Moved second reading of Bill S-204, An Act to establish a national framework on heart failure.

She said: Honourable senators, I rise today as a sponsor of Bill S-204, an Act to establish a national framework on heart failure.

This legislation seeks to mobilize a comprehensive national response to heart failure, which has become an urgent epidemic in Canada. Heart failure is a chronic cardiovascular condition in which the heart cannot pump enough blood to meet the body’s needs. It often develops after injury to the heart following a heart attack, long-standing high blood pressure or viral damage, and it leads to a cascade of health problems. Once it begins, heart failure is usually progressive and incurable, requiring lifelong management. While it can be managed and its progression slowed, it cannot yet be cured outright. Many Canadians are surprised to learn that heart failure is common, deadly and on the rise.

Over 750,000 Canadians are living with heart failure today, and there are more than 100,000 new cases each year. This means that roughly one in three Canadians will be directly touched by heart failure in their lifetime, either suffering from it themselves or caring for a family member with the condition. These numbers continue to grow every year, driven by our aging population and improved survival from heart attacks and other heart diseases. In fact, experts describe heart failure as an epidemic and one of the fastest-growing cardiovascular diseases worldwide. We can no longer view heart failure as a niche or end-stage problem; it is a present and pressing public health challenge.

The prognosis for heart failure can be as grim as — or even grimmer than — many forms of cancer. According to the Heart and Stroke Foundation of Canada, nearly half of all patients diagnosed with heart failure will die within five years. This five-year mortality rate is worse than that of several common cancers.

Heart failure is a leading cause of death in Canada. Among women, it ranks second only to cancer and ischemic heart disease as a cause of death. Living with heart failure also means enduring devastating symptoms such as chronic fatigue, shortness of breath, swelling and exercise intolerance, which drastically reduce quality of life. Patients often experience depression and anxiety as their health declines.

The condition places a heavy burden not only on those diagnosed, but also on their families and caregivers. Caring for a loved one with heart failure can require as much work as a full-time job. The toll on families is immense as they manage complex medication treatments, frequent medical appointments and repeated trips to the emergency department.

Heart failure is now one of the top reasons for hospitalization in Canada. In fact, it has been identified as the third-leading cause of hospital admissions nationwide after childbirth and COPD, or chronic obstructive pulmonary disease. It is often referred to as a revolving-door condition because patients frequently end up back in the hospital shortly after being discharged. One in five heart failure patients is readmitted to hospital within 30 days of being sent home, and 20% of patients bounce back within a month, indicating that our system is struggling to provide adequate follow-up care or manage this illness optimally.

Each hospitalization is not only a health setback for the patient but also a significant cost to the system. The health care costs associated with heart failure are staggering and rising. Right now, managing heart failure — hospital stays, medications, outpatient care, long-term care, et cetera — costs Canada’s health system on the order of hundreds of millions of dollars every year. Direct hospital care for heart failure alone consumes about $575 million annually, and when we include all health services and lost productivity, the total cost is even higher.

If we do nothing, these costs will continue to grow. By 2030, heart failure is projected to cost $2.8 billion per year in health care expenditures. This financial strain will impact every provincial health care budget, and we simply cannot afford, economically or morally, to treat heart failure in an uncoordinated and merely responsive manner any longer.

Despite the best intentions of health care providers and policy-makers, Canadians with heart failure are falling through the cracks. We must confront the critical gaps, which this bill aims to address. Too many people are diagnosed with heart failure only when they land in an emergency room in crisis. Early signs, such as fatigue or mild shortness of breath, are often missed or attributed to aging or other conditions. Part of the problem is low awareness: 4 in 10 Canadians do not understand what heart failure is, and two thirds do not know that it has no cure. Even among health care professionals, there may be under-recognition of risk factors or early symptoms.

Unlike cancer screening or diabetes screening, there is no routine screening program for heart failure. This means patients often get diagnosed late, after irreversible damage has occurred.

We need better awareness and proactive detection so that patients can receive treatment earlier, which is when it is most effective.

