When Manitoba’s new government was elected 18 months ago, it promised to do things differently. In healthcare, it added a simple yet vital goal: take better care of people. In its first year and a half we have seen movement towards this, but significant opportunities for transformation in our healthcare system remain.
One opportunity for impactful change is for Manitobans with heart failure to be treated through a coordinated, province-wide diagnosis and care system. Implementing it would take better care, not just of those patients, but of our whole health system.
Heart failure is one of our most serious medical challenges and Manitoba has one of the highest rates of the life-changing and life-shortening condition in Canada. About 30,000 Manitobans are living with heart failure and nearly 5,000 are diagnosed each year – equivalent to the population of Flin Flon or Stonewall. This puts a significant burden on the province’s healthcare system, including hospitals and emergency departments.
Heart failure means exactly what the name says. The diseased heart is unable to pump sufficient blood throughout the body, and over time, it gets worse. This makes exertion difficult, so even small activities can be impossible or leave the patient short of breath. It is a progressive disease that can be effectively managed to improve symptoms, slow patient decline and prevent hospitalizations, but there is no cure.
By its very nature, heart failure causes many patients to require periodic hospitalization to stabilize symptoms and adjust medications. Overall, in Canada, heart failure is the third most common cause of hospitalization, behind only giving birth and lung diseases. It also results in the longest average hospital stay of the top eight causes of hospitalization — 9.6 days.
In fact, Manitoba’s healthcare system has the highest average hospital stay for heart failure in Canada at 13.4 days — 40 per cent longer than the Canadian average.
There is clearly room for improvement to provide better care. Early diagnosis, the right treatment plan that includes guideline-directed medical therapy and effective follow-up are the critical keys for keeping patients out of hospital, extending their life expectancy and improving their quality of life.
There are three things we can and must do in Manitoba to help achieve this for those with heart failure and, at the same time, lessen the burden on the health system for the benefit of all Manitobans.
First, we need to address the lack of equitable access to a blood test that is an important symptomatic screening tool doctors use for heart failure. While this test is available in 70 per cent of clinics across Canada, it’s available in less than 30 per cent of Manitoba facilities. As a result, for many patients, heart failure is being diagnosed only at later stages, negatively impacting both the patient prognosis and the need for health system resources.
Second, echocardiography is the cornerstone imaging test for diagnosis and follow-up of heart failure patients and must be linked to their clinical care. However, access to echocardiography in Manitoba is among the lowest in Canada. This limits the effective and timely follow-up of patients, increasing the likelihood they will eventually appear at a hospital emergency room requiring urgent care.
Third, we need a much better coordinated provincial cardiac care system to ensure better screening, diagnosis and follow-up throughout the province. This should be the responsibility of Cardiac Sciences Manitoba (CSM), but its current structure is fragmented, preventing the integration necessary to deliver consistent cardiac care province-wide.
We urgently need to achieve the CSM goal of establishing a province-wide cardiac hub with central referral and appointment services so heart failure patients get the care they need close to home that will keep them in better health and out of hospital.
CSM, together with Heart & Stroke and the HeartLife Foundation, have combined to alert the Manitoba government of the urgent need to improve services for Manitobans with heart failure and to urge action as quickly as possible. The government has acknowledged the importance of co-ordinated cardiac care and we look forward to working together to achieve that goal.
Better access to diagnosis and care for Manitobans with heart failure through a coordinated system would be a win for us all by reducing the time patients need to spend in hospital and keeping them away from our emergency departments, while allowing them to live easier and longer lives. What better goal could we have?
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