Journal
EUROPEAN JOURNAL OF HEART FAILURE
Volume 19, Issue 9, Pages 1119-1127Publisher
WILEY
DOI: 10.1002/ejhf.709
Keywords
Heart failure; Epidemiology; Prognosis; Acute hospital admission; Primary care; Electronic health records
Categories
Funding
- Genetic Cardiomyopathy PLN
- Wellcome Trust [0938/30/Z/10/Z]
- Netherlands Heart Foundation [2014T001]
- UCL Hospitals NIHR Biomedical Research Centre
- Medical Research Council
- Arthritis Research UK
- British Heart Foundation
- Cancer Research UK
- Chief Scientist Office
- Economic and Social Research Council
- Engineering and Physical Sciences Research Council
- National Institute for Health Research
- Wellcome Trust
- National Institute for Social Care and Health Research
- British Heart Foundation [FS/14/76/30933] Funding Source: researchfish
- Economic and Social Research Council [ES/L007517/1] Funding Source: researchfish
- Medical Research Council [MR/L01629X/1, MR/K006584/1] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0611-10227] Funding Source: researchfish
- ESRC [ES/L007517/1] Funding Source: UKRI
- MRC [MR/L01629X/1] Funding Source: UKRI
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Aims The prognosis of patients hospitalized for worsening heart failure (HF) is well described, but not that of patients managed solely in non-acute settings such as primary care or secondary outpatient care. We assessed the distribution of HF across levels of healthcare, and assessed the prognostic differences for patients with HF either recorded in primary care (including secondary outpatient care) (PC), hospital admissions alone, or known in both contexts Methods and results This study was part of the CALIBER programme, which comprises linked data from primary care, hospital admissions, and death certificates for 2.1 million inhabitants of England. We identified 89 554 patients with newly recorded HF, of whom 23 547 (26%) were recorded in PC but never hospitalized, 30 629 (34%) in hospital admissions but not known in PC, 23 681 (27%) in both, and 11 697 (13%) in death certificates only. The highest prescription rates of ACE inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was found in patients known in both contexts. The respective 5-year survival in the first three groups was 43.9% [95% confidence interval (CI) 43.2-44.6%], 21.7% (95% CI 21.1-22.2%), and 39.8% (95% CI 39.2-40.5%), compared with 88.1% (95% CI 87.9-88.3%) in the age-and sex-matched general population. Conclusion In the general population, one in four patients with HF will not be hospitalized for worsening HF within a median follow-up of 1.7 years, yet they still have a poor 5-year prognosis. Patients admitted to hospital with worsening HF but not known with HF in primary care have the worst prognosis and management. Mitigating the prognostic burden of HF requires greater consistency across primary and secondary care in the identification, profiling, and treatment of patients.
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