Canada’s geography and provincial differences also create inconsistencies in heart failure care. Where you live can determine the quality of care you receive and, in some cases, whether you survive. For instance, patients in urban centres may have access to specialized heart failure clinics; cardiologists; diagnostic tests, like echocardiograms or blood tests for heart failure markers; and the latest medications and devices.

But patients in rural or remote communities often lack access to cardiologists or key diagnostic tools. A recent inventory by Heart & Stroke found that 27% of hospitals do not have access to a crucial diagnostic test for heart failure — the natriuretic peptide blood test — and 16% of hospitals do not follow published heart failure care guidelines. This is alarming. It means many patients are not getting guideline-recommended diagnostics or therapies simply because of where they live or where they seek care.

Moreover, even when care is available, not all patients receive optimal therapy. According to the Canadian Cardiovascular Society, fewer than 70% of eligible Canadian heart failure patients are on all the recommended medications, and fewer than 30% are on the optimal doses of those medications.

We can and must do better at translating our medical knowledge into practice uniformly across the country. Every Canadian with heart failure deserves access to the best standard of care, no matter their province, region or community.

Beyond geography, other factors, like income, education and ethnicity, influence outcomes. Indigenous Peoples in Canada, for example, face higher rates of heart conditions. Indigenous individuals are about 50% more likely to have a heart condition than non-Indigenous Canadians. They may also face additional barriers in accessing care that is culturally safe and close to home.

We also know that women with heart failure can experience differences in care. Historically, cardiovascular research and clinical trials under-represented women, and women’s symptoms are sometimes under-treated or misattributed.

Socio-economic status plays a role as well. Managing heart failure often requires frequent medical visits and costly medications or devices. Patients with financial constraints struggle more to adhere to treatment.

These disparities are unfair and avoidable. A national strategy needs to identify and address these gaps so that every patient has an equitable chance at a full life.

Honourable colleagues, we cannot improve what we don’t measure. Currently, Canada does not have a national registry or a comprehensive data system for heart failure outcomes. This makes it hard to track progress or pinpoint where interventions are most needed. Canada has a vibrant, world-class heart failure research community, from national networks like the Canadian Heart Function Alliance to the University of Ottawa Heart Institute and many more. Yet major organizations, like Heart & Stroke and the Canadian Cardiovascular Society, still describe heart failure care as poorly integrated and siloed, with significant gaps and geographic variation in access and outcomes among provinces. This tells us that while the research is strong, the spread and implementation of best practices across Canada remain uneven.

We also lack consistent reporting on performance indicators, like hospital readmission rates, mortality rates by region or patient-reported outcomes, like quality of life. In short, we don’t have a unified picture of how well or poorly we are doing in managing heart failure across the country. Without better data collection and coordination, high-level improvements will be difficult to achieve.

While dedicated health care professionals and organizations are doing their best, our current approach to heart failure is fragmented and falling short of what Canadians need. Patients encounter delays in diagnosis, variable care quality and a lack of support navigating their condition. The consequences are seen in avoidable hospitalizations, unnecessary suffering and lives cut short.

This is why a new approach is essential. We need to connect the dots through a national framework that brings coherence, resources and accountability to the fight against heart failure.

The case for a national framework on heart failure is compelling. Heart failure is a nationwide problem; it affects Canadians in every province and territory, and its impacts reverberate through our families, communities and economies. No single province or local health authority can tackle this challenge alone, especially given the wide disparities and systemic issues at play.

Federal leadership and coordination can add significant value here in several ways.

A national framework can establish consensus on what good care looks like for heart failure and set clear targets for improvement. It can provide a common policy direction to align efforts across provinces. With a framework, all jurisdictions and stakeholders would be working from the same playbook, guided by shared objectives and evidence-based strategies, rather than each reinventing the wheel. This doesn’t mean one-size-fits-all solutions imposed on provinces but, rather, a coordinated approach through which successes in one region can be scaled and adopted in others and through which minimum standards of care are encouraged everywhere.

