Even though Canada improved significantly in treatments, disease management, and public health interventions heart disease is still the second leading cause of death after cancer. Heart disease is highly preventable by changing behaviors such as tobacco use, unhealthy diet, sedentary life, and alcohol use with population-based strategies (WHO, 2017). This paper outlines the epidemiological data and trends spanning over the last decade in Canada, compares these data with other countries and the public health strategies are taken to address and prevent this health issue in our country.
Rates of heart disease in Canada
In Canada, public health agency monitors heart disease by using provincial and territorial health data such as incidence of heart disease, the prevalence of heart disease, the use of health services and health outcomes from the Canadian chronic disease surveillance system (CCDSS). This data helps the governments to understand evaluate and plan the public health policies and strategies to prevent and control heart disease in Canada (Government of Canada,2017).
As per CCDSS, heart disease claimed more than 51,000 lives in 2014. At about 1 in 12 (2.4 million) people aged over 20 years in Canada live with ischemic heart disease in 2012-2013 face year. In that 5,78,000 people have a history of acute myocardial infarction. Almost 3.6% of Canadian adults aged over 40 years were living with heart failure. The death rate in adults aged over 20 with diagnosed heart disease is 3 times greater than those without. Those who had a heart attack, the death rate is 4 times greater in adults age 40 and over, and who is diagnosed with heart failure it is 6 times higher mortality rate than those without (Public Health Agency of Canada, 2018).
Age standard prevalence and incidents of heart disease
The age standard prevalence between 2000-2001 and 2004-2005 increased from 7.1 to 8.1 in people aged 20 years and older with diagnosed ischemic heart disease and after that, it remained stable. On the contrary, the prevalence of acute myocardial infraction
The incidence rate of ischemic heart disease in Canadians aged 20 or over declined from 12.3/1000 in 2000-2001 to 6.8/1000 in 20012-2013. At the same time, the occurrence of new acute myocardial infraction Cases declined from 3/1000 to 2.2/1000. When we consider new cases of heart failure reported it decreased from 8.1/1000 to 5.3/1000 between 2000-2001 and 2012-2013. The incidence of all-cause mortality rates in Canadians living with ischemic heart disease, acute myocardial infarction, and heart failure declined 46 %, 17%, and 35% respectively during these 13 years. (CCDS,2018)
Men Vs women
It is observed that more men than women living with ischemic heart disease and heart failure. Men are 2 times higher chance to get first acute myocardial infarction than women. The prevalence of heart diseases and heart failure increases with age for both men and women but, the gap between the sexes reduces with age. In women aged over 85, the incidence rate is 2 times higher than men. As women tend to live longer than men, they have a high prevalence and incidence rate in older age than men.
The number of new cases reported from heart disease and heart failure is also higher among men than women. It increased us with age for both sexes. But women tend to develop heart diseases about 10 years later than men. Women have a higher risk of developing heart disease after menopause although heart disease is declining in general, but the decline is slower in women. The mortality rate of men with diagnosed ischemic heart disease and heart failure are 20% and 10% more respectively than women. (CCDS,2018)
Secondly, heart conditions are difficult to diagnose in women because they experience mild to fewer typical symptoms compared with men. So, women may present to the hospital without chest pain or with mild chest pain. As a result, women are more likely to be misdiagnosed. Longer delays are observed in women to be presented for medical care, and this may contribute to poorer outcomes and high mortality rates. (CCDSS, 2018)
Heart disease in Indigenous people
Indigenous people suffer worst the healthcare outcome In Canada. They have a higher likelihood of developing heart disease. The rate of heart disease in indigenous people is 50% higher than the general population. This might be the result of disparity in income education and housing. Community-based measures are undertaking to close these gaps between the Communities. The focus is to build capacity in indigenous community by collaborating with the health leaders within these communities (Heart and stroke)
Pan Canadian perspective
The statistics across Canada show that in 2012-2013 the prevalence of heart diseases was as low of 4.6% in Nunavut and high of 9.7% in Nova Scotia. Whereas the prevalence of acute myocardial infraction is also low in Nunavut which was 1.1% and high in Newfoundland and Labrador with 2.6%. At the same time, the people living with heart failure were lower in Quebec, New Brunswick, and Nova Scotia and higher in Nunavut with 6.4%.
