Cambridge Cardiac Care Centre

Rapid Access Heart Failure Clinic

“Heart Failure” is serious

But it doesn’t have to be as scary as it sounds.

Heart failure doesn't mean the heart has "failed" or that it has stopped working. Instead, heart failure (CHF) means the heart isn’t pumping as well as it should. If you have been diagnosed with congestive heart failure, your quality of life and even your longevity can dramatically improve with early intervention. The sooner you start taking care of yourself and start following CHF lifestyle and medical recommendations, the longer and healthier a life you can hope to enjoy.

Rapid Access Congestive Heart Failure Clinic provides fast-track assessment

Minimizes cardiac complications and maximizes your longevity

The Rapid Access Congestive Heart Failure Clinic provides swift, early cardiovascular assessments for patients with suspected or confirmed congestive heart failure who need to be seen urgently. This cardiologist-led clinic provides a “fast-track” to appropriate cardiac investigations and therapies. The CHF clinic was created in partnership with local hospitals and health care teams to help reduce stress on local hospitals while also improving the quality of life for patients with CHF. The only requirement is a referral from the hospital or your healthcare provider and a commitment to “get with the program”.

The CHF Clinic Team

Multi-disciplinary but with a single focus

Guided by our lead physician and two dedicated Congestive Heart Failure nurses, this science-based program draws on an elaborate team of allied health care professionals, carefully selected to meet the specific needs of the CHF patient. Focusing on accurate diagnosis, event-prevention, comprehensive therapy and lifestyle intervention, patients receive personalized, guideline-based care in a supportive environment.

Symptoms of Heart Failure

Everyone experiences CHF differently

Symptoms from heart failure can vary from person-to-person; no two people will have an identical set of symptoms. Below is a list of the most commonly experienced symptoms of heart failure. These symptoms may wax and wane, again and again, over time. The diagram below is a useful guide to understand symptoms you may experience with heart failure. However, patients must also seek out the professional help of their healthcare provider and be followed-up by a cardiologist.

Benefits of an out-patient Rapid Access Congestive Heart Failure Clinic

Congestive heart failure affects over 600,000 Canadians, a number that is growing by an astonishing 50,000 per year according to the Canadian Heart & Stroke Foundation. It is a growing epidemic that places tremendous burden on patients, families and the health care system. Our Rapid Access heart failure clinic seeks to ease some of that load by:

  • Providing Rapid Access non-invasive testing
  • Providing patient-centred rehabilitation and education about CHF
  • Emphasizing patient engagement and the development of self-care capabilities
  • Reduces the stress and anxiety of waiting for answers
  • Decreasing ER wait times by accepting patients who do not require urgent admission
  • Reducing length of hospital stay and minimizing readmissions

Patient Education

Why am I being sent to the Rapid Access Congestive Heart Failure Clinic?

Often the initial visit to our Rapid Access CHF Clinic is arranged by the emergency department physician who would have attended to your symptoms at the hospital. Sometimes, however, you may have seen your family doctor, walk-in clinic or urgent care physician who can make the same call. In any case, the physician would have suspected the possibility of heart failure based upon your symptoms and cardiac risk factors. They would have referred you to our Rapid Access clinic to quickly determine your risk for congestive heart failure and to help prevent the development of future cardiac events and complications.

What can you expect at your first appointment?

Upon arriving at Cambridge Cardiac Care, please register with our friendly staff at the reception window. You will first be called in by a technologist who will commence your cardiac testing which may include an ECG, Echocardiogram, Holter Monitor, ABPM, Stress Test and Stress Echocardiogram. Upon completing the full workup, you will meet with the specialized cardiac nurse or the cardiologist who will review your test results and consult with you regarding your risk of congestive heart failure. They may suggest further testing and possibly commence an appropriate treatment plan. Follow up appointments may be required.

How to prepare for your first appointment?

Since you may be undergoing cardiac testing at your first appointment, it is important to follow these instructions carefully. You may also visit the test-specific pages on our website to get more detailed information in advance of your appointment. If you are coming for tests to investigate possible CHF, please read carefully:

General Cardiac Testing Instructions:

  • Shower in the morning, before your appointment.
  • Do not wear lotions or body oil.
  • Do not wear jewelry or perfume.
  • Wear comfortable exercise clothing to your appointment.
  • Eat a light meal 2-3 hours before your appointment.
  • Stay away from caffeine. No coffee, tea, chocolate, soda pop, or decaf products.
  • Bring running shoes to change into during your appointment.
  • Bring a bottle of water and a light snack just in case.
  • Bring a list of all your medications.
  • Bring your health card. Be prepared to be in the clinic for up to four hours.

What are the most important things I need to watch for if I have CHF?

Heart failure patients must keep track of a few things everyday. First, you must record your weight everyday. You must also keep track of your symptoms. You must monitor your liquid intake. And you MUST control the amount of salt you ingest.

