HEART FAILURE
Heart failure (HF) is a chronic condition in which the heart is unable to pump blood effectively to meet the body's needs. It can develop gradually or suddenly and is a major contributor to hospitalizations and reduced quality of life. Our research focuses on improving early detection, optimizing treatment strategies, and advancing our understanding of disease progression
Research Projects
FINALITY-HF: Evaluating Finerenone in HFrEF Patients Intolerant to sMRA Therapy
PI: Dr. Aws Almufleh
The FINALITY-HF trial is a randomized, placebo-controlled study evaluating the efficacy and safety of finerenone in patients with heart failure with reduced ejection fraction (HFrEF) who are intolerant or ineligible for steroidal mineralocorticoid receptor antagonists (sMRA). The study aims to determine whether finerenone offers a safe and effective alternative for this patient population, addressing a critical gap in current heart failure treatment options.
SCHOLAR-2: Safety of Continuing Chemotherapy in Overt Left Ventricular Dysfunction using Antibodies to Human Epidermal Growth Factor Receptor - 2
PI: Dr. Raveen Pal
The objective of the SCHOLAR-2 study is to evaluate whether is it safe and effective to continue trastuzumab in patients with early stage HER2 positive breast cancer who develop mild, minimally symptomatic or asymptomatic systolic left ventricular dysfunction. Primary outcome: The primary efficacy outcome will be the likelihood of completing trastuzumab as planned at its initiation. The primary safety outcome will be left ventricular ejection fraction.
Optimizing Care Pathways for ATTR-CM
PI: Dr. Aws Almufleh
Transthyretin cardiac amyloidosis (ATTR-CM) is an underrecognized cause of heart failure with preserved ejection fraction (HFpEF), often leading to delayed diagnosis and treatment—delays that can worsen patient outcomes. Using a Plan-Do-Study-Act (PDSA) framework, we mapped the patient journey within our healthcare system to identify barriers to timely diagnosis. Our quality improvement initiative included clinician and imaging staff education, streamlined pyrophosphate (PYP) scan workflows, and faster referrals to the heart function clinic. These interventions improved ATTR-CM detection and treatment initiation. Plus, we observed rise in negative PYP scans which highlighted increased clinical awareness and the ongoing need for education, support, and quality assurance.
Integrating POCUS and Decision Aids to Optimize Heart Failure Treatment
PI: Dr. Aws Almufleh
Optimizing guideline-directed medical therapy (GDMT) and achieving effective decongestion are key to improving outcomes in heart failure (HF) patients—but both remain underutilized in routine care. This prospective quality improvement initiative explored whether integrating point-of-care ultrasound (POCUS) and a HF decision aid at the time of discharge could enhance GDMT use and reduce hospital readmissions. We compared outcomes between patients receiving this enhanced care approach (QI arm)—which included resident-performed POCUS and use of the decision aid for safe discharge—and those receiving standard hospital care. Our findings showed a trend toward improved GDMT optimization in the QI arm, with minimal adverse events, suggesting the potential benefit of incorporating POCUS and structured decision support into routine HF management.
ICP: Predicting and Preventing ED Returns in CHF and COPD
PI: Dr. Aws Almufleh
As part of the Integrated Care Pathway (ICP) initiative, this ongoing retrospective observational study at Kingston Health Sciences Centre (KHSC) focuses on patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) who are discharged from the emergency department (ED). Many of these patients return within 30 days, placing additional strain on healthcare resources. By comparing characteristics of patients who do and do not return to the ED within 30 and 90 days, we aim to identify modifiable factors that could reduce repeat visits and enhance patient care. The study involves detailed chart reviews and comparative analysis, with key findings forthcoming.
Improving Discharge Practices in a High-Volume Heart Function Clinic
PI: Dr. Aws Almufleh
Many heart function clinics face high referral volumes, yet structured discharge protocols for stable patients are rarely applied. We evaluated predictors and barriers to discharge using a two-tiered system: Tier I: Recovered ejection fraction, no significant disease Tier II: Stable residual disease, ongoing cardiology follow-up Between August 2023 and March 2024, 92 of 153 patients met discharge criteria—but only 56 (61%) were discharged. Barriers included atrial fibrillation, reduced kidney function, lower ejection fraction, more HF-related phone visits, and longer follow-up durations. The most common reasons for delayed discharge were pending reassessment and coordination with other cardiac teams. Conclusion: Even with structured criteria, discharge rates remain low. Tackling these barriers may improve clinic efficiency and patient access.