Health care in Canada is delivered provincially, but the federal government can act as a leader and collaborator. This national framework would bring together provincial and territorial health representatives, Indigenous health leaders, medical experts, patients and advocates at one table. By facilitating at least one national conference on heart failure within the year following the enactment of Bill S-204, the federal Minister of Health would enable the sharing of experiences and solutions across regions. This kind of convening power is something only a national government can effectively do. It also signals the importance of the issue, helping to elevate heart failure on the health policy agenda. Moreover, tackling heart failure isn’t just the job of health ministries. It spans public health, education, research agencies and beyond. A framework process can engage all relevant departments and sectors in a coordinated effort.

A major goal of this bill — and any national health framework — is to amplify the voices of patients and caregivers in policymaking. Heart failure patients and their families know the shortcomings of the system firsthand. By formally consulting patient advocacy groups and people with lived experience, the framework will ensure that their perspectives shape the solutions. This patient-centric approach is crucial for identifying what support is truly needed day to day. Additionally, creating a national strategy will shine a spotlight on heart failure in the public sphere.

Just as the diabetes framework helped drive broader awareness of diabetes across Canada, we expect a heart failure framework to spur conversations about what heart failure is and how we can prevent and manage it. Raising awareness is not a trivial goal. It leads to more people recognizing symptoms earlier, seeking care and supporting necessary investments. Public awareness can also reduce stigma and misinformation, for instance, clearing up the misconception that heart failure is simply “old age” or that nothing can be done for it. Neither is true; much can be done to improve and prolong life with heart failure.

Writing a national strategy into law, as this bill does, creates accountability. It compels action on a defined timeline and requires follow-up reporting to Parliament. Without such a mandate, it’s easy for big, complex issues like heart failure to be overlooked or lost among competing priorities. The bill ensures that, within 18 months, a comprehensive framework must be developed and tabled in Parliament. This will concentrate the minds of health officials and stakeholders to produce a tangible plan. Furthermore, the requirement of a five-year report on the framework’s effectiveness means that we won’t just file this strategy away and forget it. The government of the day will have to come back and tell Parliament and Canadians what was achieved and what still needs improvement. That kind of reporting mechanism is crucial for transparency and for sustaining momentum beyond the initial launch of the framework.

In essence, a national framework is about leadership and coordination, providing the glue to bind together various efforts, fill the gaps and elevate the standard of care across Canada. Heart failure is precisely the kind of complex, widespread health challenge that benefits from a national strategy.

The Minister of Health must lead this effort in collaboration with others. The bill explicitly requires the minister to consult with provincial and territorial health representatives, Indigenous governing bodies, health professionals, researchers, patient groups, caregivers and other relevant stakeholders. To kickstart this, the minister must convene at least one national conference on heart failure within 12 months of the act coming into force. This conference would gather the experts and stakeholders to share knowledge and lay the groundwork for the strategy. The tight timeline — within one year — reflects the urgency of the issue.

The legislation outlines several core priority areas that the national framework must address. This ensures the framework is comprehensive and touches on all the major gaps we’ve identified. Bill S-204 includes measures to do the following.

One, promote early detection and diagnosis so that patients are identified and treated sooner. This means looking at ways to improve screening for those at risk and boosting awareness among both the public and health care providers about the early signs of heart failure. Equitable access to diagnostic tools across regions is part of this, so that a simple blood test or echocardiogram isn’t a luxury available only in certain hospitals.

Two, improve access to care and treatment to ensure all Canadians with heart failure have access to the guideline-directed therapies and specialized care they need. This includes encouraging the use of proven medications and devices, and supporting multidisciplinary care teams and clinics that specialize in heart failure. Importantly, the framework will look at ways to integrate innovative and technological solutions, which can help patients in remote or underserved areas receive expert care. The goal is to standardize a high level of care across the country. No matter where a patient lives, they should have a pathway to access advanced heart failure treatments.

Three, enhance patient and caregiver education and support, recognizing that managing heart failure is not just a medical challenge but a daily life challenge for patients and their families. The framework will include measures to provide better education, resources and support to those living with heart failure. The bill even specifically highlights the inclusion of mental health resources as part of the support continuum. This is critical as depression and anxiety are common in heart failure patients and caregivers.

