectively. Conclusions The use of guideline-based cardiovascular medications in heart failure patients with reduced and mid-range ejection fraction is low in Oman. They were also largely not optimally dosed at target levels.

Optimizing Access to Heart Failure Care in Canada During the COVID-19 Pandemic

The traditional model of heart failure (HF) care in Canada, which relies upon a multidisciplinary team and clinic-based care processes, has been undermined as a result of the COVID-19 pandemic. As the pandemic continues, we will be challenged to improve or maintain the health status of those with HF by optimizing guideline-directed care despite physical distancing constraints and a reduction in the health care workforce. This will require development of new strategies specifically targeted at decreasing the risk of decompensation and resultant HF hospitalization. As such, we must quickly pivot to the adoption and application of novel technologies and revise usual care models, processes, and workflow. The unprecedented COVID-19 crisis has delivered the Canadian HF community a burning platform for the design and implementation of innovative approaches to support the vulnerable population we serve; born out of necessity, we now have the opportunity to explore innovative approaches that might inform the future of HF care delivery in Canada. Herein, we provide perspectives from leadership within the Canadian Heart Failure Society on how to optimize HF care during the COVID-19 pandemic.

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

OPTIMAL USAGE OF SACUBITRIL/VALSARTAN FOR HEART FAILURE TREATMENT IN CANADA POTENTIALLY REDUCES HOSPITALIZATIONS AND EARLY DISCHARGE RE-ADMISSIONS

Despite multiple evidenced-based therapies, heart failure (HF) continues to be characterized by high hospitalization rates. Sacubitril/valsartan, a first-in-class angiotensin receptor neprilysin inhibitor treatment for HF with reduced ejection fraction (HFrEF) provided incremental cardiovascular and overall survival benefit in PARADIGM-HF in HF patients. The objective of this analysis was to quantify the number of potential hospitalizations and 30-day HF re-admissions avoided with optimal usage of sacubitril/valsartan in the treatment of HFrEF patients in Canada. Data from Statistics Canada was used to quantify the population above 18 years of age. A literature search was then conducted to determine the prevalence of HF in Canada, the proportion of these with NYHA class II and III, and finally the proportion of patients with HFrEF. The number needed to treat (NNT) to avoid one hospitalization or one 30-day HF re-admission, standardized to 12 months was derived from the PARADIGM-HF trial. The potential number of hospitalizations prevented as a result of optimal usage of sacubitril/valsartan as per current approved indication in Canada (patients with HFrEF, ejection fraction ≤ 40% and NYHA class II or III symptoms) was estimated along with multiple-way sensitivity analysis using the analysis-of-extremes method. The main outcomes were HF hospitalizations and 30-day HF re-admission. A Canadian HF prevalence of 2.31% was applied to determine the number of HF patients. Of those, 64% were classified as NYHA Class II and III with 56% considered as HFrEF. It was estimated that in Canada, approximately 242,200 patients are affected with HFrEF with NYHA class II and III. Based on a NNT of 80, optimal usage of sacubitril/valsartan therapy was estimated to prevent 3,016 hospitalizations per year (range, 1,930 – 4,331 per year). Based on a NNT of 61, optimal usage of sacubitril/valsartan therapy was estimated to prevent 3,984 30 day HF re-admissions per year (range, 2,546-5,744). Evidence-based treatment for HF is well-established and has resulted in important reductions of hospitalization but there is still a need for new guideline recommended therapies to further improve hospitalization rates for HFrEF patients. The findings from this analysis suggest that a substantial number of hospitalizations and 30 day HF re-admissions in Canada could potentially be avoided by optimal usage of sacubitril/valsartan therapy. This analysis supports the importance of rapidly implementing evidence-based therapy, in this case sacubitril/valsartan, into routine clinical practice to improve clinical outcomes for HFrEF patients in Canada.

