Burden, Prevalence and Challenges Associated with Heart Disease in Canada | Healthcare Assignment

The purpose of this assignment is to give students an opportunity to assess a health issue in Canada from a public health perspective. In Canada, the emphasis in public health has shifted from the management of communicable diseases to the prevention and management of chronic diseases. One of those chronic diseases that is significant in Canada is heart disease. Heart disease is also known as ischemic heart disease or coronary heart disease. The focus of this assignment is on providing the epidemiological evidence and consequences for heart disease in Canada. Begin this assignment by reading from reputable sources about heart disease in Canada. Reputable sources are sources such as government websites or peer reviewed journals. Please do not use information from newspapers, blogs, Wikipedia or American based information. 

Running head: HEALTH CARE
Health care
Name of the student:
Name of the University:
Author’s note

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Table of Contents
Introduction:....................................................................................................................................1
Epidemiological data related to heart disease in Canada.................................................................2
Community based strategies to address the issue in Canada...........................................................5
Changing Canadian health system landscape due to heart disease..................................................7
Conclusion:......................................................................................................................................7
References........................................................................................................................................8

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Introduction:
Incidence of chronic disease in any developed or developing country is a major challenge
for health care systems as it requires a long period of supervision and observation. In Canada too,
public health is focussing on prevention and management of chronic disease. In 2015, chronic
disease was responsible for about three-quarter deaths in Ontario (Public Health Ontario, 2019).
In Newfoundland, 63% of the residents above the age of 12 were found to have at least one
chronic disease. Among chronic disease like diabetes, heart disease, COPD, cancer and lung
disease, heart disease is a significant chronic disease in the country as it accounted for the
highest number of new cases of chronic disease (Government of Newfoundland and Labrador,
2017). The focus of this paper is to explore in depth about the burden, prevalence and challenges
associated with heart disease in Canada. The report will give comprehensive epidemiological
evidence on the trends related to heart disease in Canada since the last 10-15 years. The
epidemiological data will be compared with data from other developed countries. Lastly, the
report will give a discussion on community based strategies that has been implemented in
Canada to control heart disease.
Epidemiological data related to heart disease in Canada
Heart disease includes all those diseases that cover disorders of the heart and blood
vessels. This may include coronary heart disease and ischemic heart diseases. According to the
heartandstroke.ca (2019), 91, 524 people died of heart disease conditions or stroke in 2016. The
seriousness of the disease is understood from the fact that one person dies every five minutes

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from heart disease in Canada. The review of the Chronic Disease Surveillance data for the year
2012-2013 revealed that 2.4 million adults were living with ischemic heart disease. From the
year 2000-2001 to 2012-2013, age-standardized heart disease has declined, however the
prevalence of the condition has remained stable (Government of Canada, 2018). The rate of
mortality due to the condition was much higher in 1987 as it was the leading cause of mortality
back then. Currently, heart disease is the second leading cause of death. From 2000-2001 to
2012-2013, the newly diagnosed cases of heart disease declined from 221, 800 to 158, 700. The
death rate decreased by 23% (Government of Canada, 2013). This indicates that decline in
prevalence and mortality rate has been seen with advancements in healthcare system. However,
the current problem is that prevalence of heart disease or rate of newly diagnosed case is still
leading to increased hospitalizations and additional health cost. For example, the review of heart
and stroke conditions in Canada in the year 2016-2017 revealed that there were more than 2.7
lakh hospitalizations for the condition. In the past decade, greatest increase has been seen in
number of cases of heart failure (25%) and structural heart disease (50%) which is an indication
that lot more needs to be done to reduce the incidence of heart disease in the country.
(heartandstroke.ca, 2019).
The comparison of the epidemiological data related to heart disease in the year 2017 and
the year 2011-2012 suggests that burden of heart disease is still immense for Canadian health
care system. It has resulted in economic loss for the country because of direct (medical) and
indirect (lost productivity and income) expense. For example, incidence of stroke costed the
Canadian economy about $21.2 billion per year. This figure considers the cost involved in
hospital cost, physician services, lost income and reduced productivity. It is estimated that if no
innovative actions are taken to eliminate risk factors, the cost is likely to rise to $293 billion per