COVID - VIHPR: Understanding Inflammatory Heart Conditions Post-COVID-19 and Vaccination
PI: Dr. Aws Almufleh
While clinical trials did not report inflammatory heart conditions like myocarditis or pericarditis following COVID-19 vaccination, real-world data prompted further investigation. This ongoing multicenter retrospective cohort study examines cases of confirmed or suspected myocarditis and pericarditis related to COVID-19 infection, vaccination, or other causes. Our goals are to characterize affected patients, identify risk factors, assess outcomes, and compare different causes. Findings will help shape clinical guidance and public health strategies.
Evaluating the Impact of Public Funding for NT-proBNP Testing
PI: Dr. Aws Almufleh
NT-proBNP testing was previously costly for patients when ordered in the community, limiting its use. With recent provincial funding now covering the test, the impact of this policy change remains unclear. This study examines how provincial coverage affects test utilization and patient outcomes. Using linked administrative data (ICES), we compare patterns and outcomes before and after funding implementation, with a focus on potential sex-based differences in test use.
Predictors and Outcomes of HF Diagnosed in the Community vs Acute Care Settings
PI: Dr. Aws Almufleh
Background HF is often diagnosed during acute episodes, but earlier recognition in community settings may improve outcomes and reduce healthcare burden. Study Overview In this population-based cohort study of 597,025 Ontarians aged 40 and older diagnosed with HF between 2010 and 2022, we compared patients diagnosed in acute care settings versus the community. Key Findings Over one-third of patients (36.9%) were diagnosed during an acute care episode. These patients were more likely to be older, female, lower-income, and lack a primary care provider. Compared to community diagnoses, acute care diagnoses were linked to significantly higher risks of one-year mortality, HF-related hospitalizations, and ED visits. Conclusion These findings suggest that improving early HF detection in the community could enhance outcomes and help reduce disparities in care access and health system strain.
Gender-based differences in POCUS use in the Emergency Department
PI: Dr. Aws Almufleh
Background: Are women as likely to receive POCUS in the ED when presenting with cardiac symptoms? ​ Barriers: lack of privacy (hallway beds), provider implicit bias (women can’t have heart disease)​ Aim: Review all previous studies of POCUS in the ED and compare women representation with reported prevalence of disease in the general public​ Progress: Abstract screening completed, full-text review underway
Case-based Simulation of HF Diagnosis and Management; the Heart Success App
PI: Dr. Aws Almufleh, Dr. Bryce Alexander
The HF Success App is an educational and clinical research tool designed to support learning through interactive patient cases. It allows users to review real-world case scenarios from the Heart Failure clinic, select investigations, interpret results, and follow decision-making pathways. By combining case-based education with structured data collection, the platform helps train learners, improve knowledge translation, and build capacity in heart failure care.
The Canadian Echocardiography Competency Evaluation and Optimization Project
PI: Dr. Aws Almufleh
Aim Develop and deliver an echocardiography assessment tool to test competence in independent echocardiography performance and interpretation.
Clinical Work
Improving Heart Function Clinic Efficiency by Introducing Reminder Calls
PI: Dr. Aws Almufleh
Missed appointments are a common challenge in our heart function clinic, often reducing clinic efficiency and delaying necessary treatment. Traditionally, our clinic relied on mailed appointment notices, which contributed to a high no-show rate. To address this, we implemented a two-step phone reminder system—contacting patients one week and one day prior to their appointment. This quality improvement project evaluates the effectiveness of this intervention by comparing no-show rates before and after its rollout.
Community Outreach
ICP: Bridging Emergency to Primary Care for COPD and CHF Patients
PI: Dr. Aws Almufleh
As part of the Integrated Care Pathways (ICP) initiative, this project aims to improve continuity of care for patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) who present to the emergency department (ED). Many of these patients lack consistent follow-up in the community, contributing to high rates of repeat ED visits and hospitalizations. This initiative focuses on connecting eligible patients with a local family physician for timely, coordinated outpatient care following ED discharge. By strengthening the link between acute care and primary care, the project seeks to reduce avoidable healthcare utilization and improve long-term health outcomes.
Educational Sessions with Local PCP
PI: Dr. Aws Almufleh
The purpose of the educational lunch sessions was to strengthen connections with local primary care providers (PCPs), introduce the Integrated Care Pathway program, highlight its role in improving patient care, and share the resources available to support them.