I love Banksy’s iconic drawing “Girl with Balloon” – the profile of a little girl releasing (or is she trying to grab it?) the string of a red heart-shaped balloon. I love it, not just because I’m a cardiologist but because it symbolizes hope. That’s something that’s crucial in healthcare, and particularly in my specialty, heart failure.
We need to have hope.
Heart failure is a serious chronic disease involving a progressive reduction in the heart’s ability to pump blood effectively throughout the body. Over time, this causes increasing inability to perform basic functions without discomfort, fatigue and shortness of breath.
Why do I find hope in such a condition? I see hope in many places because heart failure can be effectively managed and treated to delay or reverse progression and improve symptoms and outcomes, particularly if it is diagnosed at early stages.
Because heart failure takes a huge toll on our health system, ensuring early diagnosis for as many people as possible can go a long way to helping improve care for everyone. More than 19,000 British Columbia residents were newly diagnosed with heart failure in 2022, a number that keeps rising every year as our population ages.
In 2022, there were more than 137,000 BC residents living with diagnosed heart failure, up 20 per cent from just five years earlier.
Heart failure is also a leading cause of hospitalization — almost 9,000 in the past year with an average length of stay of 9.2 days, one of the longest of any major reason for hospitalization. A projection shows the number of annual hospitalizations almost doubling to more than 17,000 in 10 years.
We can do more to diagnose and treat those with heart failure. But it requires targeted investment.
A recent national survey of 501 acute and urgent care hospitals across Canada, including 69 in BC (representing 85 per cent of all such facilities in the province) conducted by Heart & Stroke showed shortfalls in equipment needed to provide timely and accurate diagnosis of heart failure and to track its progression.
In BC, only slightly more than half of the facilities in the survey had access to on-site echocardiography (ECHO) that should be performed in all patients with suspected heart failure.
For more advanced imaging to determine underlying causes of heart failure, fewer than one in five facilities in BC could do a cardiac MRI scan, just over a third could do a coronary CT scan and a similar number myocardial perfusion imaging (to show heart muscle blood supply) and only four out of 10 could do a stress ECHO test (to show how the heart functions under stress, such as with exercise).
These limitations in access to important testing, diagnostic procedures and medical therapies, as well as a lack of awareness of heart failure in general, often result in delays in treatment.
Unfortunately, 50 per cent of people with heart failure have had symptoms for up to five years and one in six people over 65 years of age presenting with breathlessness in primary care will have unrecognized heart failure. The result? Many only appear for care when symptoms get serious. They head to emergency departments, often resulting in those long hospital stays.
There is hope — in new research and policies.
The MAPLE congestive heart failure study which is evaluating if AI assisted ECHO testing will increase early diagnosis among patients with multiple risk factors is one of many bright lights.
Pharmacists can also help by having a greater role in monitoring patients and flagging the need for changes in medication or other care. This will help over-stretched heart failure specialists who are only able to see the more advanced cases.
It is also important for the health system in general to work better together to improve patient care and wellbeing. System-level investments are needed to improve, expand and coordinate services across the continuum of care, including supporting early diagnosis and treatment and improving access to specialized clinics and community-based services.
There is also cause for hope that new technologies can soon screen for early heart failure to help prevent further progression, in the same way we now screen for different cancers.
The artist Banksy, who gave the hope of the heart-shaped balloon, has been described as the world’s most famous invisible person. Heart failure is perhaps our most serious invisible disease. But like with Banksy, from that invisibility, there also comes great hope.
Photo courtesy of DepositPhotos
