Target Audience: Member organization leaders | Estimated Reading Time: 5 minutes
Why it Matters
We are pleased to announce that Ontario Health has committed to funding the Congestive Heart Failure initiative for an additional year. With this renewed support comes a clear set of expectations: to further advance integrated care pathways (ICP), enhance patient outcomes, and continue building integrated care across the region. This investment underscores confidence in our work to date, and challenges us to reach new benchmarks in quality, continuity, and innovation in heart failure care. The HPA-OHT proudly continues to provide funding support for Nurse Practitioner (NP) services and patient education resources through Best Care for the success of the Heart Failure ICP.
Dig Deeper
Heart failure is a complex and pervasive health challenge, particularly in rural regions where access to specialized care can be limited. In the counties of Huron and Perth, a dedicated Heart Failure (HF) Spoke-Hub-Node model ICP has played a pivotal role in reshaping the landscape of cardiac care, drawing on collaboration, innovation, and community-centered approaches. In Huron, Perth and Area, there are 31 patients living with Hearth Failure per 1000 persons, and given their complexity, 19% of heart failure patients were readmitted to hospital within 30 days of discharge between 2024-2025, higher rates than the provincial average indicating a palpable need for preventative management.
A cornerstone impact of this model has been the establishment of specialized heart failure clinics in Huron, Perth and Area, that hold standardized care pathways and ongoing education as foundational building blocks. Designed to function as hubs for assessment, treatment, and ongoing management, these clinics are staffed by multidisciplinary teams, including nurses, social workers, dietitians, and physicians—who collaborate to deliver patient-centered care.
For patients, this model means more than just medical management; it includes education on lifestyle changes through partnership with Best Care, support for medication adherence, and close monitoring for warning signs of decompensation. The clinics have also fostered strong ties with primary care providers, ensuring continuity and coordination across the patient’s journey.
In addition to the positive impacts on patient care and health system navigation, of significant consideration is the 23% reduction in 30-day hospital readmission rates between 2023 and 2025. Not only does this alleviate the burden on hospital systems, but it is also an indication of better health outcomes for patients.
The HF ICP will continue its work to now include Hypertension care pathways as well as support the expansion of access to a standardized Cardiac Rehabilitation program across the region.
Next Steps
Place an enhanced emphasis on prevention and early intervention by consistently identifying and implementing innovative ways to integrate care at every stage of the patient experience.