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GPs are letting down heart failure patients

Patients receive limited follow-up care after leaving hospital and insufficient doses of life-saving medicines

Ingrid Torjesen

Tuesday, 28 August 2018

Heart failure patients in the UK are being let down by limited follow-up care after leaving hospital, insufficient doses of life-saving medicines, and dangerously unequal care for women and the elderly, according to research* funded by the British Heart Foundation (BHF).

Researchers from the University of Oxford used electronic health records from the Clinical Practice Research Datalink and linked this to data on hospital admissions to identify 93,074 patients diagnosed with heart failure between 2002 and 2014, and followed their pathway of care for one year.

The findings, presented at the European Society of Cardiology Congress in Munich, showed that heart failure patients are more and more likely to be diagnosed in hospital rather than outpatient settings (i.e. a GP or an outpatient specialist consultation), that too few patients are being followed-up by their GP after being diagnosed in hospital, and that doses of essential heart failure medicines are too low across the board. Women are also far more likely to experience these shortcomings.

Amongst heart failure patients who survived hospitalisation, only 17 per cent had their heart failure diagnosis recorded by their GP pointing to a lack of communication between hospitals and GPs. An accurate record is imperative because patients with heart failure will be managed across primary, secondary and community care systems.

The average daily dose of heart failure medication prescribed was less than half the recommended dose for ACE-inhibitors, a quarter of the recommended dose for beta-blockers, and a fifth of the recommended dose for diuretics. The study found that doses of these medicines have changed little over the past decade, and even declined for ACE-inhibitors.

Women were less likely to have their condition diagnosed outside of hospital, received fewer investigations in diagnosis (for example echocardiograms or ECG’s), received fewer treatments, were given lower treatment doses and were less likely to receive follow-up care after being discharged from hospital compared to males of a similar age and background.

Jeremy Pearson, associate medical director from the BHF, said: “Heart failure is a cruel and debilitating illness affecting more than half a million people across the UK, and the leading cause of hospital admissions in over 65’s.

“This study paints a worrying picture of heart failure care in the UK, but identifying the shortfalls is the first step towards addressing them. We need the communication between hospitals and primary care providers to make sure patients with heart failure receive that all-important follow-up care after they leave hospital.

“We may need to develop targeted, specific health policies for managing heart failure for women, with more research to identify the best way to treat women who have heart failure.”

The findings also question the validity of the UK’s Quality of Outcomes framework (QOF) scheme, which depicts a very positive picture of heart failure care in the UK with GP practices achieving 90% of these targets. However, the BHF pointed out that the QOF targets only reflect two narrow measures – use of diagnostic investigations and yearly drug prescriptions.

*Conrad N, Judge A, Donnell JO, et al. Patients' journey of care following incident heart failure: diagnostic tests, treatments and care pathways in 93,000 patients. Presented at ESC Congress, European Heart Journal ( 2018 ) 39 ( Supplement ), 229.

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