When we consider the incidence rate of ischemic heart disease it is lower in Nunavut with a rate of 4.5/1000 and high in New Brunswick with 8.2/1000. Whereas in the case of acute myocardial infraction British Columbia has lower incidence and Nova Scotia has higher. Heart failure incidents ranged from 4.8/1000 in Nova Scotia, Newfound land, and Labrador to 11.3/1000 in Nunavut. These differences spread across the provinces may relate to differences in the distribution of risk factors. (CCDSS,2018)
Trends in heart disease
Due to improved cardiovascular health, heart disease outcomes are improving nowadays. ischemic heart disease and heart failure incidents and all-cause mortality rates decreased by 45% and 35% to 24% and 26% respectively in 2000 two 2001 and 2012 to 2013 time. But prevalence remains stable. (CCDS, 2018). Since 1970 the hospitalization rates and mortality rates of ischemic heart disease and heart attack have been decreased, most likely due to healthier lifestyles [avoiding smoking, improved physical activity, and healthy eating habits], early detection and management of risk conditions such as high blood pressure diabetes and high cholesterol and effective management of ischemic heart disease and heart attacks(Public health agency of Canada,2009).
The method of preventing heart disease that has emerged over last decades smoking cessation, better recognition of the role of lipids, better control of hypertension and diabetes and advances in cardiac surgery have all contributed to the reduction in mortality due to heart disease (University of Ottawa heart institute,2011)
Comparison of heart disease rates In Canada with other countries
The international comparison of heart disease allows the governments to learn from each other and import the strategies taken in those countries who have low rates thus improve the performance of the health system (Canadian institute of health information,2017). when comparing the rates of heart diseases with other G7 countries it is observed that Japan had the lowest mortality rate at 39/100,000 population in 2011. On the contrary, the United States exhibited a high rate at 124/100,000 whereas, Canada ranked in the middle with 95/100,000 (Government of Canada,2016). In US heart disease is the leading cause of death.
Heart disease is a major health burden to Canadians so, it is very important to formulate a community-based strategy in all levels of prevention to address the issue. The Canadian heart health strategy and action plan were introduced with the input from honorable Leona Aglukkaq (Minister of Health) and Dr. David Butler-Jones (Canadian chief public health officer) in 2009(NCBI,2009). There are six major recommendations for prevention in the community.
Create a heart-healthy environment
This strategy mainly focuses on Healthy and supportive environments for all Canadians to make healthy choices. It includes steps to address the socio-economic equities in society. It also accounts for the importance of developing policies to improve food quality by reducing too much trans and saturated fat and salt and to provide more access to traditional food by providing funding for traditional harvesting like hunting fishing agriculture etc.(Canadian heart health strategy and action plan,2009).
Canada made some limitations in advertising unhealthy food for children. Mandatory nutrition labeling for all food is needed to enhance healthy food choices. Implementation of legislation to limit access to tobacco by supporting nonsmoking policies in public places is another step to create a healthy environment for all. Collaborate with employers and schools to adopt policies such as no smoking healthy food options and opportunities for physical activities is a good move in the prevention of heart disease (British Colombia ministry of health, 2001).
Canada needs to use the combination of creating awareness about the risk factors and the need to adopt healthy lifestyles, promote legislation and regulation, and policies to enhance healthy eating and physical activity reduce smoking, and address inequities that affect heart health (British Colombia Ministry of health, 2001).