Editorial introductions

Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Thierry MesanaThierry MesanaDr Mesana is the President and Chief Executive Officer of the University of Ottawa Heart Institute. He received his medical degree in 1985 at the Université de la Méditerranée, Marseille, France, where he trained in thoracic and cardiovascular surgery. In 1990, he received his PhD in biophysics and biomechanics from the Université de la Méditerranée after extensive experimental work and design development on artificial hearts and ventricular assist devices. In 1991, Dr Mesana was, at the time, the youngest cardiac surgeon in France to receive a full Professorship. He then became the Chair of Thoracic and Cardiovascular Surgery at La Timone University Hospital, France, the largest hospital in Marseilles, where he introduced a number of advanced techniques in valve surgery, thoracic aorta surgery and ventricular assist devices and greatly expanded their cardiac surgery program, doubling its size in a 10-year period. Dr Mesana was appointed Chief of Cardiac Surgery at the University of Ottawa Heart Institute in 2001. Under his leadership, the Institute's surgical program became a leading Canadian and International program and his valve repair program has become recognized as one of the best in the world. His emphasis on repairing failing heart valves helped to establish this approach as a gold standard for treatment. He is a strong advocate of basic science research in the field of myocardial regeneration. In the last few years, his group in Ottawa has published papers extensively on studies in basic research related to stem cells and angiogenesis, clinical research papers on long-term follow-up of patients with heart valve prosthesis, as well as studies on aortic prosthesis mismatch and predictors of long-term outcome such as stroke, heart failure and reoperation. In addition, he has encouraged the development of minimally invasive surgical procedures for coronary bypass grafting and complex cardiac arrhythmias, and utilization of miniaturized rotary blood pumps as bridge to transplantation. During his tenure at the Institute, he marked the milestone of its 500th heart transplant. Haissam HaddadHaissam HaddadDr Haddad received his BSc from Tichreen University in Syria in 1980 and graduated from Medical School at Tichreen University in 1983. Following a family medicine practice in Syria, Dr Haddad immigrated to Canada and trained in internal medicine at Dalhousie University, Canada, and successfully completed his Cardiology training at the University of Alberta, Canada. In July 1997, Dr Haddad joined the Division of Cardiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University in Halifax, Nova Scotia and was Medical Director of the Heart Transplant Program and Director of the Cardiac Rehabilitation Program. In September 2001, Dr Haddad joined the University of Ottawa Heart Institute, Canada; he is Professor of Medicine, Division of Cardiology, Director of the Heart Failure Program, and Medical Director of Heart Transplant Program (2001–2013). He is also the Vice President of Medical Staff, The Ottawa Hospital and member of The Board of Directors. Dr Haddad was a member of the Primary Panel of the Canadian Cardiovascular Society's consensus conferences on the management of heart failure (2001–2010), on heart transplantation in adults (2003) and on heart transplantation in pediatrics (2005). He also chaired the Society's consensus conference for heart transplant in 2008–2009. Dr Haddad was the chair of The Canadian Cardiac Transplant Group, 2006–2008. He is the vice president, Canadian Heart Failure Association. He is the founder of the annual educational meeting for The Canadian Cardiac Transplant programs (Ottawa 2008, Calgary 2009, Quebec City 2010). Dr Haddad has earned numerous prestigious awards, namely the Anemia Institute for Research and Education Award in 2005, and the 1st Award Prize in the International Competition of the American College of Physicians in 2000.

Editorial introductions

Current Opinion in Cardiology was launched in 1985. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of cardiology is divided into 14 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Thierry MesanaThierry MesanaDr Thierry Mesana is a Professor of Cardiac Surgery at the University of Ottawa Heart Institute (UOHI), Canada, former Chairman of Cardiac Surgery at the University of Ottawa, Canada. He was recently nominated as President and CEO of the UOHI, commencing in 2014. He received his MD degree at University of Méditerranée, Marseille, France in 1985 where he completed his training in thoracic and cardio-vascular surgery. He also received, in 1991, a PhD degree in biophysics at the same university after extensive experimental work on artificial heart and ventricular assist devices. In 1991, He was promoted to full Professor of Cardiac Surgery, and further nominated as the Chairman of Adult Thoracic and Cardiovascular Surgery in Marseille, France. In October 2001, he was appointed at the University of Ottawa Heart Institute as Chairman of Cardiac Surgery, until January 2013. Dr Mesana has been particularly active in the field of valve surgery with specific emphasis in mitral valve repair. His leadership has led to significant changes in the Division of Cardiac Surgery at the UOHI, particularly with the development of complex mitral valve repair in degenerative or ischemic disease, aortic valve-sparing program and the expansion of a world-class minimally invasive coronary revascularization program as well as AF surgical ablation. He is also a strong advocate of basic science research in the field of myocardial regeneration. In the last few years, his group in Ottawa has published papers extensively on studies in basic research related to stem cells and angiogenesis, clinical research papers on minimally invasive CABG, innovative mitral valve repair techniques and long-term results in mitral valve prolapse, long-term follow-up of patients with heart valve prosthesis, as well as studies on aortic prosthesis mismatch and predictors of long-term outcome such as stroke, heart failure and reoperation. Haissam HaddadHaissam HaddadDr Haddad received his BSc from Tichreen University in Syria in 1980 and graduated from Medical School at Tichreen University in 1983. Following a family medicine practice in Syria, Dr Haddad immigrated to Canada and trained in internal medicine at Dalhousie University, Canada, and successfully completed his training in cardiology at University of Alberta, Canada in 1997. In July of that year, Dr Haddad joined the Division of Cardiology, Queen Elizabeth II Health Sciences Centre at Dalhousie University in Halifax, Nova Scotia, as Medical Director of the Heart Transplant Program and director of the Cardiac Rehabilitation Program. In September 2001, Dr Haddad joined the University of Ottawa Heart Institute where he is a Full Professor of Medicine, Division of Cardiology, Director of the Heart Failure Program, Medical Director of Heart Transplant Program and the Director of Pulmonary Hypertension Clinic. He is also an Adjunct Professor in the Department of Systems and Computer Engineering at Carleton University in Ottawa, Canada. Dr Haddad is an active member of the Canadian Cardiovascular Society, The American College of Cardiology, The International Society of Heart and Lung Transplantation, The Canadian Heart Failure Network and the Heart Failure Society of America. He is on the Primary Panel of Canadian Cardiovascular Consensus on management of Heart Failure and Heart Transplantation and Adult and Pediatric. He is the Chair of Canadian Cardiovascular Society Consensus on Heart Transplant 2008–2009 and Reviewer of the Heart and Stroke foundation, NIH and Ontario Ministry of Health. He has published over 150 manuscripts and abstracts, and also lectures in USA, Canada, Argentina, Jamaica, Syria, Lebanon, Saudi Arabia and Egypt. His clinical and research interests include heart failure, transplantation and prevention of cardiovascular diseases.