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year by 2040 (Heart and Stroke Foundation of Canada, 2018). To identify actions to improve
public health response to tackle the burden of disease, considering the risk factors and the
population groups which are more at risk is important.
The analysis of trends in Canadian people living with heart disease has revealed that men
are more likely to be diagnosed with heart disease compared to women. For example, prevalence
of ischemic heart disease and myocardial infarction are consistently higher among men
compared to women. The difference in rate of myocardial infarction between men and women is
increasing overtime. However, the trend is completely different for women who already had a
heart attack as this group of women have 30% more chance to die compared to men with heart
attack history (Government of Canada, 2017).. The main factor behind such change in risk is that
women have more co-morbidities and absence of pain symptoms leading to delay in treatment
and more complications in this group (Robitaille, McRae & Toews, 2017). The risk of ischemic
heart disease is found to increase with age too. The main reason for this being effect of ageing on
changes in the heart and blood vessels. As the survival rate of women is longer than men, the
incidence of heart disease in old age will be higher for women. As seniors in Canada is a rapidly
increasing group, the trends above shows that more and more number of women will be affected
by heart disease. The disease will disproportionately affect women as they live longer than men
(Peters et al., 2016). These disparities in prevalence rate also indicate gaps in health service of
Canada to deal with heart disease diagnosis. For example, incidence of undertreatment and
underdiagnosis is high among women.
To gets a broader understanding about heart disease burden and status of Canada in
dealing with the issue, comparing data with other country is important. For example, in Canada,
the cost associated with heart disease was $21.2 billion per year and in the United States, heart

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disease cost about $219 billion each year. It was estimated that the cost is going to increase to
$749 billion in 2035. This suggest that burden of the disease is much higher in US than Canada.
This different in statistics might be due to difference in population size of both countries. In
addition, in Australia, cardiovascular disease is the leading cause of death in 2015 with about
29% of deaths with an underlying cause of cardiovascular disease and the incidence of disease
was found to be much higher in Aboriginal and Torres Strait Islander people (The Department of
Health, 2016). The trend is similar for US too as heart disease is the leading cause of death for
men, women and people of racial and ethnic groups. One in every four deaths in America is
attributed to heart disease (Centre for Disease Control and Prevention, 2016). Thus, it can be
concluded that heart disease is a major public health issue in all the three countries as it accounts
for major cause of death.
The distribution and prevalence of heart disease in Canada and US differs by ethnicity
too. Canada is an ethnically diverse nation and four common ethnic minority groups residing in
Canada include South Asians, Chinese, Black and Aboriginals. The incidence of heart disease
and stroke is highest in people from South Asian descent and Caucasians. Examination of
differences in heart disease risk by race has revealed South Asian people to have greater
cardiovascular risk profile compared to Chinese, whites and Blacks (Chiu, Maclagan, Tu &
Shah, 2015). In contrast, racial groups living in US include Whites, Blacks, Hispanics or Latinos
and Asian or Pacific Islander. The review of data from 1999 to 2017 revealed an increased in
trend of heart disease in all ethnic groups. In addition, non-hispanic Blacks were found to be at
twice more risk of heart disease compared to other racial groups (cdc.gov, 2019). The prevalence
of the risk factor of obesity is high in almost all groups. These differences in heart disease
outcome might be due to several changes in health behaviours and cultural practices of different

