The Changing Face of Heart Disease and Stroke in Canada 2000

PDF Version (882 KB, 109 pages)

ISBN 1-896242-28-6

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Prepared in Collaboration with
Laboratory Centre for Disease Control, Health Canada
Statistics Canada
Canadian Institute for Health Information
Canadian Cardiovascular Society
Canadian Stroke Society
Heart and Stroke Foundation of Canada

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Executive Summary

Heart disease and stroke are major causes of illness, disability and death in Canada and they exact high personal, community and health care costs. The goal of The Changing Face of Heart Disease and Stroke in Canada, the fifth in a series of reports from the Canadian Heart and Stroke Surveillance System (CHSSS), is to provide health professionals and policy makers with an overview of current trends in risk factors, interventions and services, and health outcomes of heart disease and stroke in Canada.

Risk Factors

The high prevalence rate of the major risk factors - smoking, physical inactivity, high blood pressure, dyslipidemias, obesity, and diabetes - continues to contribute to the epidemic of heart disease and stroke in Canada. There is a lack of significant improvement in these risk factors. Differences in risk factors exist among men and women, various age groups and individuals living in different regions of the country.

Recent research findings on the underlying causes of heart disease and stroke related to infection, micronutrients, homocysteine and oxidants, as well as genes provide possible new avenues for prevention.

Ongoing data captured through a surveillance system are necessary to monitor risk factors in the population. The most recent national level data for risk factors that require personal measures such as blood pressure, blood sugar for diabetes, blood lipids, and weight and height for obesity, are over ten years old. This limits our ability to assess the impact of prevention initiatives. In addition, better data are needed on nutrition and the dietary habits of Canadians.

Implications

• More effective preventive measures with adequate resources targeted at individuals and communities, and supported by policies and legislation, will help reduce risk factors for heart disease and stroke.
• Sub-groups such as youth, First Nations and Inuit, and sedentary overweight middle-aged individuals merit a more concerted effort with health promotion and prevention programs tailored to meet their needs to decrease the risk of heart disease and stroke.
• At a time of constrained resources, health organizations for various diseases (for example, heart and stroke, diabetes, cancer) could derive benefit from working together on the reduction of common risk factors and conditions.
• More research on the underlying pathophysiology of heart disease and stroke and the effectiveness of prevention interventions will enhance the evidence base for the development of effective programs and services.
• Ongoing population surveys that include personal measures of blood pressure, blood sugar, blood lipids, and weight and height would provide valuable information for planning and evaluation of services, policies and legislation. Ideally, this data would be available at the community, provincial/territorial, and national level for all Canadians, including First Nations and Inuit people.

Interventions, Services and Costs Interventions, Services and Costs

Interventions, Services and Costs Interventions, Services and Costs Cardiovascular disease (heart disease and stroke) is the leading cause of hospitalization for men and women (excluding childbirth). Based on the rates of hospitalization by age group, acute myocardial infarction and ischemic heart disease become important health problems starting at age 45 for men and 55 for women. Congestive heart failure and stroke affect older individuals with much higher admission rates over age 75 for both men and women. Marked differences exist in the rate of hospitalization and procedures for men and women that are still unexplained.

Clinical practice guidelines based on the latest research evidence provide direction for the appropriate use of the wide range of therapeutic interventions by health professionals. Gaps exist between recommendations for practice and actual practice, not only for treatment but also for prevention. Greater adherence to these guidelines would improve the treatment of heart disease and stroke. Recent initiatives by the pharmaceutical industry to promote a more holistic approach to treatment are a welcome step toward achieving better health outcomes.

An increase in the number of elderly in the population who have high risk profiles will lead to an increased need for the full range of health services required to manage heart disease and stroke effectively - ambulatory care, acute and chronic care hospitals, rehabilitation, home care and support, pharmaceuticals, health education, and other interventions. Improved data at the community, provincial/territorial and national level on interventions and health services would assist health service providers and funders in planning for and evaluating these services more effectively.

