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I was very pleased to have the opportunity to speak with my colleague and former president of the Canadian Cardiovascular Society (CCS), Dr Lyall Higginson, as I prepared to write this month’s President’s Page. Lyall was the CCS’s liaison on the Canadian Heart Health Strategy and Action Plan (CHHS-AP) Steering Committee. The committee was also chaired by another CCS past-president, Dr Eldon Smith. For two years, Lyall met with stakeholders across the country to provide input and helped to develop the key focus areas and recommendations put forth in the final CHHS-AP that was presented to the federal health minister, Leona Aglukkaq, in February 2009.
The CHHS-AP is the prescription that Canada urgently needs. It is a major step forward in developing a pan-Canadian strategy to tackle heart disease and stroke, similar to those that have already been developed for both diabetes and lung health. Although no funding commitment has been made for the CHHS-AP, I firmly believe that it makes good economic sense to invest now in cardiovascular prevention and care to produce significant health care cost savings in the future. The CCS is fully committed to taking a leadership role in the implementation of the plan, and we urge all of our members to call on the government to support the plan so that we may see it through to fruition.
Cardiovascular disease (CVD) kills more Canadians each year than any other illness. It is estimated that by 2030, 23.4 million people will die from heart disease and stroke compared with 11.8 million from cancer. Nine of 10 Canadians older than 20 years of age have at least one risk factor for CVD. Moreover, one-third of Canadians have three or more risk factors – these risks are increasing as the population ages. Thanks to advances in acute cardiac care, more Canadians are now surviving heart attacks; however, many will go on to develop chronic heart failure.
Heart disease and stroke are also a significant threat to Canada’s economic well-being. The cost of increased health care use and lost productivity has been estimated at $22 billion per year. In fact, three of the top four most expensive conditions in Canada are CVDs. If we do not act immediately, the situation will get worse and these costs will continue to grow.
Implementing a broad range of prevention strategies will most certainly have the greatest impact on reducing Canada’s health care spending. Recent studies in the United States have shown that, for every one dollar invested into an effective prevention program that increases physical activity, improves nutrition or reduces smoking, five dollars in health care costs are saved.
Chronic diseases are unique: the complex relationship among risk factors, possible future advances in diagnosis and therapies, as well as the effect of changing traditional health care delivery models make it difficult to accurately estimate the true cost savings. However, I remain confident that the Steering Committee’s detailed economic assessment will prove to be very conservative.
“Based on the Committee’s economic assessment, we estimate that by implementing the recommendations set out in the CHHS-AP, the Canadian health care system stands to save approximately $7.6 billion in direct costs and $14.6 billion in indirect costs by 2020,” said Dr Higginson as we discussed why Canada needs an immediate investment in improved cardiovascular care. “Given these difficult economic times, the action plan demonstrates a very attractive and significant return on investment.
“Our patients are counting on this investment, not just for themselves, but for their children – many of whom are already the new faces of cardiovascular disease that we see on a daily basis.”
Dr Smith and the members of the CHHS-AP Steering Committee should be very proud of their work on the action plan. It marks the first time that CVD has been looked at as a lifelong disease. It also takes into account many of the important factors that affect patient outcomes, including the environment, genetic factors, our schools and neighbourhoods, patient treatment and care models, proper prevention strategies and aboriginal issues. The CHHS-AP makes six key recommendations:
I am very proud of the fact that the CCS was one of the leading organizations involved in developing the CHHS-AP. Once funded, we will continue to play an important role in several of the above focus areas. I look forward to the opportunity to work in partnership with organizations across Canada, using our expertise to establish best practices and professional guidelines to help improve current prevention and treatment programs. We will also coordinate the development of national data definitions to facilitate the gathering and sharing of registry information from across the country to improve patient care in all regions.
To continue reforming health services and provide integrated, patient-centred care, we must make better use of people, technology and other resources to address inequities. This is not specific to the cardiology community. We must adopt models of care that can be easily translated and used in a primary care setting. The CCS has a well-established and proven process for developing treatment guidelines that are easily used by all health care professionals treating chronic disease. Our ‘closed-loop’ model has proven to be highly effective in translating guideline knowledge into clinical practice. We will not only continue to use the model as we update our own heart failure guidelines, but we will also apply our expertise and take a leadership role in the development and continuous updating of best practice guidelines in other areas.
Timely access and sharing of accurate information is critical to proper health care delivery. This allows health care providers and hospitals to create effective treatment and prevention programs, improve care and support research. In Canada, this type of information sharing simply does not exist. To close the gap, we must build the proper information infrastructure and gather standard data on cardiovascular risk factors; support the development and implementation of electronic health records, chronic disease prevention and management programs, and consumer health interfaces; and improve our knowledge of cardiovascular prevention and cardiac care.
The first step in accomplishing this goal is to establish national standards for data collection and reporting. Several provincial groups – including the Cardiac Care Network of Ontario, the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease, the British Columbia Cardiac Registry (APPROACH), the Improving Cardiovascular Outcomes in Nova Scotia (ICONS) registry and the Quebec Cardiac Registry – have already made significant inroads in developing separate electronic systems to improve monitoring and better manage patient access to care. Later this year, the CCS will bring these groups together, along with additional groups from all areas of the country, to discuss processes and define the necessary common data definitions so that we can begin moving forward. This is a crucial step. Ensuring that each and every allied group is using common data sets is the only way to accurately pool baseline data so that we can gather a national scope and understanding of CVD. Moreover, as we improve our data collection and monitoring efforts in the future, we can expand the data collection to include other important quality measures such as mortality and readmission rates.
There is no doubt that Canada is faced with a looming epidemic – the costs of treating CVD and lost productivity are staggering. While we certainly recognize the current economic challenges, Dr Smith and his team have clearly demonstrated that with a relatively small investment now, the Canadian health care system and our economy will save billions of dollars each year.
“We must make every effort to encourage investment now in improved cardiovascular disease prevention and care,” said Dr Higginson. “If we do not come together and act now to ensure that the government funds the CHHS-AP, the situation will only degrade further.”
I would like to personally thank Dr Higginson, not only for his work on the CHHS-AP, but also for his ongoing commitment to helping those with chronic CVD to live longer, healthier lives. As always, I invite you to contact me via e-mail at ac.SCC@tnediserp with any questions, input, ideas or constructive criticisms. I pledge to either reply to you personally or have one of the appropriate members of our executive team or CCS staff respond to you directly.