Linked by the heart
Heart Outcomes Prevention Evaluation in Heart Failure: HOPE-HF
The HOPE-HF collaborative project is led by Dr. Robert McKelvie of Western University, London, ON, Canada.
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Adoption of proven therapies for HF is suboptimal in Canada. Specialized HF clinics improve HF management, but these are mostly located in tertiary hospitals and are accessed by only 10% of HF patients. There is a lack of integration of HF care in primary care. Therefore, building integrated and supported HF care in primary care is critical to improving HF management in the community, especially in settings where access to a HF cilinic is limited. HOPE-HF will then evaluate whether a non-physician health workers (NPHW)-led HF management program, delivered in primary care and centrally supported from tertiary care centers, will improve HF management and outcomes.
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Team Lead
Dr. Robert McKelvie
Western University
HOPE-HF team members
A multi-phase approach
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The HOPE-HF project is being developed in three distinct phases. During Phase 1, the Executive Team, in collaboration with experts and stakeholders, will develop a Network Model of Care that aims to articulate the case for system change and outline a standardized approach to operationalize and evaluate integrated services for people living with HF. Elements of the network model will include guidance on how to identify partners, conduct gap analyses and environmental scans, implement and manage the network, and measure quality of care.
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Then, in Phase 2, the network model will be implemented by regional provincial groups within the participating provinces (Ontario, Quebec, and British Columbia). This phase will assess the feasibility of implementing the network model, refine the implementation processes, and conduct a preliminary evaluation of the network model on key outcomes.
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Ultimately, these two phases will lead to Phase 3 which will consist of a national, multi-site heart-failure study.
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Currently, the team is in the early stages of Phase 1.
Dr. George Heckman
University of Waterloo
Dr. Christopher Licskai
Western University
Environmental scan
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The team conducted an environmental scan, which aimed to assemble a spectrum of individual level perspectives representative of healthcare landscape for patient with HF. Specific topics of exploration were: current system-level initiatives related to HF care such as if HF is a provincial priority; care gaps; system process strengths and deficits; environmental capacity planning including human resources for specialized case managers or other support staff; implementation of evidence-based guidelines; reporting and ongoing evaluation of programs; and access to care.
Four provinces participated in the environment scan: Ontario, British Columbia, Quebec, and Nova Scotia. Heart failure champions, identified from these provinces, included 16 individuals who participated in the virtual interviews: cardiologists, nurse practitioners, patient and caregiver advocates, heart failure case managers, Indigenous researcher and community leader, and government policy administrators.
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Many of the identified gaps were consistent across Canada such as: healthcare systems are currently structured around the provider and not person centred; people with HF are often navigating a complex system where primary and specialty care work in silos rather than as an integrated and connected system; the need for more resources in both primary and secondary care; lack of care pathways for unattached patients; and insufficient rural access to diagnostic testing; multiple electronic health records that are disconnected, inhibiting seamless integration and communication of health information. Importantly, all provinces reported a lack of coordination and collaboration among the various initiatives related to HF and system transformation, as well as delay in HF diagnosis.
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Potential solutions to the identified healthcare gaps were proposed: provide more specialized allied health resources to support both specialty and primary care physicians to mange complex people with HF in right place; improve connectivity of electronic health care records and communication between healthcare sectors; implement electronic and/or virtual platform to support remote regions and communities; and develop care pathway with real-world implementation including concurrent evaluation cycles to inform quality improvement measures.
Research activities
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Cluster randomised control trial
The team conducted a cluster randomised control trial (protocol published in BMJ Open) to evaluate the efficacy of integrated disease management (IDM), focused on optimising medication, self-management and structured follow-up in a high-risk primary population. 100 family physicians and 223 patient participants with HF (2-3 patients per physicians) were recruited. Physicians were randomized to IDM or to usual care. The IDM program included case management, medication management, education, and self-care management delivered collaboratively by the family physician and a trained HF educator. The primary outcome measured the combined rate (events/patient-years) of all cause hospitalisations, emergency department visits and mortality over 12-month follow-up. Secondary outcomes included other health service utilisation, quality of life, knowledge assessments and acute HF episodes. Data analysis of the study is in progress.
An innovative patient-centred approach to heart failure management: the Best Care heart failure integrated disease management program
The team conducted a retrospective evaluation of 715 patients treated in community based IDM program (2016-2023) to: 1) Characterise the community-based population with HF enrolled in the program; 2) Investigate change in pre- program and post-program HF-related hospital admissions, emergency department visits and urgent family physician visits; 3) Assess change in Quality of Life; and 4) Examine change in guideline-directed medical therapy (GDMT) in patients with HFrEF. A manuscript is under review at CJC Open.
Hope-HF model of care
The team completed a Delphi survey with a group of expert in cardiology, primary care and cardiovascular education to establish program standards for an IDM model of care. The purpose of this study was to come to a pragmatic consensus approach to the patient in primary care with heart failure examining questions on process of care and where guidelines are unclear, unavailable, and/or not adapted to a primary care practice setting. The 5 domains within which the expert group attained consensus recommendations were: diagnosis, management, referral process, tools (e.g., practice-aids, patient action plans), and program evaluation indicators.
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The team is now conducting a Delphi survey to establish a model of care in a real-world setting. The objective is to attain consensus on using IDM as the model of care to animate the program standards within the healthcare system. At this stage, the survey has been created, the study protocol is complete and submission to ethics is in progress, as well as virtual focus group meeting with patient and caregivers.
Executive team
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Dr. Robert McKelvie - Lead, Cardiologist, HF specialist, Professor of Medicine at Western University.
Dr. George Heckman - Geriatrician, Associate Professor, School of Public Health Sciences, University of Waterloo.
Dr. Christopher Licskai - Respirologist, Professor of Medicine at Western University, CEO and Medical Director of Best Care.
Dr. Tim O'Callahan - Lead Family Physician at Amherstburg FHT.
Dr. Karen Harkness - Assistant Clinical Professor, Nursing at McMaster University.
Dr. Karen Geukers - Internal Medicine.
Dr. Nathaniel Hawkins - Cardiologist, Clinical Associate Professor at University of British Columbia.
Rody Pike - HF Nurse Practitioner
Dr. Anne Pascale-Bartleman - Primary Care Physician.
Madonna Ferrone - Director of Best Care.
Anna Hussey - Evaluation Lead & Epidemiologist for Best Care.
Alyson Hergot - Project Manager, Best Care.