Four, address disparities in care by making sure the framework actively works to reduce inequities in heart failure outcomes for underserved groups. This means identifying where gaps exist — for example, in rural and remote communities or among Indigenous populations or other marginalized communities — and coming up with targeted strategies to close those gaps. It could involve training more specialists in remote areas, tailoring educational materials for different cultural groups or investing in community programs that improve heart health literacy. The framework will shine a light on these disparities and commit to action so that we don’t have a scenario where someone in a remote northern community is far more likely to die from heart failure than someone in a big city.

Five, strengthen data, research and performance measurement. In other words, fill the information gap and foster innovation. Bill S-204 mandates that the framework include measures to improve data collection on heart failure and to support research efforts. One very exciting aspect specified in the bill is the development of a national heart failure registry. A registry would be game changing. It could track patients’ journeys and outcomes across the country, allowing us to identify trends, successful interventions and areas needing improvement.

The bill also mentions leveraging existing data sources like the Canadian Community Health Survey and defining national performance indicators. By collecting and publicly reporting on these outcomes, we can hold the system accountable and continually adjust policies to improve care. Additionally, promoting research means the framework will likely encourage funding and collaboration in heart failure research, be it clinical trials for new therapies, studies on care delivery models or investigations into prevention. Canada already took a step in this direction with the recent creation of the Canadian Heart Function Alliance, a national research network on heart failure that the federal government helped fund. A national framework can complement such efforts by ensuring that research findings are translated into practice and by identifying further research priorities.

Honourable senators, Bill S-204 provides a roadmap for action and leaves flexibility for the exact details to be worked out in collaboration with stakeholders. It ensures the framework will cover all the critical areas and that it will be developed with input from those on the front lines and those most affected. By embedding this in legislation, we signal the enduring commitment of Parliament to tackling heart failure in a serious and structured way.

I find it compelling to note the strong parallel to a recent success story in our Parliament: the establishment of a national framework for diabetes, which I previously mentioned. In 2021, Bill C-237, the National Framework for Diabetes Act, was passed unanimously by both the House of Commons and the Senate. That effort was spearheaded by member of Parliament Sonia Sidhu in the other place, and I was pleased to serve as the Senate critic for the bill during its journey here. The diabetes framework initiative is a model of what we can achieve and is highly relevant to today’s debate on heart failure.

Prior to Bill C-237, Canada did not have a comprehensive national diabetes strategy, even though millions of Canadians live with diabetes. The passage of that bill changed the landscape. It mandated the health minister to develop a national framework on diabetes, focusing on prevention, treatment, research and awareness in collaboration with provinces and stakeholders. Doesn’t that sound familiar after what I just outlined? Notably, it required holding a national conference and set a one-year timeline for producing the framework — very similar to Bill S-204 and what it calls for on heart failure.

The diabetes framework has since moved from legislation to reality. The National Framework for Diabetes Act received Royal Assent on June 29, 2021, and within the required timeline, the government carried out extensive consultations across Canada. By late 2022, the Framework for Diabetes in Canada was released.

This framework provides a comprehensive road map for tackling diabetes, including raising public awareness, improving training for health professionals, promoting research and addressing health inequalities related to diabetes. It was built on broad engagement. The Public Health Agency of Canada hosted dialogues with experts, patients, Indigenous communities and provincial representatives to inform it. I assume territorial as well.

One immediate outcome of the diabetes framework’s passage was a federal funding commitment in Budget 2021. The Government of Canada allocated $35 million over five years specifically for diabetes research, surveillance and prevention as well as the development of the framework. This demonstrates how getting a disease on the national radar can attract resources and political will.

This shows that national frameworks work. They rally stakeholders, focus government attention and catalyze concrete actions. Diabetes is, of course, a different disease with its own unique challenges, but the template of a national framework is proving effective. It has raised the profile of diabetes on the policy agenda and set in motion collaborative efforts that simply were not happening in a coordinated way before.

