Methods to identify heart failure patients in general practice and their impact on patient characteristics: A systematic review

Smeets, Miek; Henrard, Séverine; Aertgeerts, Bert; Cools, Filip; Janssens, Stefan; Vaes, Bert

doi:10.1016/j.ijcard.2017.06.108

Cited by 13 publications

(33 citation statements)

References 31 publications

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“…Additionally, a rising trend in diagnoses, registration of diagnoses and survival may account for the increase in multimorbidity, together with (negative) lifestyle changes with respect to smoking, physical inactivity and diet 39 41. Furthermore, our data confirm the phenotype of general practice patients with HF as older female patients with hypertension rather than ischaemic heart disease 28. These findings have two important implications.…”

Section: Discussionsupporting

confidence: 67%

“…If this finding is not included, recommendations for HF management only apply to a minority of the community patients with HF 39 44 45. Second, the same applies to randomised controlled trials excluding patients with concomitant chronic conditions targeting younger, male patients with ischaemic heart disease and higher drug prescription rates at baseline, thus not reflecting the community reality 28 46…”

Section: Discussionmentioning

confidence: 99%

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Burden of heart failure in Flemish general practices: a registry-based study in the Intego database

et al. 2019

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ObjectivesTo assess the prevalence and incidence of heart failure (HF) stages A to C/D and their evolution over a 16-year period. Additionally, trends in comorbidities and cardiovascular (CV) treatment in patients with HF were studied in the same period.DesignRegistry-based study.SettingPrimary care, Flanders, Belgium.ParticipantsData were obtained from Intego, a morbidity registration network in which 111 general practitioners of 48 practices collaborate. In the study period between 2000 and 2015, data from 165 796 unique patients aged 45 years and older were available.Outcome measuresPrevalence and incidence were calculated for HF stage A, B and C/D by gender. Additionally, the trend in age-standardised prevalence and incidence rates between 2000 and 2015 was analysed with joint-point regression. The same model was used to study trends in comorbidity profiles in incident HF cases and trends in cardiovascular medication in prevalent HF cases.ResultsWe found a downward trend in the incidence and prevalence of HF stage C/D in Flemish general practice between 2000 and 2015, whereas the prevalence and incidence of stage A and B increased. The burden of comorbidities in incident HF cases increased during the study period, as shown by an increasing disease count (p<0.001). The prescription of cardiovascular medication such as renin-angiotensin-aldosterone system blockade, β-blockers and statins showed a sharp increase in the first part of the study period (2000–2008).ConclusionAge-standardised incidence and prevalence of HF stage C/D showed a slightly downward trend over the past 16 years, probably due to the sharp increase in cardiovascular treatment. However, the increasing age-standardised incidence and prevalence of stage A and B, as precursors of symptomatic HF, together with a rising comorbid burden, highlights the challenges we are still facing.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Burden of heart failure in Flemish general practices: a registry-based study in the Intego database

et al. 2019

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“…16 Given the mean age of the patients on the two heart failure registers (77 years) in this study, a higher proportion of patients with possible HFpEF would be expected. A pooled analysis of 105 studies with 196 105 patients with undifferentiated heart failure recruited from general practice indicated that the predominant phenotype was an older woman with hypertension rather than ischaemic heart disease, 17 which would be suggestive of a high prevalence of HFpEF. The patients with possible HFpEF in the current analysis had a non-significant trend toward older age, a higher proportion of women, and multiple comorbidities.…”

Section: Discussionmentioning

confidence: 99%

The tip of the iceberg: finding patients with heart failure with preserved ejection fraction in primary care. An observational study

et al. 2018

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BackgroundHeart failure with preserved ejection fraction (HFpEF) is under-identified in primary care.AimThe aim of this study was to determine what information is available in patients’ primary care practice records that would identify patients with HFpEF.Design & settingRecord review in two practices in east of England.MethodPractices completed a case report form on each patient on the heart failure register and sent anonymised echocardiography reports on patients with an ejection fraction (EF) >50%. Reports were reviewed and data analysed using SPSS (version 25).ResultsOne hundred and forty-eight patients on the heart failure registers with mean age 77 +12 years were reviewed. Fifty-three patients (36%) had possible HFpEF based on available information. These patients were older and multimorbid, with a high prevalence of overweight and obesity. Confirmation of diagnosis was not possible as recommended HFpEF diagnostic information (natriuretic peptides, echocardiogram parameters of structural heart disease and diastolic function) was widely inconsistent or absent in these patients.ConclusionWithout correct identification of HFpEF, patient management may be suboptimal or inappropriate, and lack the needed focus on comorbidities and lifestyle that can improve patient outcomes. This study describes in detail the characteristics of many of the patients who probably have HFpEF in a real-world sample, and the improvements and diagnostic information required to better identify them. Identifying more than the tip of the iceberg that is the HFpEF population will allow the improvement of the quality of their management, the prevention of ineffective health care, and the recruitment of patients into research.

