The Canadian health care system is ill-prepared to deal with a large and growing number of Canadians who either have – or are likely to develop – multiple heart and brain-related conditions, according to Heart & Stroke.
In its annual report, released Thursday, the non-profit organization says Canadians who are hospitalized for one vascular condition, such as a heart condition, stroke or impairment of brain function caused by damage to the blood vessels to the brain, are at significant risk of experiencing additional vascular conditions. But the health system, for the most part, is not set up to deal with their complex needs.
“There’s much more complexity and interrelationships between these conditions than we ever appreciated," says Dr. Patrice Lindsay, Heart & Stroke’s director of systems change and stroke program. "And now that we know that, we really have to start looking at how we deliver care and support people who have any one of these.”
In an analysis of national hospitalization data from the Canadian Institute for Health Information, Heart & Stroke found 1.5 million Canadians were admitted to hospital between 2007 and 2017 for a vascular condition. Of those, 40 per cent were re-admitted at least once for another related illness.
According to the report, people with heart failure are 2.6 times more likely to have vascular cognitive impairment, or thinking problems, including vascular dementia, caused by damage to the brain’s blood vessels, compared with those who do not have heart failure. Those with atrial fibrillation, or an irregular heart rhythm, are 1.4 times more likely to experience such impairment, and people who have experienced a stroke are 2.2 times more likely.
It also showed over the 10-year period it examined that hospitalizations were on the rise for structural heart disease, vascular cognitive impairment, heart failure, stroke, and heart rhythm disorder. Moreover, the report noted 90 per cent of Canadians have at least one risk factor for heart conditions, stroke or vascular cognitive impairment. These risk factors include high blood pressure, poor diet, lack of physical activity and smoking.
There is an upside to understanding that these various conditions are linked, says Dr. Vladimir Hachinski, an expert on stroke and dementia and distinguished professor at University of Western Ontario’s Schulich School of Medicine & Dentistry.
“If you control the risk factors of one, you control the risk factors for [others],” he says, adding that experts who specialize in stroke, dementia or heart disease are now recognizing each relates to the other.
“More and more, we realize that we cannot afford to just have specialized care,” Dr. Hachinski says. “If we get together, there will be savings and scale, and if we realize one condition is a risk for another, we come to realize the gain is much greater.”
Currently, patients tend to receive health care in a disconnected way; each of their conditions are treated independently, and often, too late, says Yves Savoie, chief executive of Heart & Stroke. There needs to be more emphasis on prevention, and ensuring everyone can afford their medications, he added.
Other solutions may be found in smaller communities that have come up with ways to deal with patients who have multiple conditions, Dr. Lindsay adds. For instance, she says, Halifax has a vascular clinic, where patients can have access to various specialists, from heart disease to stroke, and receive holistic care.
Patient navigators can also help educate families and direct them to the resources they need, she says.