Heart failure is a preventable and manageable chronic health condition that remains a leading cause of death and driver of health care costs in Canada.
Heart failure has been labeled a public health emergency, which mainly affects older people with both its incidence and prevalence rates increasing rapidly among those aged 60 and older. While about 10% of adults aged 65 and over report having heart failure, experts believe that it may be more prevalent due to undetected cases.
While older adults are more likely to have heart failure, the disease burden is also greater for them and much more complex to manage than younger patients with heart failure. Older adults with heart failure are more likely to be managing other chronic health conditions, as well as auditory, visual and cognitive impairments. Older adults diagnosed with heart failure can typically expect to live just 5.5 years, with 25% dying one year after diagnosis and 16% dying within 30 days of being hospitalized. In addition, 25% of hospitalized heart failure patients are readmitted within 30 days and 50% are readmitted within six months.
Heart failure-related hospital admissions really add up for health care costs in Canada. The oldest Canadians, those aged 80 and older, are the largest consumers of health services for heart failure. As that age group grows in Canada, so too will heart failure-related health care costs. In 2013, admissions to hospital where heart failure was the primary diagnosis cost $482 million. By 2030, that cost is expected to grow to $720 million, and increase further to $2.8 billion when hospitalizations in which heart failure is the secondary diagnosis are included.
As is true with most things in medicine, an ounce of prevention is worth a pound of cure. Lifestyle changes to prevent heart failure can go a long way to reducing the health care costs associated with heart failure over time. Three things that older adults – and all of us – can do to prevent developing heart failure are don’t smoke, don’t smoke, and don’t smoke. Smoking is associated with a 47% increased risk of heart failure, as well as a long list of well-documented negative health outcomes including shorter life expectancies. In addition, moderate physical activity and a higher walking speed are more useful for preventing heart failure in older patients than high-intensity exercise.
However, since heart failure is a prevalent high-risk and high-cost condition for patients and the health care system, some specialists have looked to alternative models of care to provide ongoing management and support to patients outside of traditional hospital settings. Among the most successful of these models is telemedicine.
Our own telemedicine program has been of great benefit to older patients with heart failure and their specialists. Sinai Health System’s Telemedicine Program for Homebound Elders was established in 2014 to improve access to specialist services and maintain the continuity of care for homebound individuals 65 years and older living with frailty across Toronto. The vast majority of its patients live with heart failure and use the program to access cardiology specialist care. The program uses secure telemedicine technology to provide specialist consultations and follow-ups, coordinated by a nurse with advanced training in providing geriatrics-oriented consultative assessments for individuals who would otherwise not be able to access office-based specialist care due to an inability to make it out of their homes.
In its first two years, working with 42 specialists representing 19 unique medical specialties, our nurse facilitated 123 telemedicine events that were either new geriatric and other specialty consults or follow-ups, providing care to 78 homebound patients. The patient visits typically involved one or more specialists who overwhelmingly report, along with their patients, that this unique model has allowed them to fill a unique care gap and maintain continuity of care for frail older patients.
For these patients, the Telemedicine Program for Homebound Elders has produced significantly better outcomes by supporting them once they have been discharged from the hospital. For example, between April 2015 and December 2016, 17 homebound congestive heart failure (CHF) patients were specifically enrolled to facilitate their ongoing management of their CHF after a hospitalization. Of them, only one, who was actively palliative, was readmitted to the hospital within 30 days of an appointment with a telemedicine nurse.
The program’s success doesn’t just benefit our older patients, but it supports the health care system more generally. It is reasonable to estimate that the program has saved Mount Sinai Hospital and the health care system more than $150,000 as a result of avoided hospitalizations. As our program expands to increasingly support our older patients, the cost savings are expected to grow as well.
As a result, the program meets the needs of patients, caregivers and health care providers. In fact, in a survey of patients and providers, 95% of participating primary care physicians and specialists agreed that the program enabled a consult that may not have otherwise occurred. Further, 100% of patients, caregivers and providers who responded to the survey were satisfied with their experience in the program.
While the burden of heart failure is expected to increase in the coming decades as our population rapidly ages, strategic investments in innovative models of care, such as telemedicine technologies, can help support older patients remain at home and reduce associated health care costs.
Date modified: 2019-02-20
