Cardiac researcher finds one-third of Canadian heart attack patients don't receive recommended followup care

About 10 per cent of heart attack survivors are left with pump dysfunction caused by scar tissue, leaving them at a higher risk of heart failure, which impacts about 600,000 Canadians. Heart failure has a negative impact on quality of life and can lead to cardiac arrest, which is estimated to cause half of the deaths from heart disease in North America. 

Pump function often improves within the six months following a heart attack, but if it doesn’t — and the damage is severe enough — patients may need more intense treatment, such as an implanted cardiac defibrillator, which helps identify and treat the heart rhythms that cause cardiac arrest. 

Guidelines recommend patients receive a followup echocardiogram, or ‘echo’, a special ultrasound test that measures heart function, three to six months after a heart attack to assess their risk. But a recent national study, co-led by the Libin Cardiovascular Institute’s Dr. Stephen Wilton, MD, found that about one-third of patients don’t have the recommended followup. 

“When we asked patients why they did or didn’t have a followup echo, the most common reason was that it wasn’t ordered,” says Wilton, an associate professor in the Cumming School of Medicine at the University of Calgary. “As far as we could tell, it wasn’t that there weren’t enough testing facilities available or that patients didn’t want to have their followup; it was more of a gap in care.” 

The study followed 501 patients at 14 urban academic and community hospitals across Canada. The research team didn’t note any large differences between the provinces or physician specialties in the study. 

Wilton noted a second goal for the study was to determine the number of people whose pump function levels indicated further treatment was needed. 

“In the patients who received their followup assessment, about 17 per cent met the criteria to receive a defibrillator, but only about a quarter of those were referred to see a specialist,” says Wilton. 
For Wilton, the study reveals more education is needed for health-care providers. Protocols should also be created to ensure followup care for heart attack patients and he encourages patients to advocate for themselves if they don’t receive the recommended checkup. 

Wilton says the Cardiac Arrhythmia Network of Canada, of which he is a member, is working on an app that will provide reminders for patients following a heart attack, with the goal of improved care.