Evolving Heart Failure Profiles in Quebec from 1998-2021: Insights from the Vision C+ Database

Heart failure (HF) affects over 750,000 Canadians and remains a major cause of hospitalization. Although specialized HF clinics deliver structured multidisciplinary care, population-level data describing patients followed in these settings are limited. Vision C+, established in 1998, provides a comprehensive dataset to evaluate changes in HF characteristics across Quebec.

We conducted a retrospective cross-sectional analysis of adults followed in Quebec outpatient HF clinics between 1998 and 2021 using the Vision C+ electronic medical record. Baseline data at inscription were analyzed and compared across periods (1998-2009 and 2010-2021). Analyses were descriptive and were based on available data without imputation.

Data of 63,755 patients were analyzed (1998-2009: 14,908; 2010-2021: 48,847), with a median age of 77 years (quartile 1-quartile 3: 67-85), and 65% were male. HF with reduced ejection fraction (left ventricular ejection fraction ≤ 40%) remained predominant (70%), while HF with preserved ejection fraction (left ventricular ejection fraction > 40%) was higher in 2010-2021 (31% vs 26%). New York Heart Association functional class III-IV was higher in 1998-2009 (58% vs 39%), as was ischemic etiology (84% vs 56%). Comorbidities were highly prevalent overall, with small between-period differences observed (all P < 0.001). Cardiac resynchronization therapy with defibrillator use was higher in 2010-2021, whereas coronary revascularization was higher in 1998-2009.

This first comprehensive description of the Vision C+ dataset shows outpatient HF populations with higher proportions of HF with preserved ejection fraction, substantial multimorbidity, and lower ischemic disease in the later period.