  1. Weight tracking: Keep a reliable record of your weight. Log your weight every day first thing in the morning (after urination and before eating). Make sure to do it at the same time everyday, wearing similar clothing. Bring your weight record with you to your cardiology and cardiac rehab appointments. Remember: weight gain of 3 pounds in 2 days, or 5 pounds or more in a week, may be a significant marker in disease progression and is cause for possible further followup or investigation.
  2. Symptom monitoring: Watch out for any of these symptoms since they may indicate disease progression. Call your healthcare provider if you experience:
    1. Worsening shortness of breath or a persistent cough
    2. Difficulty breathing, lying down or needing to sleep in a chair due to difficulty breathing
    3. Increased swelling or abdominal girth
    4. Worsening fatigue/weakness
    5. Pain or feeling of ‘fullness’ in stomach area
  3. Limit fluids: Consume no more than 1.5L (6 cups) to 2.0L (8 cups) per day. This includes all liquids from water and coffee/tea to soft drinks and alcohol.
  4. Watch your diet: Reduce your salt/sodium in your diet. Strictly follow a low-salt diet (DASH diet in English; DASH diet in Portuguese) to reduce high blood pressure, keep swelling under control, and make breathing easier. This means limiting salt intake to 1.5 g - 2 g per day. Always read the label: salt is found in most foods so don’t just calculate what you sprinkle from the salt shaker. Learn how to manage your potassium intake as well by following our useful Potassium guide If you have diabetes, you should also be following the STEP 2 diet.

What is Congestive Heart Failure (CHF)?

Heart failure means the heart is not able to pump enough blood to keep up with the basic demands of the rest of the body. “Failure” refers to the failure to keep pace with the body’s needs, not that the heart has stopped. There may be many root causes for the heart to become inefficient at pumping blood. Often heart failure develops as a result of damage sustained by a heart attack or by inflammation from a heart infection (myocarditis). Still others will develop CHF due to a stiffening of the heart chambers that can be the result of chronic high blood pressure, for example.

Heart failure is a very serious condition. Historically, only 50% of heart failure patients would make it past 5-years after diagnosis. Now, with newer therapies and diligent adherence to lifestyle changes, some heart failure patients could achieve a near-normal life expectancy. Although there is no cure for heart failure, it is possible to control and possibly even reverse some of the underlying causes of heart failure in some patients. Thanks to modern medicine and science-based cardiac rehabilitation programs, there is reason for optimism and hope for many heart failure patients .

What is the difference between heart failure (CHF), a heart attack and cardiac arrest?

Although the three conditions may sound similar in their terminology, heart failure, heart attack and cardiac arrest each refers to a very different disease process. These differences are important for patients to understand.

What's the Difference?

What causes Congestive Heart Failure (CHF)?

Although there many possible causes of heart failure, one of the most common causes is a heart attack. A heart attack can damage and weaken the heart, reducing its ability to pump blood to the body. Keep in mind, heart attacks can eventually lead to heart failure, but heart attacks and heart failure are two different things.

Another common cause of CHF is a disease of the heart muscle called cardiomyopathy which can result from excessive alcohol or drug use, metabolic disorders (such as high blood pressure, diabetes, or obesity ), viral infections or auto-immune conditions.

Causes of Heart Failure

What is ejection fraction (EF)?

Ejection fraction (EF) is a measurement of how well the heart pumps blood. This measurement can be used to determine the severity of heart failure and to develop an appropriate treatment plan. A healthy EF is between 50-70%. Meanwhile, borderline ejection fraction falls between 41-49% which means a little less than half of the oxygenated blood in the heart’s chamber is actually getting pumped out to the rest of the body. This is sometimes called Heart Failure with Mid-range Ejection Fraction and can cause symptoms like shortness of breath during regular daily activities. When 40% or less of the oxygen-rich blood is pumped to the body, it results in Heart Failure with Reduced Ejection Fraction.

While ejection fraction is an important marker for heart failure, it is not a definitive diagnostic tool: heart failure can occur even with a normal EF if the heart muscle is stiffened by conditions like high blood pressure. In fact, nearly half of all heart failure patients have normal range EF, a condition called Heart Failure with Preserved Ejection Fraction. Therefore, a normal range EF on its own does not rule out heart failure. Other tests may be needed to get a clearer picture of what is going on.

If you have been prescribed medication and lifestyle changes for heart failure, your symptoms and ejection fraction may improve as a result. You must, however, maintain these changes and continue on medication. Studies show that stopping medication weakens heart strength further, making it even more difficult to get back previous gains. With CHF, you must stay the course.

How long will the initial appointment last?

The initial assessment appointment at the Rapid Access Congestive Heart Failure Clinic may take up to 4-hours. As such, it is best to be prepared with a bottle of water and a light snack in case the appointment runs long. The duration will depend on what specific tests are being done in your case. As well, medical emergencies with other patients can also sometimes cause delays; we appreciate your patience.

