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Heart Failure Quality & Outcomes

A priority at the Ted Rogers Centre is delivering the best possible care to people with heart failure and their families – patient-centred, timely, efficient, equitable.

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nurse holding patient hand

We constantly strive to improve patient outcomes by integrating quality improvement (QI) concepts into clinical care. We leverage knowledge gained from research and apply it everywhere we care for patients: the ICU, transplant, ambulatory, emergency, and in transitions of care.

Our world-leading outcomes research seeks to build predictive models and tools to reduce hospitalizations and deaths, improve quality of life and find cost savings and innovations in the health system. We use modern statistical methods as well as artificial intelligence and machine learning to explore population data, health systems utilization data and individual patient factors.

Ultimately our findings drive toward new standards of care here in Ontario and beyond to improve health outcomes for all.

Areas of Impact

Making the right discharge decisions in the emergency department

Most people with acute heart failure spend a week in hospital. That’s because emergency physicians have no way to determine each person’s risk of dying to decide who can be safely discharged home and who must be admitted.

We developed the Emergency Heart Failure Mortality Risk Grade (“EHMRG”) score, a world-first risk prediction tool that uses easily available data to predict a patient’s risk of dying after seven or 30 days. The EHMRG tool helps guide physician decision-making about who should be hospitalized: by discharging low-risk patients and directing them to appropriate outpatient care, we impact their outcomes, reducing all-cause deaths and rehospitalizations. This has been studied in the “COACH” trial in 6,000 patients, with results expected soon.

Improving critical care

Improving outcomes for patients with cardiac shock is a priority for our team at Peter Munk Cardiac Centre. They are leading a collaborative effort to ensure the best decisions are made for each patient using “shock teams” from different hospitals who meet virtually whenever needed to determine next steps on a patient. Through this collaborative pathway, patients are supported by multiple hospitals ensuring equitable, fast care no matter what emergency department someone enters.

Another such collaboration sees clinicians strategizing how to provide expedited care to anyone who has had a heart attack blocking one or more coronary arteries. The longer such vessels are “occluded”, the worse the outcomes can be.

Setting a new standard of care for transplant recipients

Our QI team developed a list of transplant indicators to help assess whether the care decisions made for a heart transplant recipient were the correct ones that adhere to the best practice guidelines. This unique tool ensures high-quality care in our heart transplantation program. It also benefits from collaborations with several other transplant centres in Canada with the hope that these indicators become standard of care and influence guidelines.

Integrated care pathway

Discharge from hospital is a critical time for people with heart failure, as they leave the safety of that specialized circle of care. It can be overwhelming for them to return home and have to manage their chronic disease outside the clinic. To fill this gap, our unique integrated program supports this transition back into the community.

This integrated care pathway leverages our remote management program Medly and our expert nurse practitioners to provide back-up support – enhanced care – for months after someone leaves the hospital. And it’s worked: we’ve reduced patients returning to the ER by about 50%.

Measuring outcomes with patients

The patient’s own voice and experience must be central to their care. To support QI and achieve patient-centered care, it is vital to learn of a patient’s health status from them directly. Patient Reported Outcome Measures (PROMS) are vital to effective, personalized and collaborative heart failure care and better outcomes.

We incorporate PROMS as a routine part of ambulatory heart failure care and heart transplant, and we integrate data into our Digital Cardiovascular Health Platform to further identify and bolster QI initiatives.

Exploring the unexplored

By funding a Ted Rogers Chair in Heart Function Outcomes position (held by Dr. Douglas Lee), and leveraging datasets and machine learning, we can visit as-yet unexplored areas where questions persist for heart failure outcomes.

We are, for example, leading studies to better understand the interaction between coronary artery disease (CAD) and heart failure (where there are no clear guidelines for care). We have found that early use of angiography is a valuable tool in diagnosing CAD in acute heart failure and reducing deaths and hospitalizations.

Machine learning allows us to analyze data, bringing pie-in-the-sky ideas to life. One example: using the language patients speak to their care team to help predict outcomes and rehospitalizations. We can analyze what patients say, in depth, and see if it influences admissions to hospital within 30 days. These are missing links in understanding outcomes that have never before been studied.

Strengthening remote patient management

We continuously test and integrate new technology into our care model. We are the largest centre in Canada to evaluate the multisensor HeartLogic® algorithm developed by Boston Scientific and test this implantable device’s ability to enhance remote monitoring.

When combined with our Medly technology, HeartLogic gives clinicians even more insight into someone’s real-time status in an effort to pursue the most appropriate intervention.