654 Use of Implantable Cardioverter Defibrillators in Specialized Multidisciplinary Outpatient Clinics: Insights From the Canadian Heart Failure Network

Implantable cardioverter defibrillators (ICD) are indicated for primary prophylaxis of sudden cardiac death in patients with mild to moderate heart failure (HF) due to left ventricular systolic dysfunction (LVEF < 35%). The Canadian Heart Failure Network (CHFN) of multidisciplinary HF outpatient clinics (n=26) have enrolled and followed HF patients in both academic and community centers from 1999 to 2010. We sought to determine ICD usage rates for qualifying patients treated in specialty HF clinics in Canada.

N039 Cardiovascular Nurses: The Key Factor in the Success of the First Canadian Heart Failure Remote Monitoring Clinic

Heart failure is a common, debilitating, and costly chronic disease condition. The rising cost of health care is forcing health care providers to be more accountable in offering a more efficient and economical systems with regards to providing care. Health Care providers are pursuing innovative approaches that are clinically and financially more proficient. Remote monitoring of heart failure patients is made possible through telemonitoring of the physiologic data derived from devices combined with a structured telephone support.

N005 Who Will be the Next Canadian Heart Failure Champion?

N005 Who Will be the Next Canadian Heart Failure Champion?

873 HYPERTENSION AND COMORBIDITIES IN PATIENTS WITH HEART FAILURE IN CANADA, 1999-2011

Background: Hypertension is a common comorbidity in patients with heart failure (HF) which covers a spectrum of cardiac function from diastolic to systolic dysfunction. The Canadian Heart Failure Network (CHFN) has followed HF outpatients longitudinally in specialized HF outpatient clinics across Canada with a broad spectrum of background origins and cultures. The database records pre-existing comorbidities, symptoms, physical signs, treatments and outcomes. Methods: This analysis is of selected variables at the time of each patient's first specialized CHFN outpatient visit. We wished to determine the associations of systolic blood pressure (SBP) with common comorbidities in 18,722 HF patients who have been referred for specialized HF management and enrolled over a 13 yr period from 1999 to 2011. Results: In these HF patients, males were more likely than females to have SBP's <125mmHg, p < 0.001. Across the five identified BP ranges from SBP < 100mmHg to >175mmHg, a progressive increase in prevalence was observed for diabetes p < 0.001, dyslipidemia p < 0.001, obesity p < 0.001, renal disease p < 0.001, arthritis p < 0.001, smoker p = 0.02, cerebrovascular disease p = 0.015, and atrial fibrillation p = 0.048.Conclusions: Hypertension and HF are modern ‘epidemics’ and both are associated with a broad range of comorbidities. An integrated multidisciplinary clinical approach is strongly warranted to provide comprehensive care that will further reduce clinical complications and improve clinical outcomes.