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racial groups. This might have influenced diet patterns and adoption of western lifestyles. These
data can have great implication in determining the health promotion method needed for reducing
disease burden based on different characteristics of the population (Chiu et al., 2015).
Community based strategies to address the issue in Canada
In response to rising burden of heart disease and increased health care cost, various
community based campaigns and health promotion programs have been implemented to decrease
the risk of heart disease and provide appropriate treatment to Canadians. One of the programs
implemented by the Ministry included the Heart Health Program, a five year investment project
that aimed to prevent cardiovascular disease. The main goal of the program was to raise public
awareness about key lifestyles factors linked to a reduced risk of heart related disorders. Through
community wide educational campaigns, the program encouraged people to make positive
changes in their lifestyle to prevent disease. These changes included preventing tobacco use,
staying physically active and eating a healthy and low fat diet. It was the largest ever program
with Ontario as the main jurisdiction of the program (health.gov.on.ca, 2013). This was part of
primary prevention strategy to control incidence of heart disease. The significance of such
community based prevention program is that it mitigates lack of awareness surrounding the risk
and symptoms of heart disease and encourages positive behavioural change among at-risk
population groups (Romero et al., 2016).
The main purpose of secondary intervention is to minimize the impact of a disease on
diagnosed individual by encouraging them to adopt personal strategies to combat the disease.
One example of this kind of secondary prevention program implemented in Canada is the
‘Living with stroke’ program. It is a community based support and educational program designed

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for strokes survivors and their care partners. This 6-8 week program mainly aims to build the
confidence of those people who go through the burden of living with stroke. The sessions are
highly interactive where participants get the opportunity to share their experience with one
another and build skills (Heart and Stroke Foundation of Canada, 2018). Such programs are
highly useful as stroke patients suffer from various challenges like lack of mobility and inability
to complete daily activities of living. In such situation, family caregivers are burdened by care
responsibilities (Kalavina, 2019). Thus, educating this group of people can help people to
effectively deal with the condition and prevent complication and psychosocial issues because of
poor management of the disease.
Tertiary prevention strategies include implementing activities to soften the impact on an
illness and its long-lasting effects. In the context of heart disease in Canada, several cardiac
rehabilitation services have been implemented in various jurisdictions. The significance of such
service is that it helps prevent recurrent cardiac events and total cardiac mortality rate in patients.
Some rehabilitation services available in Canada includes Northern Alberta Cardiac
rehabilitation program in Alberta, LiveWell Cardiac program in Saskatchewan and Cardiac
Rehabilitation and Secondary Prevention Program Rehabilitation Institute in Ontario. People
participating in this program mostly receive care from multidisciplinary team and education and
supervised exercise classes are provided (Toma et al., 2020). However, one drawback is that
such programs are not actively utilized by all.
Changing Canadian health system landscape due to heart disease
From the above epidemiological analysis of heart disease, it can be said that it is
transforming the health care system in many ways. Firstly, health care system of Canada is

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spending maximum amount to lessen the burden of heart disease by implementing primary as
well as secondary prevention programs. Similarly, greater awareness about the issue has resulted
in increased implementation of Cardiovascular Funder programs. Canada releases annual stroke
evaluation reports for several jurisdiction and various tools and resources like cardiovascular
disease websites has been implemented to provide all information about the heart disease Public
(Health Agency of Canada, 2020). However, one problem in Canada is that despite benefits of
cardiac rehabilitation, this service remains underutilized in Canada (Toma et al., 2020). Thus, in
the future, health advocates must encourage people living with the disease to actively utilize
these services. To achieve this, there is a need to address accessibility issues, program delivery
related challenges and issues in primary care linkage.
Conclusion:
From the epidemiological analysis of heart disease in Canada, it can be concluded that
heart disease still remains a major public health burden in Canada despite the decrease in
mortality rate since the past 10-15 years. The incidence rate and the cost of the disease is still
increasing and the rate of deaths due to heart disease is a major concern. The comparison with
countries like US and Australia shows that mortality related to heart disease is high in major
developing countries and the common finding was that people from ethnic and racial groups are
at high risk of developing the disease. Various community based preventive programs and
rehabilitation programs has been implemented in Canada in response to the rising incidence of
heart disease. However, Canada government must analyse all these programs to identify
loopholes and address accessibility and poor participation related issues.

