Leveraging a partnership of decisionmakers, patients, caregivers, and clinicians to co-design community-driven health initiatives to address brain-heart interconnected conditions.

Background: Individuals at risk of, or living with, cardiac conditions such as heart failure are at increased risk of mental health conditions such as depression and anxiety, and vice versa. There is a need to establish better processes for supporting communities to understand gaps in their care delivery systems for brain-heart interconnected conditions and for the co-design, implementation and evaluation of community-driven health initiatives such as community planning tools and education/communication strategies developed in collaboration with local government decision-makers and other community partners to address existing gaps in brain-heart interconnected care.

Approach: We established a research coalition with patients/caregivers, primary care physicians and cardiac and mental health specialists, and government decision-makers to guide this project.In collaboration with regional decision-makers in two Ontario Health Teams and provincial level decision-makers at Ontario Health we used asset mapping to identify and catalog services and resources in Ontario, Canada that support adults with interconnected brain-heart conditions.  We interviewed patients, caregivers, clinicians and service providers (n=25) to understand their living/lived experiences accessing the brain-heart care services identified in the asset maps. Alongside decision-makers and patient, caregivers, and clinicians, we collaboratively identified priority areas for intervention and conducted a rapid scoping review to detail existing options for intervention. We are now co-designing an intervention that will be implemented in two Ontario Health Teams and evaluated to determine acceptability, effectiveness, scalability, and sustainability.

Results: Few services exist to support the mental health needs of people with heart failure. Clinicians and patients/caregivers are not aware of the services that do exist. There is a lack of patient buy-in for preventative services that target modifiable behavioural risk factors (e.g., smoking cessation, diet, and exercise programs) despite evidence of their effectiveness in reducing risk of brain-heart conditions. Patients experience long wait times for services. Most services offer limited support in French and other languages; patients must rely on interpreters. There are very few services customized for patients and caregivers from ethno-cultural minority groups.

The research coalition has targeted the need to increase clinician and patient/caregiver awareness about and buy-in for of community-based interventions that address the prevention and self-management of interconnected heart-mental health challenges (e.g., exercise programs, self-coaching, support groups, nutrition services). Our scoping review is underway guide intervention co-design work; it will be complete by March 2025. Intervention testing will begin in April 2025.

Implications: This project demonstrates how clinicians and service providers can be supported to work with and alongside government decision-makers and communities to create partnerships for integrated care that can result in the co-design of new models of integrated regional care delivery systems for adults with brain-heart interconnected conditions. Based on our evaluation results, we will work with government decision-makers to spread and scale our intervention across the province and country.