Our federal and provincial governments have in place surveillance monitoring to understand our population in terms of chronic diseases and leading cause of death. This information is very useful for me for managing the Cardiac Sciences program at the Foothills Medical Centre. It allows me to support specific initiatives, develop policy and support new technology for treatment and management of chronic cardiovascular diseases such as a coronary heart disease, hypertension and cardiac heart failure.
Theresa Tam (Canada, 2021a), Canada's Chief Public Health Officer, shares that:
Canada's population is aging. Most Canadian seniors living in the community report that they are happy, satisfied with their lives and have good physical and mental health. However, the aging process can bring about many challenges. One of these is the impact of chronic diseases and conditions, which can affect activities of daily living, reduce quality of life and increase mortality risk.
Four chronic diseases, namely cancer, cardiovascular diseases, diabetes and chronic respiratory diseases account for over 60% of all deaths in Canada. The onset of these diseases can be delayed or mitigated through changes in behavioural risk factors as well as broader determinants of health.”
The Auditor General of Alberta (2014) has reported that:
“AHS defines chronic diseases as “conditions which are long-lasting, non-reversible and often require special therapy, education and training for the individual with the chronic disease to maintain health. AHS considers the highest priority chronic diseases in Alberta to be (in alphabetic order):
arthritis
asthma
chronic obstructive pulmonary disease
coronary artery disease
depression
diabetes
heart failure
hypertension
obesity
Let’s now take a look at the specific data that is available from the federal and provincial surveillance programs to understand the prevalence of coronary heart disease in Canada and specifically in Alberta.
In Canada, heart disease is the second leading cause of death, after cancer, and accounted for almost 20% of all deaths in 2012.
The prevalence of most chronic diseases and conditions increases with age. Among those aged 85+, the five diseases with the highest prevalence were hypertension (83.4%), osteoarthritis (54.0%), ischemic heart disease (IHD) [42.0%], osteoporosis (36.9%) and chronic obstructive pulmonary disease (COPD) [27.3%].
Compared to women the same age, men aged 65+ are 1.5x more likely to have diagnosed IHD
It’s interesting to note that when we look at the prevalence of chronic diseases, they often have very similar risk factors or primary determinants. The other key factor is our aging population and increase life expectancy. Therefore in our clinical setting in the FMC Cardiac Cath Lab that serves Southern Alberta, we need to consider use of language lines, designated support person, bariatric supplies and equipment and advanced technology for fragile and complex procedures. Before we look into the specifics on how this patient population is managed, let’s explore various risk factors or primary determinants.
Management of chronic cardiac disease is through agreed upon AHS guidelines, protocols and patient resources. These tools are created in collaboration fro
m various stakeholders which includes – Alberta Health, Cardiovascular SCN, The Libin Institute and Heart and Stroke Foundation. The goal of our care is treatment and also focusing on patient education on prevention and management in the community.
AHS (2016) describes chronic disease management as “provides care that helps people with chronic disease improve their quality of life and live as long as possible. Chronic disease management emphasizes several approaches in managing chronic diseases effectively.
Self-care and self-management: supporting people to take an active role in managing their own care to be as healthy as possible and to prevent complications from occurring.
Disease management: interdisciplinary teams providing high quality, evidence-based care, including the use of pathways and protocols or clinical practice guidelines.
Case management: the active management of high-risk individuals with complex needs within an integrated care system.
Proactive strategies: the ability to identify at-risk individuals and groups within the population, carry out needs assessment, understand resource and activity levels and identify trends.
Minke et al (2006) - Recognition of the common risk factors for leading chronic diseases in Canada has contributed to the development of integrated chronic disease prevention and health promotion approaches. The Alberta Heart Health Project studied the capacity of health organizations in Alberta, Canada, to engage in heart health promotion. This article describes how the Alberta Heart Health Project acted on emerging research findings describing the preliminary stages of integrated chronic disease prevention in Alberta to provide leadership to encourage provincial chronic disease prevention efforts.
The Alberta Healthy Living Program (AHLP) is an integrated community-based chronic disease management program
The program includes the following services:
Patient education, including disease-specific and general health and lifestyle topics
Self-management support through Better Choices, Better Health ® workshops
Supervised exercises
Services may also include specialty services and services targeting diverse and vulnerable populations.
References
AHS (2016). A Vision for Chronic Condition and Disease Prevention and Management.
https://www.albertahealthservices.ca/assets/info/hp/phc/if-hp-phc-ccdmp-strategy.pdf
AHS (2021). Primary Health Care Resource Centre – Alberta Healthy Living Program. https://www.albertahealthservices.ca/info/page8930.aspx
Auditor General Alberta (2014). Report of the Auditor General of Alberta – Health-Chronic
Disease Management. https://www.oag.ab.ca/reports/oag-health-report-chronic-disease-management-sept-2014/
Canada (2021a). Aging and chronic diseases: A profile of Canadian seniors.
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/aging- chronic-diseases-profile-canadian-seniors-report.html#app4
Canada (2021b). Heart Disease in Canada. https://www.canada.ca/en/public-
health/services/publications/diseases-conditions/heart-disease-canada.html
Canada (2021c). Report from the Canadian Chronic Disease Surveillance System: Heart Disease in Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-heart-disease-Canada-2018.html
Minke, S. et al. (2006). The Evolution of Integrated Chronic Disease Prevention in Alberta,
Canada. Preventing Chronic Disease;3;3. http://www.cdc.gov/pcd/issues/2006/ jul/05_0225.htm
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