Good morning. I apologize, but my French is not very good.
My name is Andrew.
I'm a heart rhythm cardiologist who works in Vancouver. That means that I spend my day seeing patients who need pacemakers or have heart rhythm problems, or families where sudden death is going on. My friends tease me and say I'm an electrician up at the hospital.
Access, equity and quality of care are common goals for all of you health leaders, as well as for us, leaders in the area of health care delivery. I'm here representing 2,500 cardiovascular specialists from across Canada.
I live this in spades in the area of access. I go up north to Whitehorse for two weeks out of the year to do clinics, and to Prince Rupert as well. In those situations, you see the people who have access, the local quality of care. I see a large indigenous population and see those people struggling to get the best health care that we can provide. We know that the outcomes of these situations are not very good. What we don't have is a map and the tools with which to try to create improvement. We need to understand what the gaps are and try to deliver on them.
As specialists, we are the team leads to deliver a $30-billion business. It's a staggering amount of money, and we know that people also get low-value care. That low-value care is represented in unnecessary testing, ventures that are not necessarily advantageous, inappropriate hospital admissions and so on, but we lack the tools to be able to compare and use that data to try to improve the system.
Imagine investing in a $30-billion business that doesn't measure, report, compare or have system improvement. You would never invest in something like that, and yet that is the state that we're in and that we are aspiring to try to improve and change.
Sadly, the data is there. The Canadian Institute for Health Information, CIHI, has much of that data, but in fact, in many of its forms, it's siloed. It's not integrated or analyzed and then turned into improvement tools. There are no resources or mandate to roll cardiac care data up into a national comparative report, as we do in cancer care with CPAC, the Canadian Partnership Against Cancer. Provinces and territories have few tools with which to do a comparative analysis to understand how other places are improving their systems, how they're gaining efficiencies and how they're delivering better care. If you are a heart institute in New Brunswick or Manitoba, you're the only game in town. As a result, understanding whether your length of stay, mortality rates or costs are in line or aspire to be the best in Canada is impossible right now. We are looking to try to address that problem.
As you know, the population is getting older. The scope of our population is getting bigger. Two of the top five reasons to come to the emergency room are heart failure and atrial fibrillation. Heart failure is going to cost you three-quarters of a billion dollars this year. That's an immense amount of funding. Atrial fibrillation is the same. Right now, about 45,000 people will be admitted to hospital next year due to atrial fibrillation. Our recent guidelines that look at quality processes suggest that we could probably avoid 60% of those admissions. Imagine the cost of hospitalization for a heart problem. It doesn't resolve itself, typically, in a day or two. It's expensive and intensive, and there's a huge cost-avoidance opportunity.
Believe it or not, we can now actually replace your heart valve and have you go home the next day without doing surgery. A catheter procedure to give you a new heart valve is possible. This is a new venture. It typically targets seniors who have a poor quality of life and a poor outcome. The procedure restores quality of life and extends their life, but this is an expensive venture. It's innovation. Our ability to do this is wonderful for the people who want this, who want to avoid open heart surgery, but the cost is a recognized need that seniors are advocating for on the access front. What we need to do is collect and utilize the data to try to develop system improvements to realize this.
Twenty years ago, the federal government came to CCS in conjunction with PHAC and said that we need to develop those measures and methodologies for doing cardiac care reporting. We rose to the challenge and developed the tools in partnership with CIHI in 2012. We received funding through PHAC to work on a project that was funded for three years. We then developed those measurement tools, those reporting tools, proven methods and an annual report. The funding ended in 2015, and since then, we have gone into our health reserves and virtually bankrupted ourselves to be able to show our commitment to this project as a member organization. This includes thousands of hours of volunteer time and expertise.
We do have a nucleus of activities in six areas where we continue to generate a national map and report. What we are lacking in 2020 is funding to expand and sustain this. These are just six out of many areas within cardiac care that require some measurement, comparative analysis and then system improvement.
Our ask is for $2.5 million each year for the next three years to sustain and fully roll out that reporting system and work with CIHI to integrate this. In summary, we're asking for support to improve care, eliminate expensive, unhelpful components of care and enable a learning cardiac health care system.
Thank you. Meegwech. I look forward to your questions.