Heart failure today is in a position much like diabetes was a few years ago: a common chronic condition that has lacked a unified national action plan. With Bill S-204, we will no longer leave heart failure solely to uncoordinated efforts. We are applying the same logic that Parliament applied to diabetes, dementia and other chronic conditions: bring people together, map out a strategy and make everyone accountable to it. The unanimous support that the diabetes framework bill received in Parliament speaks to our ability, across party lines and across chambers, to come together for the health of Canadians.

Today’s passage of the sickle cell bill is in line with this exact concept of a national framework and the work we can do together if we put our attention and our hearts and minds to it.

I sincerely hope we can replicate that spirit of collaboration for heart failure because the Canadians suffering from this condition deserve nothing less.

One of the encouraging aspects in developing Bill S-204 has been the involvement and support of the heart health community: patients, clinicians, and organizations who have been raising alarms about heart failure for quite some time.

I want to acknowledge one of the main voices and advocates for heart failure: the HeartLife Foundation. The HeartLife Foundation stands out as a key inspiration for this bill. HeartLife is Canada’s first and only national, patient-led heart failure organization. Founded and run by patients and caregivers, HeartLife has first-hand insights into the challenges of living with heart failure. They have taken those lived experiences and turned them into advocacy for change.

Drawing on those lived experiences, HeartLife helped develop the Canadian Heart Failure Patient and Caregiver Charter and, more recently, led the creation of the National Heart Failure Policy Framework, a practical action plan that calls for integrated systems of care, timely diagnosis, evidence-based treatment, smoother transitions between hospital and home and better support for caregivers. They have done the homework and shown what better care can look like. Bill S-204 builds on that work by asking the federal government to turn those patient-driven priorities into a national framework for action.

The numbers and facts about heart failure are compelling on their own, but at the core of this issue are people — people like Marc Bains, who was only 23 when he was diagnosed with heart failure and lived for years with constant questions in the back of his mind as he waited for a call that there was a heart for him. When he finally got that call, his words were, “Is this the one? I have to call my wife. Am I ready for this?”

Dr. Jillianne Code, who was 27 when she was diagnosed, has said that accepting the inevitable truth of heart failure if left untreated was simple — she could die — but what is complicated is living with it, figuring out how to live with it and what it could mean to face your own mortality. After receiving the gift of a new heart more than once, she describes waking each morning and greeting her mortality by saying, “Not today.”

Together, Marc and Jillianne co-founded the HeartLife Foundation and have become leaders and advocates for hundreds of thousands of people living with heart failure and their families across Canada. For every statistic I have cited, there are real Canadians and families living that reality, and the HeartLife Foundation has helped ensure that their voices are at the centre of this bill.

I also want to recognize my colleagues who share a commitment to this issue. Senator Osler has kindly agreed to act as the critic for this bill, and I look forward to her informed perspective and any constructive critiques she might offer. We are fortunate in this chamber to have many senators with health and medical expertise and many others with a passion for improving health outcomes. I hope you, honourable colleagues, will lend your voices to this debate at second or third reading. The more attention we bring to heart failure, the more momentum this effort will have.

Honourable senators, we have a duty as parliamentarians to respond to this kind of suffering with meaningful action. Bill S-204 gives us the mechanism to do so. It is not a bill asking for massive new spending or a bill that dictates provincial delivery of health care. Rather, it is about leadership and partnership. It’s about saying the federal government will take responsibility to bring everyone to the table, craft a plan and ensure accountability for progress. It is about ensuring that heart failure receives the level of attention its impact demands. It is about raising awareness, recognizing that when Parliament clearly says, “This issue matters,” it can profoundly shape public consciousness and help galvanize further action.

This framework will not suddenly cure heart failure or instantly fix all the issues, but as we saw with the diabetes framework and others, it lays the groundwork for accelerated improvements. It creates a virtuous cycle. A framework brings focus and resources, which lead to pilot programs and research, which yield new insights and successful interventions, which then can be shared and scaled up through the network the framework established. Over time, this can fundamentally change the trajectory of a disease in a country.

