Canadian Journal of Cardiology

Assessing the Burden of Hospitalized and Community-Care Heart Failure in Canada

Published:December 23, 2013DOI:



      The surveillance of heart failure (HF) is currently conducted using either survey or hospital data, which have many limitations. Because Canada is collecting medical information in administrative health data, the present study seeks to propose methods for the national surveillance of HF using linked population-based data.


      Linked administrative data from 5 Canadian provinces were analyzed to estimate prevalence, incidence, and mortality rates for persons with HF between 1996/1997 and 2008/2009 using 2 case definitions: (1) 1 hospitalization with an HF diagnosis in any field (H_Any) and (2) 1 hospitalization in any field or at least 2 physician claims within a 1-year period (H_Any_2P). One hospitalization with an HF diagnosis code in the most responsible diagnosis field (H_MR) was also compared. Rates were calculated for individuals aged ≥40 years.


      In 2008/2009, combining the 5 provinces (approximately 82% of Canada's total population), both age-standardized HF prevalence and incidence were underestimated by 39% and 33%, respectively, with H_Any when compared with H_Any_2P. Mortality was higher in patients with H_MR compared with H_Any. The degree of underestimation varied by province and by age, with older age groups presenting the largest differences. Prevalence estimates were stable over the years, especially for the H_Any_2P case definition.


      The prevalence and incidence of HF using inpatient data alone likely underestimates the population rates by at least 33%. The addition of physician claims data is likely to provide a more inclusive estimate of the burden of HF in Canada.



      La surveillance de l’insuffisance cardiaque (IC) est actuellement réalisée à l'aide des données d’enquêtes ou de données d'hospitalisation, qui ont plusieurs limitations. Puisque le Canada collecte des renseignements médicaux dans les données médico-administratives, la présente étude vise à proposer des méthodes de surveillance nationale de l’IC en utilisant les données populationnelles jumelées.


      Les données médico-administratives jumelées de 5 provinces canadiennes ont été analysées pour estimer les taux de prévalence, d’incidence et de mortalité des personnes ayant une IC entre 1996-1997 et 2008-2009 en utilisant 2 définitions de cas : 1) 1 hospitalisation liée à un diagnostic d’IC dans tous les champs (H_Any) et 2) 1 hospitalisation dans tous les champs ou au moins 2 facturations à l'acte en 1 an (H_Any_2P). Une hospitalisation liée à un code de diagnostic d’IC dans le champ du diagnostic principalement responsable de cette hospitalisation (H_MR) a également été comparée. Les taux ont été calculés chez les individus ≥ 40 ans.


      En 2008-2009, pour les 5 provinces combinées (approximativement 82 % de la population totale du Canada), les taux de prévalence et d’incidence de l’IC standardisés selon l’âge ont été respectivement sous-estimés de 39 % et de 33 %, lorsque H_Any était comparé à H_Any_2P. La mortalité était plus élevée pour la définition de cas H_MR comparativement à la définition H_Any. Le degré de sous-estimation variait par province et par âge, les groupes d’âge avancé montrant les plus grandes différences. Les estimations de la prévalence étaient stables au cours des années, particulièrement pour ce qui est de la définition de cas H_Any_2P.


      La prévalence et l’incidence de l’IC obtenues par les données hospitalières seulement sous-estiment vraisemblablement les taux de la population d’au moins 33 %. L’ajout des données de facturations à l'acte est susceptible de fournir une estimation plus adéquate du fardeau de l’IC au Canada.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Roger V.L.
        The changing landscape of heart failure hospitalizations.
        J Am Coll Cardiol. 2013; 61: 1268-1270
        • Dzau V.J.
        • Antman E.M.
        • Black H.R.
        • et al.
        The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: part I: pathophysiology and clinical trial evidence (risk factors through stable coronary artery disease).
        Circulation. 2006; 114: 2850-2870
        • Dai S.
        • Walsh P.
        • Wielgosz A.
        • et al.
        Comorbidities and mortality associated with hospitalized heart failure in Canada.
        Can J Cardiol. 2012; 28: 74-79
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • et al.
        Heart disease and stroke statistics—2013 update: a report from the American Heart Association.
        Circulation. 2013; 127: e6-245
      1. Public Health Agency of Canada. Tracking Heart Disease and Stroke in Canada. 2009. Available at: Accessed January 8, 2014.

