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(Dis)connected: How unseen links are putting us at risk – 2019 Report on Heart, Stroke and Vascular Cognitive Impairment

Press Release

Introduction

The heart, brain and mind are inextricably connected. They work together and are dependent on each other; if something happens to one, the others are affected.

A new in-depth analysis, conducted by Heart & Stroke, of the interconnections between our hearts, our brains and our minds has revealed that the relationship is much stronger and more complex than previously thought, and the impact of the connections on the already overloaded health system — and on people’s lives — is profound. The analysis uncovered gaps in the health system that have resulted in delays in diagnosis and secondary prevention, leading to unnecessary suffering in thousands of people in Canada. There is great opportunity to better coordinate care and improve outcomes for people living with our diseases.

The new knowledge is raising the stakes on the risks and impacts of these conditions for all people in Canada.

“The heart, brain and mind are at the core of everything, including our health,” says Yves Savoie, CEO, Heart & Stroke. “We mapped the connections between heart, brain and mind diseases and conditions for the first time and found even stronger links and a much greater impact than anticipated. People managing these conditions are overwhelmed and the system is overloaded. This is a crisis and it is not sustainable. We need to find solutions now.”

Heart & Stroke is continuing its support of people living with heart, brain and mind conditions. It is also sharing its research, raising awareness and calling out for health system leaders to work together to improve integration and coordination of care and save lives.

Heart, brain and mind diseases and conditions share many things: they are physically connected, and they have many of the same risk factors. Further, the impact of the connection is often cumulative: If you prevent one condition, you can prevent many others. Unfortunately, at the same time, if you develop one condition, you are at significantly higher risk of developing others. With nine in 10 people in Canada having at least one risk factor for heart conditions, stroke or vascular cognitive impairment, the impact is even further amplified.

And yet the health system that manages heart, brain and mind conditions can be disjointed. Each specialty focuses on specific parts of the body and on specific conditions. Addressing multiple needs requires additional referrals, dialogue and collaboration between specialties. Wait lists and increasing demands for specialty services create hardships for patients and their families who experience the human costs. For many, this means serious illness and early death that might have been prevented if access to all needed services were more readily available.

What we mean by mind

In this report, Heart & Stroke is using the term “mind” for the first time. By mind we refer to the ability to be aware, to think and to feel. The mind is affected by vascular cognitive impairment, which may be caused by tiny clots that block small vessels in the brain, resulting in a lack of oxygen and damage to brain cells. It consists of a range of cognitive impairments associated with cerebrovascular disease, including problems with attention, memory, language, and executive function (e.g., problem solving). The severity can range from mild problems with concentration and thinking, to more severe and widespread problems termed vascular dementia, causing difficulty performing even basic tasks such as getting dressed and bathing. While there are many other diseases and conditions that affect the brain and mind, Heart & Stroke’s interest is in the areas of stroke and vascular cognitive impairment.

Patients can enter the healthcare system through many different points. Whichever way they come in, most share common needs for understanding and managing their underlying health risks and risk factors, for lifestyle change, for access to medications and tobacco control. This points to the pivotal role of family doctors and primary health teams, who provide referrals to more specialized care and who maintain the relationships that support a wholistic approach to patient well-being.

Even when they have a diagnosis, patients and their families must navigate a complicated network of health-related services, usually involving multiple providers to meet their often-increasing medical needs. They do this with little understanding of what should happen, what is available, what will happen next and where they need to go. This is a startling reality given that 2.6 million hospitalizations in Canada over the past decade involve people with at least one of these conditions.

We have made tremendous gains in increasing survival rates from heart conditions and stroke through improvements in diagnosis and treatment, and we have started to slow the progression of vascular cognitive impairment, of which dementia is the most severe form. But these gains are only half the story. As the population ages, and as more young people develop these conditions, we see an increasing number of people living with heart conditions, stroke or vascular cognitive impairment — often more than one — and having to cope with them for a longer period. Their growing numbers and complexity increase the need for medical, rehabilitation and community-based health services.

Despite healthcare providers’ best efforts, timely access to multiple specialty and supportive care services remains elusive. The higher demand created by the growing number of people with these conditions and their increased complexity outweighs the current capacity of our healthcare system, a system that was designed to manage individual conditions and risk factors. The fragmented system creates a significant time and financial burden for patients and families, and results in increased stress and frustration, decreased quality of life and poorer outcomes.

“I was lucky once my diagnosis finally came; I had surgery within three months. But the follow-up did not go well,” says Caroline Lavallée, who had surgery for supraventricular

tachycardia, a heart rhythm disorder. “I was released from hospital and did not know what to expect. Yet I consider myself lucky compared with others. I can’t imagine the psychological distress that some people must feel — not only the patients but also their families. They don’t know what to do, what’s happening, what’s coming or how to support their family member.”

  1. The big picture

This report explores the many connections among heart diseases and conditions, stroke and vascular cognitive impairment, and the challenges faced by people who experience one or more of these. The challenges occur from the onset of conditions through diagnosis, treatments, prevention of further damage, rehabilitation and ongoing self-management of these conditions in their community and facing end-of-life.

For the first time, the connections between a broad set of heart, brain and mind conditions have been systematically mapped, revealing their complex interconnectivity and the real magnitude of this crisis in Canada. By examining available data and published studies through the lens of interconnection, we found many strong associations between these conditions, the challenges and impact on the people experiencing them and their families, and how the health system supports them through their journeys from recognition and diagnosis to prevention of further damage, treatment and longer-term recovery and management. Some notable differences between men and women surfaced.

As we advance our understanding of the connections between the heart, brain and mind, most people are unaware of these connections, and the extent of their impact is only starting to become clear:

  • 91,524 people in Canada died of heart conditions, stroke or vascular cognitive impairment in 2016. This equates to one out of every three deaths.
  • One person dies in Canada every five minutes from heart conditions, stroke or vascular cognitive impairment.
  • 40% of people admitted to hospital with a heart condition, stroke or vascular cognitive impairment will be readmitted at least once more for another similar event or a different heart, brain or mind condition.
  • There is a negative impact on health outcomes for people with multiple conditions, including decreased quality of life and increased mortality.
  • People with more than one of these conditions are up to eight times more likely to die in hospital compared to those with only one condition.

The continuum of care: Stages that may be experienced by people living with one or more heart, brain or mind conditions.

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