Before I conclude, I want to underscore that this is a timely initiative. Our health care system is under strain. We hear daily about crowded hospitals and clinician shortages. Addressing heart failure effectively could alleviate some of that strain by reducing avoidable hospital visits and optimizing use of specialist services. The sooner we act, the better positioned we will be to handle the growing burden as our population ages.

Honourable senators, I ask for your support in sending Bill S-204 to committee for further study and, ultimately, in passing this much-needed legislation. Heart failure may not have had the profile of some other diseases in the past, but together we can change that.

Let us give hope to the 750,000, and counting, Canadians living with heart failure — hope that a better system of care is on the horizon. Let us also honour the memory of those hundreds of thousands who have lost their lives to this condition, by learning from our shortcomings and doing better for the next generation of patients.

Honourable colleagues, I urge you to join me in making the fight against heart failure a national priority. Thank you.

Yes.

Thank you, Senator Batters, and for the work that your husband had done in the past in terms of raising awareness about some of these alarming statistics. I’m not an expert, but through meeting individuals like Marc and Jillianne at the HeartLife Foundation and in preparing for this speech, I realized that I myself have so much more awareness I can gain. This is something on which we need to focus.

One of the things the bill calls for is to raise awareness with education and to ensure that those who do suffer from other conditions that lead to heart failure know exactly the kinds of resources and medication and support they can receive. Depending on your geography, that doesn’t exist today. We need to ensure that we talk about this and bring the national framework into a reality so that we can help Canadians across the country. Thank you.

That’s one of the possibilities in the framework, a coordinated effort across the country to at least gather the data. That helps clinicians, hospitals and just Canadians in general to understand the widespread nature of this illness.

In terms of the provinces, I’m not aware. Maybe my critic might be able to address that in her speech. We do know there is nothing coordinated within Canada nationally. This is something that is treated in various regions depending on what’s available. That, too, is one of the things that the minister could examine in the coordination of a meeting with provinces and territories, stakeholders, patients, et cetera: What are some of the key action items that could be undertaken by this framework?

Will Senator Martin take an additional question?

Yes.

Senator Martin, this is a very interesting bill, and I listened very closely to your speech. I didn’t hear any reference to the Canadian Institute for Health Information, or CIHI, to which every province and territory submits all kinds of information, by diagnosis, according to the ICD classification system. For example, the Yukon would submit the number of individuals who have been diagnosed with heart failure. Does the framework call for investigation or research with CIHI?

The framework asks the minister to convene a meeting. I’m sure that various health agencies and entities would be part of that discussion. I don’t have a list of all of them, and it wasn’t mentioned in my speech. The minister would look at what is available, what exists, as well as meet with the stakeholders and the health agencies in the provinces and territories to really look at what needs to be done with heart failure on a national level.

That’s what I’m suggesting: The Canadian Institute for Health Information should already have all the information that exists across the country. The problem with establishing a health registry, as Senator Batters has suggested, is that, for small communities, the health information protection acts prevent smaller communities from submitting that information because you are able to then pinpoint who has received a specific diagnosis.

That being said, perhaps the larger discussion is whether the Canadian Institute for Health Information is doing what it needs to do in bringing this to the public’s attention nationally and in supplying this information. Perhaps in the discussion of this bill, when it gets to committee, that could be raised as a point.

I was just going to say that this is something that could be carefully looked at by the committee, as to what the best approach would be and what could happen as a result of the passage of this bill.

Would Senator Martin take a question?

Yes.

Senator Martin, I don’t know if your research got you this far: We live in a time when everyone has access to more of everything. It’s pretty easy to go and find more of everything. In your research and your preparation for this speech, have you come across the answer to this question: How many hearts does each person have? It’s an easy question. How many hearts?

Only one.

Is that your answer? My question is simply how many hearts does each person have?

We each have one heart.

Thank you very much. So you’re saying it’s important that we take care of our heart because we each only have one heart, and a framework would be essential?

Yes. Absolutely.