Help Canadians lead healthier lives
To achieve this goal, it is very important to create awareness about the risk factors initially, to avoid conflicts and confusion. It is recommended that all chronic disease organizations must work together for providing consistent, reliable information to Canadians and develop more convenient and community-based screening for the contributory factors. (NCBI,2009) Social marketing and awareness champions should target the general public as well as individuals at high risk such as aboriginal/indigenous people, Asians, black, senior women over 50 years, people who have more than one risk factors and low-income groups (British Columbia ministry of health,2001)
To deal with the urgent crisis among aboriginal/indigenous people
Heart disease is a crisis for these communities. Community-based heart disease prevention Include ensure community participation in planning implementation and evaluation. Create equitable access to health care in the community and improve screening surveillance and monitoring system in these communities. The recommendations include creating a multiyear action plan to meet the cardiovascular needs of these communities by involving the health leaders from these communities. Create a national Aboriginal/indigenous Centre for chronic disease prevention and management to coordinate the implementation of the action plan. (Canadian heart health strategy and action plan,2009)
Continue the reform of health services
It means providing timely integrated patient-centered care. It is important that the health care system to be more effective and efficient to meet the increasing health care demand. The best way to organize the Cardiac services depends on the need of the population, age, ethnicity and risk factors to meet these goals integrated regional networks to triage patients, provide proper care, improve waiting times and improve patient’s ability to self-manage the conditions when they wait for the care. (NCBI,2009)
Building the knowledge infrastructure to enhance prevention and care
This strategy is aimed at collecting surveillance data about the risk factors prevalence incidence and treatment outcomes. Canada needs this information to develop policies and regulations and invest in prevention programs finally there are recommendations for more research in several important areas. This includes more support for genomic and proteomic research and the establishment of a network of centers of excellence in vascular health. (NCBI,2009)
Develop the right service providers with the right education and skills
Canada needs more workforce to meet the growing demand in cardiac care including epidemiologists, social scientists, public health professionals, primary care physicians, and nurses aboriginal/ indigenous health care workers. It is recommended to provide specialized training and skills for all the workforce to address heart health issues in Canada. To encourage health professionals in this strategy, recommend providing incentives for education programs, and guide them to work in interprofessional teams. (Canadian heart health strategy and action plan,2009).
The mortality rate from heart disease has been declined to an extend and this reflects the advancements in knowledge and technologies across main areas of care. Heart disease is becoming less of a cure disease to be survived and more of a chronic disease to be managed over people’s lifetime (university of Ottawa heart institute,2011). We are also seeing an enormous decline in heart attack rates due to getting people in the best practice guidelines and strong prevention and rehabilitation program. Even though we had tremendous advancements in cardiovascular care, more than 50,000 people still dying of heart disease in Canada.
A major challenge in the treatment of heart disease in the future will be the aging Canadian population. Surgical and other advances have to allow the doctors to consider much older patients as a candidate for surgery nowadays than in the past. We’re going to see trends in integrated chronic disease management. Cardiovascular surgeries became less invasive over the last decades, so the recovery is fast and economically it is a tremendous boom by reducing the hospital stay. The technology in interventional cardiology and electrophysiology continued to improve providing additional options to surgery. Improving imaging techniques help to identify most of the heart diseases early and can treat them as early as possible (University of Ottawa heart institute,2011).
When we consider prevention, major advancement is happening in the case of the genetic study of heart disease, which may account for about half of any individual’s cause of heart disease. The quality of life of a heart disease survivor is improving. Many return to live a normal life if they follow a cardiac rehabilitation program. They can make remarkable changes and lead an even healthier life (Heart and stroke,2015)
In a nutshell, there is no doubt that we have improved so much in cardiovascular care and prevention but we are still experiencing some challenges that some of the risk factors of heart disease are increasing sharply. Diabetes rates skyrocketed from 17% to 31% in a matter of a decade. Rates of overweight and obesity are greater than ever. It is predicted that increasing the aging population with poor diet and high obesity, increase diabetic rates and physical inactivity will contribute to a high rate of heart disease. we need to reverse this trend (Heart and stroke,2017). Moving from knowledge to action is easier.
It is also taking considerable time and effort to convince individual and medical communities’ institutions and systems to implement innovation in healthcare and changes in their practice patterns. It is crucial to invest in research, to improve diagnosis treatment and care, addressing all risk factors, supporting all Canadians to make healthy choices, creating healthy public policies, collecting and translating knowledge and, promoting recovery (Heart and stroke foundation,2015). To be successful we must invest in resources and efforts. We must work together within governments, across governments, across sectors in communities, in schools, workplaces, and our homes to reduce the risk of heart disease (Canadian heart health strategy and action plan,2009). All must take responsibility for their health and the future of other country’s health.