Addressing barriers in treating heart failure patients: - PowerPoint Presentation

1. Addressing barriers in treating heart failure patients: Introducing the newWorld Heart Federation Roadmap for Heart FailurePresenter: João Pedro Ferreira, MD, PhDUniversity of Lorraine, Nancy Hospital, FranceUniversity of Glasgow, ScotlandUniversity of Porto, Portugal2 September 2019

2. The World Heart Federation200+ membersThe only CVD organization in official relations with WHO

3. The WHF missionconnect and co-ordinate the diverse cardiovascular communitytranslate science into policy to influence agencies, governments and policymakerscatalyse and stimulate the exchange of information, ideas, practices across all borders to achieve heart health for everyone, everywhere

4. The reality of heart failure26 million people live with heart failure world wide. Mortality rates remain high for heart failure patientsSources: www.who.int/cardiovascular_diseases/en/: WHF key facts website IDF Atlas 2017 http://diabetesatlas.org/resources/2017-atlas.html Awareness of symptoms and general public awareness about heart failure can dramatically improve early detection and diagnosis

5. Improving quality of life forheart failure patientsA large scale global effort is needed to:raise awareness of heart failure among the general publicimprove early diagnosis and outcomes for patientsimprove adherence to medication among patientssupport disease management and integrated care models

6. World Heart Federation Roadmap for Heart FailureGini coefficient: 0 (0%) indicates absolute income equality and 1 (100%) absolute income inequalityDewan P, Ferreira JP, McMurray JV et al. Income Inequality and Outcomes in Heart Failure: A Global Between-Country Analysis. JACC-HF 2018. (PARADIGM and ATMOSPHERE)Income and inequality interplay (“MACE”)Ferreira JP, Zannad F et al. Accepted AHJ(EMPHASIS, EPHESUS and EXAMINE)

7. World Heart Federation Roadmap for Heart FailureTromp J, Ferreira JP, Lam C et al. Heart failure around the world. EJHF 2019Dewan P, McMurray JV et al. HFrEF. comparison of patient characteristics and clinical outcomes within Asia and between Asia, Europe and the Americas. EJHF 2019

8. What is a Roadmap?A key reference document, outlining a vision of an ideal pathway of care for heart failure patients, roadblocks along this pathway and evidence-informed solutions and examples from practiceThis roadmap aims to make the case for urgent action to reduce the burden of heart failureThe Roadmap can be used:to assist leaders in cardiovascular health to assess needs and gaps in their communities as a first line approachas a framework to assess priority areas along an ideal pathway of patient careto identify roadblocks along this pathway and look towards examples of evidence based solutions that could be relevant in different contexts

9. What is a Roadmap and for whom?An integrated approach to patient care

10. Development of the RoadmapAuthors: Joao P. Ferreira, Sarah Kraus, Sharon Mitchell, Pablo Perel, Daniel Pineiro, Ovidiu Chioncel, Roberto Colque, Rudolf de Boer, Juan Esteban Gomez-Mesa, Hugo Grancelli, Carolyn S.P. Lam, Antoni Martinez-Rubio, John J.V. McMurray, Alexandre Mebazza, Clyde Yancy, Faiez Zannad, Karen SliwaSurvey to WHF members who shared comments and examples of national interventions, with 146 responses across all continents.

11. Most Common Causes of Heart Failure Around the World

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13. LEVELROADBLOCKSPOTENTIAL SOLUTIONSPREVENTION OF HEART FAILUREPatient factors- Lack of education and awareness- Lack of affordability of healthier lifestyle choices and therapies- Public awareness programmes about risk factors and HF- Community-based healthy living programmes Health care workers - Lack of education/training- Improve HF awareness amongst health care professionals Health care systems - Environmental barriers to lifestyle modification- Lack of, or inadequately supported, screening programmes- Government level engagement between sectors to address education and environmental barriersDIAGNOSIS OF HEART FAILURE – factors that delay diagnosis and result in delayed treatment initiation Patient factors- Limited access to health care facilities with expertise- Late presentation due to poor socioeconomic status, education or isolation- Patient fears and stigma of having a diagnosis of HF- Standardization of costs for investigation, government-driven cost subsidies for essential diagnostic investigationsHealth care workers - Lack of downstream support from specialize services- Facilitate interaction between primary level health care workers and specialistsHealth care systems - Lack of the appropriate tests/equipment to make a HF diagnosis - Lack of funding for experienced/qualified staff- Provide access to investigations necessary to diagnose HF at a primary care level e.g. natriuretic peptides, point of care echocardiography

14. LEVELROADBLOCKSPOTENTIAL SOLUTIONSTREATMENT OF HEART FAILURE – Accessibility and affordability of therapiesPatient factors - Out of pocket expenditure for medications, hospitalisation or interventions- Compliance on treatment- Advanced disease at presentation due to late presentation to health care facility- Application for disability compensation if appropriate, engagement with employers- Patient education (pamphlets, waiting room education initiatives, nurse-driven counselling) to improve patient awareness - Promotion of patient-driven HF associationsHealth care workers- Clinician inexperience and lack of adherence to guidelines- Failure to titrate doses of medical drug therapies- Infrequent follow-up- Failure to identify and manage precipitating factors (e.g. anaemia) and co-morbidities- Failure to identify and treat underlying cause of HF- Periodic training of health care professionals- Provision of summarized guideline-based protocols to assist clinicians in practice- Nurse-run clinics for follow-up - Standardization of investigations in HF, aimed at identifying aetiologies, precipitating factors, and co-morbiditiesHealth care systems - Lack of availability of essential medications - Lack of affordability of essential medications- Lack of monitoring of drug quality- Lack of surgical and percutaneous intervention expertise/facilities- Lack of rehabilitation services- Lack of palliative care programmes- Prolonged waiting periods related to service delivery  - National EDL listing of essential medications- Ensuring availability of EDL listed drug therapy- Implementation of quality assurance strategies- Cost-reducing strategies - development and procurement of generic therapies, standardization of drug costs, tendered procurement of drugs- Private fundraising initiatives- NGO and government collaborations- E-health platforms for monitoring

15. An ideal pathway of care for heart failure patientsThe ideal pathway will have specific barriers relevant to different contexts around the worldIt is not an expectation for health systems to follow, but rather a framework to consider barriers along the pathway of care

16. Dissemination Published in Global Heart, the official journal of the World Heart Federation, Glob Heart 2019;14:197-214Summary brochure for Policy makersPatient groupsMediaVisit WHF booth PO3 at ESC Plaza 

17. ImplementationFacilitation of national stakeholder discussions through RoundtablesGLOBAL IMPLEMENTATIONFacilitation of national scorecardsPlanning & research of evidence informed solutions by creating a global networkProviding a toolkit for implementation of solutions

18. Patient voices“A lot of people with heart failure think that’s the end of their lives, as soon as they get a diagnosis. I did at first, I thought, that’s it.”“With heart failure it’s very unknown, people just don’t know what it is.”Source: Pumping Marvellous website. Accessed 1 July

19. … each one fraught by challenges too often caused by a lack of resources, inefficient health systems, or lack of educationBehind every statistic is a personal journey…