Implications

• Service providers and funders will have to provide the full range of health services for an increased number of elderly individuals, many of whom may have several illnesses.
• More widespread use of clinical practice guidelines is required to improve evidence-based practice.
• The expansion of hospital-based clinical databases with standardized indicators in all hospitals will promote continuous quality improvement and increase the ability to compare health services and interventions across the country.
• Future surveillance that includes such indicators as length of hospital stay, access to surgical procedures and ambulatory care services, use of interventions according to clinical practice guidelines, and satisfaction with services will provide useful information to health service providers and funders.
• The linkage of physician, hospital, home care, pharmaceutical, and mortality databases at the provincial/territorial levels would add to the knowledge base that could be used to improve clinical practice and health outcomes. This would be facilitated by a unique identifier that could track an individual over time.

Health Outcomes

Cardiovascular disease (heart disease and stroke) is the leading cause of death of over one-third of Canadians. It not only affects the elderly but is also the third leading cause of premature death under age 75. Mortality rates for ischemic heart disease and acute myocardial infarction continue to decrease, but mortality rates for stroke have not changed significantly during the past ten years.

The number of elderly in the Canadian population has been increasing in recent years. As a result of this trend, there has been an increase in the number of deaths due to stroke and ischemic heart disease. This trend is expected to continue for the next fifteen years.

Heart disease has a major impact on an individual's quality of life, including chronic pain or discomfort, activity restriction, disability, and unemployment.

While there are detailed data on deaths from heart disease and stroke, there is a lack of data on other critical health outcomes, such as incidence, prevalence and quality of life, needed to plan and evaluate prevention and management interventions.

Implications

• Both primary and secondary prevention efforts must attain priority to decrease the incidence of fatal and non-fatal heart disease and stroke in the population.
• Collaborative efforts are required by health service providers to assume a wide range of services that will enhance the quality of life of individuals living with heart disease and stroke as well as their families.
• The Canadian Heart and Stroke Surveillance System (CHSSS) needs to be enhanced to provide more useful information to decision-makers on
  • quality of life - activity restriction, side-effects of drugs, psychological reaction, impact on family dynamics, social life, personal and economic, sexuality;
  • incidence of heart disease and stroke and linked to morbidity and mortality for longitudinal follow-up; and
  • mortality rates for Aboriginal people and by ethnic background.

Youth

Behaviours that increase the risk of heart disease and stroke and the underlying pathophysiologic changes begin early in life. Therefore, it is essential that prevention begins in early childhood.

Greater effort must be made to prevent children and youth from starting to smoke cigarettes. The rates of smoking among youth aged 15 to 19 continue to increase with the greatest increase evident among young women. The factors that influence smoking include personal factors such as low self-esteem but also include smoking patterns in the family and the accessibility of cigarettes.

Young children are physically active but physical activity decreases during the teenage years, particularly among young women.

Obesity is a problem for a significant proportion of children aged 7 to 12. Programs to promote healthy weights must also address the concern young women have about the need to be thin, as this contributes to the decision to smoke.

There is a lack of data on congenital heart disease in Canada. This limits the ability to track this important health problem and plan effectively for health services for this population group.

Implications

• A greater effort is needed to address smoking among youth. This includes programs and policies specifically for youth. Programs, policies and legislation are also needed to decrease smoking in the population as a whole, which will in turn have a positive effect on the incidence of youth smoking.
• More attention to the promotion of healthy nutrition and weight and regular physical activity throughout childhood and adolescence will help to promote lifelong healthy behaviour.
• Ongoing collection of data on physical activity, nutrition, weight, height, and skin-fold measures among children and youth will enable effective planning and evaluation of health promotion programs, policies and legislation.
• The development of a national surveillance system on congenital heart disease with data on incidence, prevalence, quality of life, use of health services, costs, and mortality will facilitate planning for health services for individuals living with this disease.