Thank you very much, Mr. Chair.
Good afternoon, everyone.
I'd like to begin by thanking all the members of the committee for the opportunity to represent the Canadian Cardiovascular Society. We are grateful for the opportunity to describe some of the challenges in caring for patients with heart disease during this COVID-19 period and to recommend some solutions.
I'm a cardiologist from Toronto representing the Canadian Cardiovascular Society. Our 2,500 members include cardiologists, cardiac surgeons and scientists. We provide specialized and ongoing care for close to three million Canadians living with heart disease. We're very grateful for this opportunity to present to the committee.
What I'd like to do first is to describe the consequences of a pandemic on heart patients and then suggest some recommendations to help improve patient care in the short term as the first wave of a pandemic unfolds, and in the future as subsequent waves of this or other infections hit.
At the front line, what we are observing is that sick people are not seeking the care they should. You heard that just a few moments ago. When the COVID pandemic struck in Canada, we were quick, as a community, to enact strict measures to contain its spread, including widespread stay-at-home messaging. Canadians have been very good at listening and adhering to this advice, so much so that we have seen a significant reduction in patients seeking emergency care for all illnesses, but particularly for cardiac care. Although the numbers of those seeking care are way down, heart attacks and other emergencies have not stopped occurring.
We believe our patients perceive hospitals to be overloaded with cases of COVID, correctly or incorrectly, and they're afraid of coming to hospital and being exposed to the virus. As a result, patients with emergency needs are staying at home and waiting to see if symptoms go away and some, unfortunately, are dying while they wait. When they finally do seek emergency care, they have often delayed so long that their conditions have become more serious and harder to treat. This is something we've observed over the past month or so.
The later patients present for treatment, particularly for heart attacks, the less we can do for them; and we're seeing more complications, which are harder to treat.
Second, while we deal with COVID patients, wait-lists for cancelled procedures have skyrocketed. To be ready for an anticipated surge, hospitals have appropriately, we think, reallocated resources and freed up beds, but in our efforts to be prepared, hospitals have been operating under capacity. Since March, across Canada, a huge number of planned, life-saving procedures were postponed.
As an example, as of March 15 in Ontario, there were about 2,000 patients waiting for valve procedures and 450 for defibrillators. As of May 3, that wait-list had grown to 2,500 valve cases and 680 defibrillator cases. These wait-lists have unfortunately resulted in patients suffering and, indeed, some have died. My colleagues speak of their valve patients who have been accepted for procedures dying at home before the surgery could be done.
We have avoided a surge in COVID patients, but the backlog of heart patients waiting for treatment has surged. Wait times are now longer than they've ever been in years, in some cases.
A major complicating factor, we think, in planning for and delivering care has been the lack of real-time data. Without real-time data, we have no way to understand local health service supply and demand trends and to make regional comparisons to inform decisions about allocation of services and to inform our patients about opportunities to seek care.
Recently we've collected some hospital data where there have been drops as great as 40% per month in several provinces since March in the number of patients coming to hospital with a kind of heart attack called STEMI, the most serious type of heart attack. This has been observed in other countries as well, but we don't have all the information needed to interpret what's happening. Were there fewer heart attacks occurring? We think probably not. Did the patients delay calling 911? Did ambulances make fewer and slower trips? Did patients in the field arrive at hospital already deceased? Was care in hospital delayed because of COVID precautions? We, unfortunately, don't know.
It's frustrating for us to note that much of the data to answer these questions exists and is collected already in real time, but is tracked in data collection systems that don't talk to each other technologically, or that prevent the data from being shared due to geographic boundaries or for legislative, contractual or policy reasons. Collectively, these barriers prevent health data from being used for the very reason it's collected, which is to enable care through evidence-informed decision-making.
We must note that our national resource, the Canadian Institute for Health Information, CIHI, has responded as best it can throughout the pandemic to supply data; however, CIHI itself is limited by the same barriers I've just mentioned. In this moment, we need data in days, whereas the typical time frame for obtaining data is months.
We're eager to help resolve these challenges brought on by the pandemic. In looking to contribute solutions, the CCS has several that we would like to propose.
First, we think we need to refine public messaging in the face of a pandemic. If we can anticipate that stay-at-home orders result in heart attack victims not seeking or delaying care, public messaging needs to be more precise and widely shared. The federal government, through the Public Health Agency and Health Canada, are well positioned to lead this, and the CCS is willing to help develop and spread these messages.
Second, public health officials, health service planners and care providers need shareable real-time data. Current information that can easily be shared would enable more nimble actions in an emergency. We would know where and whether scheduled and essential procedures might still take place, based on need and in balance with local demand. With better access and sharing of data, we can reduce the impact of national health crises on cardiac and other patients, while still providing crisis-related care to those affected.
In the current situation, COVID-19 patients have been appropriately prioritized. The consequences for other patients, unfortunately, have been higher than would have been ideal. Without data, we don't think we can do better next time. Our ask of the government, colleagues and this committee is to take the lead to improve the sharing of real-time data.
This could be done, for example, by forming a national expert working group to oversee coast-to-coast streamlining of data access and sharing. This expert group would work with federal and provincial health data stewards to identify and resolve the long-standing legislative and technical barriers to rapid, shareable information. Their mandate would be to enhance coordination by locating all the datasets and getting them to talk to each other; I emphasize that this data is already being collected.
This committee would also help aggregate data so that it could legally and virtually be “all in the same place”. Through understanding what's going on locally and comparing that to what's happening in other regions or provinces, we can accelerate best care and resource use.
In the long run, we think improved access to data can refine health care system delivery. Care can be more equitably available and higher in quality; care pathways could be more efficient; virtual care could be deployed in the most effective ways; low-value care can be identified and reduced; savings can be reallocated to where resources are needed the most; and, if we get this right, we can expect to see better patient outcomes during but also beyond any crisis.
For those of you on the committee with whom the CCS has met in the past, you will know that the need for access to high-quality data and national comparative reporting is a call that the society has been making for some time, and we are very grateful for the support we've received from our partners and supporters in government.
The COVID crisis has shone a light on access to data as a major impediment in responding to a pandemic. Drawing attention to this at the highest policy-making level is a key contribution that the CCS aims to make. I'd like to just briefly list the actions that the CCS has already taken to support the pandemic.
Thus far, in the last six weeks or so, we have developed, published and shared clinical guidance for health professionals who care for cardiac patients affected by COVID. We've developed and widely shared clear messages stating that people experiencing chest pain or other signs of heart attack should urgently seek care; we've done this in partnership with the Heart and Stroke Foundation of Canada and others, but I think we can do more. We've also funded research to learn more about COVID and its effects on patients with heart disease.
The CCS will undertake to continue to do all we can to help in this crisis, and if we can be of help, I'd like to signal to the committee that in light of this pandemic we're willing and able to consult and provide guidance on any matter concerning Canadians living with heart disease.
We will all have the most success working together if we align our efforts and support one another. Merci, and thank you for this opportunity. I look forward to your questions.