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“…Although the European Society of Cardiology guideline is used to diagnose HFpEF 9 in WP2b, this pragmatic definition was employed given the literature detailing the challenges of identifying patients with HF from primary care records. [34][35][36] The following exclusion criteria were applied to WP2a and WP2b: any severe neurocognitive condition that would confound outcome assessment; New York Heart Association class IV classification; or other life-threatening condition. Heart failure exacerbations resulting in hospitalisation in the 6 weeks before screening were included in WP2b owing to the nature of the physical assessments.…”

Section: Participantsmentioning

confidence: 99%

“…Gait speed measured over 10 metres, a valid objective measure of functional mobility 44 Acceler Objective measure of activity obtained via Axivity AX3 wrist-worn triaxial accelerometer programmed to start at 19:00 hours on the day of the baseline visit (to prevent capturing of protocol forced activity) and capture triaxial acceleration data over a 7-day period at 100 Hz with a dynamic range of +-8 g 45 Anxiety and depression HADS HADS is a widely used questionnaire that screens for the separate dimensions of anxiety and depression and has been validated in multiple populations 32 HF QoL KCCQ KCCQ is a valid, reliable and responsive health status measure for patients with chronic heart failure that has been shown to have clinically meaningful changes 33 HF self-care EHFScBQ A valid, reliable and practical scale to measure the self-reported self-care behaviour of heart failure patients. 34 HF symptoms SSQ-HF Valid and reliable score to assess physical symptoms in patients with heart failure. 35 Health-related QoL EQ-5D…”

Section: Gsmentioning

confidence: 99%

Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF): rationale and protocol for a multi-method study

et al. 2019

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BackgroundHeart failure with preserved ejection fraction (HFpEF) is less well understood than heart failure with reduced ejection fraction (HFrEF), with greater diagnostic difficulty and management uncertainty.AimThe primary aim is to develop an optimised programme that is informed by the needs and experiences of people with HFpEF and healthcare providers. This article presents the rationale and protocol for the Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF) research programme.Design & settingThis is a multi-method programme of research conducted in the UK.MethodOPTIMISE-HFpEF is a multi-site programme of research with three distinct work packages (WPs). WP1 is a systematic review of heart failure disease management programmes (HF-DMPs) tested in patients with HFpEF. WP2 has three components (a, b, c) that enable the characteristics, needs, and experiences of people with HFpEF, their carers, and healthcare providers to be understood. Qualitative enquiry (WP2a) with patients and providers will be conducted in three UK sites exploring patient and provider perspectives, with an additional qualitative component (WP2c) in one site to focus on transitions in care and carer perspectives. A longitudinal cohort study (WP2b), recruiting from four UK sites, will allow patients to be characterised and their illness trajectory observed across 1 year of follow-up. Finally, WP3 will synthesise the findings and conduct work to gain consensus on how best to identify and manage this patient group.ResultsResults from the four work packages will be synthesised to produce a summary of key learning points and possible solutions (optimised programme) which will be presented to a broad spectrum of stakeholders to gain consensus on a way forward.ConclusionHFpEF is often described as the greatest unmet need in cardiology. The OPTIMISE-HFpEF programme aims to address this need in primary care, which is arguably the most appropriate setting for managing HFpEF.

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Methods to identify heart failure patients in general practice and their impact on patient characteristics: A systematic review

Cited by 13 publications

References 31 publications

Burden of heart failure in Flemish general practices: a registry-based study in the Intego database

Burden of heart failure in Flemish general practices: a registry-based study in the Intego database

The tip of the iceberg: finding patients with heart failure with preserved ejection fraction in primary care. An observational study

Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF): rationale and protocol for a multi-method study

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