Do I take my medications on the day of my appointment?

Some patients may be required to discontinue taking certain medications the day of their initial assessment. This does not, however, apply to all patients. So, please, do not stop any medications on your own without the express instructions of your healthcare provider. If you are instructed to suspend certain medications on the day of your appointment, you may resume taking them immediately upon completing the necessary cardiac tests.

Not sure how to manage your CHF at home?

Explore these important resources specifically for heart failure patients.

The clinic nurse, rehab team and cardiologist are full of information and helpful guidance, but you can’t take these experts home with you to help make the right choices day to day. That’s why we have compiled these valuable resources: from the CHF diet and recipes to exercise and lifestyle management, these tools can help guide you along the way.

Why you need prevention-rehab now.

The P.R.E.V.E.N.T. & Rehabilitation Clinic

If you have been referred to the Congestive Heart Failure Clinic, you have direct, Rapid Access to our P.R.E.V.E.N.T. Rehabillitation & Risk-reversal Clinic: the largest unit of its kind in the region. Why? Because in many cases, time is of the essence. Studies show that cardiac rehab can reduce the risk of future cardiac events and disease progression by upto 90% in some cases! If you start managing it now by making lifestyle changes and adhering to recommended therapies, you could extend your life, living longer and better even with CHF. Learn how at The P.R.E.V.E.N.T. Rehabillitation & Risk-reversal Clinic.

What tests might I need?

Accurate diagnosis means the right tests, by the right people, at the right time.

It is important to determine exactly what is going on, and why, in order for your cardiologist to develop an appropriate plan of care. You can expect to have some, or all, of the following tests done in preparation for your assessment by the cardiologist:

Physical Exam

  • Come prepared knowing your symptoms, medical and family history!
  • Measurements of blood pressure, height & weight and listening to heart & lungs stethescope
  • Be completely honest! It's your health!

Blood Test

  • Blood tests may be done at any lab that is convenient for you. Some blood tests require you to fast 8-10 hours, others do not. Please check the requisition or check with your health care provider.
  • Blood tests help determine your risk for development or progression of various heart diseases.
  • Measurements of substances like liver enzymes, sodium, potassium and creatinine can indicate the health of other organs that may be effected by heart disease.
  • Biomarkers like BNP might also be used for diagnosis of heart failure (CHF).

Chest X-Ray (CXR)

  • Chest X-rays are performed in radiology labs
  • Chest x-rays can show whether the heart is enlarged (like in heart failure)
  • Chest x-rays can also show fluid or congestion in the lungs

Electrocardiocgram (ECG)

  • During an ECG, electrodes are placed on the chest and detect the electric signals in the heart
  • This can indicate prior heart attacks, and abnormal heartbeats (like atrial fibrillation)
  • They can also be used to detect whether the left ventricle is thickened/enlarged
  • Electrocardiocgram testing at CCCC

Echocardiogram (Echo)

  • An echo machine bounces sound waves off the heart to examine its structure and motion of fluids like blood
  • This can be used to measure the structure of the heart (how thick/rigid the walls are) and how well the heart pumps (ejection fraction) as well as the structure and function of valves
  • They can also be used to detect whether the left ventricle is thickened/enlarged
  • Echocardiography testing at CCCC

Stress Test

  • In a stress test, you will exercise on a treadmill while equipment measures your heart
  • Stress tests examine the response of the heart to exertion and whether blood flow to the heart is impaired
  • Stress tests help determine what kind of exercise is appropraiate
  • Stress testing at CCCC

Nuclear Imaging (MIBI/MUGA)

Cardiac Catheterization / Angiogram

  • A very thin tube called a catheter is inserted into a blood vessel and threaded towards the heart
  • A dye is released that is visible by x-ray
  • The movement of the dyed fluid throughout the heart can show blocked or narrowed arteries as well as how much blood is flowing through the heart
  • Cardiac Catheterization Lab at St. Mary's General Hospital

Wait Times

Drag to see the table

Cardiac Test Routine Test Wait Time Urgent Test Wait Time
ABPM 2 weeks Same day
ECG 24 hours Same day
Echocardiogram 2 weeks 36 hours
Stress Test (Exercise / Treadmill) 2 weeks Same day
Stress Echocardiogram 2 weeks 24 hours
Holter Monitor - 24 Hour 2 weeks 24 hours
Holter Monitor - 48 Hour 2 weeks 24 hours
Holter Monitor – 72 Hour 2 weeks 48 hours
Holter Monitor - 2 Weeks 2 weeks 48 hours
Spirometry 24 hours Same day

The above wait-times indicate the standard benchmarks that Cambridge Cardiac Care strives to meet each and every day. Unforeseen circumstances and Public Health mandates, may effect these wait times. Rest assured that timely access is a driving force at CCC: we will get you in as soon as possible, based on your assessed level of urgency.