Closing the Gaps in Heart Failure Care: A Call for a National Strategy in Canada.

Heart failure (HF) is a growing public health challenge in Canada, affecting over 787,000 individuals and contributing substantially to morbidity, mortality, and health care costs. Despite advances in therapies, HF care delivery remains fragmented, with significant variability in access to diagnostics, specialized services, and guideline-directed medical therapy (GDMT). Critically, the challenge is not a lack of evidence, but rather gaps in coordination, implementation, and accountability. Three dominant system-level issues drive poor outcomes: delayed diagnosis, vulnerability during transitions of care, and GDMT underuse. These are further compounded by geographic and sociodemographic disparities, particularly in rural, remote, and Indigenous communities, as well as the absence of standardized performance metrics and accountability frameworks. Evidence from national and international health care systems demonstrates that coordinated, data-driven approaches---incorporating standardized care pathways, performance measurement, and system-level accountability---can improve outcomes and efficiency. Early diagnosis, timely specialist follow-up, GDMT optimization, and multidisciplinary care models are associated with fewer hospitalizations, improved survival, and lower costs. Addressing these gaps will require a coordinated national strategy. Near-term priorities include establishing a national HF strategy, expanding access to diagnostic testing and improving GDMT access. Medium-term priorities include implementing standardized care pathways, strengthening care coordination, and enhancing data infrastructure to support performance measurement and quality improvement. Over the longer term, integrating HF into broader chronic disease frameworks and scaling digital solutions will be essential to ensure sustained coordination, accountability, and equitable access. Bill S-204 provides a critical opportunity to align key partners and advance a comprehensive, patient-centred, evidence-informed approach to HF care in Canada.