Quality Standard Details
Heart Failure: Care in the Community for Adults
- Publication Date
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2022-January-01
- Status
- Published
- Topic Area
- Heart Disease
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Heart failure is a progressive, ultimately fatal condition: 50% of people with heart failure die within five years of diagnosis, and over 90% die within 10 years. People with heart failure also often have multiple comorbidities: in Ontario, 37% of people with heart failure have four or more coexisting chronic conditions.
There are opportunities to improve care for people with heart failure in Ontario and to reduce the health system burden of this disease, particularly as a number of regional variations in heart failure care and outcomes have been identified across Ontario.
This quality standard addresses care for adults who have heart failure, including the assessment and diagnosis of people with suspected heart failure. It applies to community settings, including primary care, specialist care, home care, hospital outpatient clinics, and long-term care.
This quality standard does not address care provided in hospital emergency departments or inpatient settings. It does not discuss heart failure related to congenital cardiac conditions. It also does not address the primary prevention of heart failure, although it does provide guidance on risks and lifestyle factors that may affect the progression of heart failure. These may be topics addressed in future quality standards.
Quality Standard in Brief
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Quality Statement 1: Diagnosing Heart Failure
People suspected to have heart failure undergo an initial evaluation that includes, at minimum, a medical history, a physical examination, initial laboratory investigations, an electrocardiogram, and a chest x-ray. If appropriate, natriuretic peptide levels are tested to help formulate a diagnosis. If heart failure is confirmed or suspected after these tests, an echocardiogram is then performed.
Quality Statement 2: Individualized, Person-Centred, Comprehensive Care Plan
People with heart failure and their caregivers collaborate with their care providers to develop an individualized, person-centred, comprehensive care plan. The care plan is reviewed at least every 6 months, and sooner if there is a significant change. It is made readily available to all members of the person’s care team, including the person and their caregiver(s).
Quality Statement 3: Empowering and Supporting People With Heart Failure to Develop Self-Management Skills
People with heart failure and their caregiver(s) collaborate with their care providers to create a tailored self-management program with the goal of enhancing their skills and confidence so that they can be actively involved in their own care.
Quality Statement 4: Physical Activity and Exercise
People with heart failure are informed of the benefits of daily physical activity and offered a personalized, exercise-based cardiac rehabilitation program.
Quality Statement 5: Quadruple Therapy for People With Heart Failure Who Have a Reduced Ejection Fraction
People with heart failure who have a reduced ejection fraction (HFrEF) and New York Heart Association (NYHA) class II to IV symptoms are offered pharmacological management with “quadruple therapy.” They may require additional medications and are prescribed these as needed.
Quality Statement 6: Worsening Symptoms of Heart Failure
People with heart failure who report gradual, progressive, worsening symptoms are assessed by a care provider and have their medications adjusted (if needed) within 48 hours.
Quality Statement 7: Management of Non-cardiac Comorbidities
People with heart failure are treated for non-cardiac comorbidities that are likely to affect their heart failure management.
Quality Statement 8: Specialized Multidisciplinary Care
People with newly diagnosed heart failure, those who have recently been hospitalized or treated in the emergency department for heart failure, and those with advanced heart failure (NYHA III–IV) are offered a referral to specialized multidisciplinary care for heart failure.
Quality Statement 9: Transition From Hospital to Community
People hospitalized or treated in the emergency department for heart failure receive a follow-up appointment to reassess volume status and medication reconciliation with a member of their community health care team within 7 days of leaving the hospital.
Quality Statement 10: Palliative Care and Heart Failure
People with heart failure and their families have their palliative care needs identified early and are offered support to address their needs.
Supporting Documents
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Patient guide for this quality standard
Know what to ask for in your care
Placemat for this quality standard
A quick-reference resource for clinicians that summarizes the quality standard and includes links to helpful resources and tools
Quality improvement tools and resources for health care professionals, including an action plan template
Supplementary information to support the data collection and measurement process
Additional Resources
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- Case for improvement (slide deck)
Share why this standard was created and the data behind it, to get the support you need to put it into practice - Technical specifications
See the technical specifications for the indicators within the quality standard - Summary of the public feedback we received
- Case for improvement (slide deck)
Last Updated: February 24, 2026