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References
cdc.gov 2019. Racial and Ethnic Disparities in Heart Disease. Retrieved from:
https://www.cdc.gov/nchs/hus/spotlight/HeartDiseaseSpotlight_2019_0404.pdf
Centre for Disease Control and Prevention (2016). Heart Disease in the United States. Retrieved from:
https://www.cdc.gov/heartdisease/facts.htm
Chiu, M., Maclagan, L. C., Tu, J. V., & Shah, B. R. (2015). Temporal trends in cardiovascular disease
risk factors among white, South Asian, Chinese and black groups in Ontario, Canada, 2001 to
2012: a population-based study. BMJ open, 5(8).
Government of Canada. (2013). Heart Disease in Canada. Retrieved from:
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-
canada.html
Government of Canada. (2017). Heart disease in Canada: Highlights from the Canadian Chronic
Disease Surveillance System. Retrieved from:
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-
canada-fact-sheet.html
Government of Canada. (2018). Report from the Canadian Chronic Disease Surveillance System: Heart
Disease in Canada, 2018. Retrieved from:
https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-heart-
disease-Canada-2018.html

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Government of Newfoundland and Labrador. (2017). The Way Forward Chronic Disease Action Plan.
Retrieved from: https://www.health.gov.nl.ca/health/chronicdisease/pdf/chronic_illness.pdf
health.gov.on.ca (2013). Ontario Programs for Health Promotion and Disease Prevention. Retrieved
from: http://www.health.gov.on.ca/en/public/publications/hpromo/hpromo.aspx#top
Heart and Stroke Foundation of Canada, (2018). Connected by the numbers. Retrieved from:
https://www.heartandstroke.ca/articles/connected-by-the-numbers
Heart and Stroke Foundation of Canada, (2018). Living with Stroke program. Retrieved from:
https://www.heartandstroke.ca/stroke/recovery-and-support/living-with-stroke
heartandstroke.ca (2019). 2019 Report on Heart, Stroke and Vascular Cognitive Impairment.
https://www.heartandstroke.ca/-/media/pdf-files/canada/2019-report/
heartandstrokereport2019.ashx
Kalavina, R. (2019). The challenges and experiences of stroke patients and their spouses in Blantyre,
Malawi. Malawi Medical Journal, 31(2), 112-117. DOI: 10.4314/mmj.v31i2.2
Peters, S. A., Singhateh, Y., Mackay, D., Huxley, R. R., & Woodward, M. (2016). Total cholesterol as a
risk factor for coronary heart disease and stroke in women compared with men: A systematic
review and meta-analysis. Atherosclerosis, 248, 123-131.
DOI: 10.1016/j.atherosclerosis.2016.03.016
Public Health Agency of Canada (2020). Cardiovascular disease. Retrieved 29 February 2020, from
https://cbpp-pcpe.phac-aspc.gc.ca/chronic-diseases/cardiovascular-diseases/
Public Health Ontario (2019). The Burden of Chronic Diseases in Ontario. Retrieved from:
https://www.publichealthontario.ca/-/media/documents/cdburden-report.pdf?la=en

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Robitaille, C., McRae, L., & Toews, J. (2017). MONITORING THE BURDEN OF HEART DISEASE
WITH THE CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM. Canadian
Journal of Cardiology, 33(10), S138-S139. https://www.onlinecjc.ca/article/S0828-
282X(17)30644-X/pdf
Romero, D. C., Sauris, A., Rodriguez, F., Delgado, D., Reddy, A., & Foody, J. M. (2016). Vivir Con Un
Corazón Saludable: a community-based educational program aimed at increasing cardiovascular
health knowledge in high-risk Hispanic women. Journal of racial and ethnic health
disparities, 3(1), 99-107. DOI: 10.1007/s40615-015-0119-6
The Department of Health (2016). Cardiovascular disease. Retrieved from:
https://www1.health.gov.au/internet/main/publishing.nsf/Content/chronic-cardio
Toma, J., Hammond, B., Chan, V., Peacocke, A., Salehi, B., Jhingan, P., ... & Marzolini, S. (2020).
Inclusion of People Post-stroke in Cardiac Rehabilitation Programs in Canada: A Missed
Opportunity for Referral. CJC Open. https://doi.org/10.1016/j.cjco.2020.01.007