        • Garg R.
        • Yusuf S.
        Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure. Collaborative Group on ACE Inhibitor Trials.
        JAMA. 1995; 273: 1450-1456
        • Pitt B.
        • Zannad F.
        • Remme W.J.
        • et al.
        The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators.
        N Engl J Med. 1999; 341: 709-717
        • Lambert L.
        • Blais C.
        • Hamel D.
        • et al.
        Evaluation of care and surveillance of cardiovascular disease: can we trust medico-administrative hospital data?.
        Can J Cardiol. 2012; 28: 162-168
        • Quan H.
        • Smith M.
        • Bartlett-Esquilant G.
        • et al.
        Mining administrative health databases to advance medical science: geographical considerations and untapped potential in Canada.
        Can J Cardiol. 2012; 28: 152-154
        • Muggah E.
        • Graves E.
        • Bennett C.
        • Manuel D.G.
        Ascertainment of chronic diseases using population health data: a comparison of health administrative data and patient self-report.
        BMC Public Health. 2013; 13: 16
        • Lix L.M.
        • Yogendran M.S.
        • Shaw S.Y.
        • et al.
        Population-based data sources for chronic disease surveillance.
        Chronic Dis Can. 2008; 29: 31-38
        • Atwood K.M.
        • Robitaille C.J.
        • Reimer K.
        • et al.
        Comparison of diagnosed, self-reported, and physically-measured hypertension in Canada.
        Can J Cardiol. 2013; 29: 606-612
        • Robitaille C.
        • Dai S.
        • Waters C.
        • et al.
        Diagnosed hypertension in Canada: incidence, prevalence and associated mortality.
        CMAJ. 2012; 184: E49-E56
        • Lipscombe L.L.
        • Hux J.E.
        Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995-2005: a population-based study.
        Lancet. 2007; 369: 750-756
        • Robitaille C.
        • Bancej C.
        • Dai S.
        • et al.
        Surveillance of ischemic heart disease should include physician billing claims: population-based evidence from administrative health data across seven Canadian provinces.
        BMC Cardiovasc Disord. 2013; 13: 88
      2. Public Health Agency of Canada. Report from the Canadian Chronic Disease Surveillance System: Hypertension in Canada, 2010. Available at: Accessed January 8, 2014.

      3. Public Health Agency of Canada. Report from the National Diabetes Surveillance System: Diabetes in Canada, 2009. Available at: Accessed January 8, 2014.

        • Anderson R.N.
        • Rosenberg H.M.
        Age standardization of death rates: implementation of the year 2000 standard.
        Natl Vital Stat Rep. 1998; 47 (20): 1-16
        • Hugli O.
        • Braun J.E.
        • Kim S.
        • Pelletier A.J.
        • Camargo Jr., C.A.
        United States emergency department visits for acute decompensated heart failure, 1992 to 2001.
        Am J Cardiol. 2005; 96: 1537-1542
        • Pang P.S.
        • Jesse R.
        • Collins S.P.
        • Maisel A.
        Patients with acute heart failure in the emergency department: do they all need to be admitted?.
        J Card Fail. 2012; 18: 900-903
        • Darling C.
        • Saczynski J.S.
        • McManus D.D.
        • et al.
        Delayed hospital presentation in acute decompensated heart failure: clinical and patient reported factors.
        Heart Lung. 2013; 42: 281-286
        • Mills G.D.
        • Chambers C.V.
        Effective strategies to improve the management of heart failure.
        Prim Care. 2012; 39: 393-413
        • Yeung D.F.
        • Boom N.K.
        • Guo H.
        • et al.
        Trends in the incidence and outcomes of heart failure in Ontario, Canada: 1997 to 2007.
        CMAJ. 2012; 184: E765-E773
        • Zarrinkoub R.
        • Wettermark B.
        • Wandell P.
        • et al.
        The epidemiology of heart failure, based on data for 2.1 million inhabitants in Sweden.
        Eur J Heart Fail. 2013; 15: 995-1002
        • Quach S.
        • Blais C.
        • Quan H.
        Administrative data have high variation in validity for recording heart failure.
        Can J Cardiol. 2010; 26: 306-312
        • Schultz S.E.
        • Rothwell D.M.
        • Chen Z.
        • Tu K.
        Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records.
        Chronic Dis Inj Can. 2013; 33: 160-166