The Burden of Chronic Heart Failure in Primary Care in Italy

Piccinni, Carlo; Antonazzo, Ippazio Cosimo; Simonetti, Monica; Mennuni, Marco; Parretti, Damiano; Cricelli, Claudio; Colombo, Delia; Nica, Mihaela; Cricelli, Iacopo; Lapi, Francesco

doi:10.1007/s40292-017-0193-4

Cited by 22 publications

(17 citation statements)

References 32 publications

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“…Nearly half of the HF patients were women, and the average age was 85 years. The sex distribution was similar to other studies, 22,[25][26][27] but the average age was considerably higher. 11,12,26,27 This can partly be explained by the different study designs, 28 as previous studies were either not based on databases, 11,12,26 or investigated newly treated patients.…”

Section: Discussionsupporting

confidence: 89%

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Heart failure epidemiology and treatment in primary care: a retrospective cross‐sectional study

et al. 2020

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Aims Heart failure is one of the leading causes of morbidity and mortality worldwide, but little is known on heart failure epidemiology and treatment in primary care. This study described patients with heart failure treated by general practitioners, with focus on drug prescriptions and especially on the only specific treatment for heart failure with reduced ejection fraction, namely sacubitril/valsartan. Methods and results This was a retrospective cross‐sectional study using data from an electronic medical record database of Swiss general practitioners from 2016 to 2019. Multilevel logistic regression was used to find determinants of sacubitril/valsartan prescription; odds ratios (ORs) and 95% confidence intervals (CIs) were reported. We identified 1288 heart failure patients (48.5% women; age: median 85 years, interquartile range 77–90 years) by means of diagnosis code, representing 0.5% of patients consulting a general practitioner during the observation period. About 73.6% received a renin–angiotensin–aldosterone system inhibitor, 67.8% a beta‐blocker, 34.6% a calcium channel blocker, 86.1% a diuretic, and 40.1% another cardiac drug. Sacubitril/valsartan was prescribed in 6% predominantly male patients (OR 2.10, CI 1.25–3.84), of younger age (OR 0.59 per increase in 10 years, CI 0.49–0.71), with diabetes mellitus (OR 1.76, CI 1.07–2.90). The recommended starting dose for sacubitril/valsartan was achieved in 67.1% and the target dose in 28.6% of patients. Conclusions Prevalence of heart failure among patients treated by general practitioners was low. Considering the disease burden and association with multimorbidity, awareness of heart failure in primary care should be increased, with the aim to optimize heart failure therapy.

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Section: Discussionsupporting

confidence: 89%

“…In our study, the prevalence of HF among patients visiting a GP was 0.5%. This is low in comparison with other European database studies, where HF prevalence was 1.2–1.3% (Netherlands 21 and Italy 22 ). For Switzerland, HF prevalence has been estimated at 2.5% 23 .…”

Section: Discussioncontrasting

confidence: 77%

Heart failure epidemiology and treatment in primary care: a retrospective cross‐sectional study

et al. 2020

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“…Globally it remains the single largest cause of death. The prevalence of this condition in Italy is about 1.25% [95% confidence interval (CI), 1.23–1.27], and the incidence rate was 1.99 per 1000 person-years (95% CI, 1.81–2.08) that is expected to grow ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

The CARPEDIEM Algorithm: A Rule-Based System for Identifying Heart Failure Phenotype with a Precision Public Health Approach

Franchini

Pieroni

Passino

et al. 2018

Front. Public Health

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Modern medicine remains dependent on the accurate evaluation of a patient’s health state, recognizing that disease is a process that evolves over time and interacts with many factors unique to that patient. The CARPEDIEM project represents a concrete attempt to address these issues by developing reproducible algorithms to support the accuracy in detection of complex diseases. This study aims to establish and validate the CARPEDIEM approach and algorithm for identifying those patients presenting with or at risk of heart failure (HF) by studying 153,393 subjects in Italy, based on patient information flow databases and is not reliant on the electronic health record to accomplish its goals. The resulting algorithm has been validated in a two-stage process, comparing predicted results with (1) HF diagnosis as identified by general practitioners (GPs) among the reference cohort and (2) HF diagnosis as identified by cardiologists within a randomly sampled subpopulation of 389 patients. The sources of data used to detect HF cases are numerous and were standardized for this study. The accuracy and the predictive values of the algorithm with respect to the GPs and the clinical standards are highly consistent with those from previous studies. In particular, the algorithm is more efficient in detecting the more severe cases of HF according to the GPs’ validation (specificity increases according to the number of comorbidities) and external validation (NYHA: II–IV; HF severity index: 2, 3). Positive and negative predictive values reveal that the CARPEDIEM algorithm is most consistent with clinical evaluation performed in the specialist setting, while it presents a greater ability to rule out false-negative HF cases within the GP practice, probably as a consequence of the different HF prevalence in the two different care settings. Further development includes analyzing the clinical features of false-positive and -negative predictions, to explore the natural clustering of markers of chronic conditions by adding additional methodologies, e.g., Social Network Analysis. CARPEDIEM establishes the potential that an algorithmic approach, based on integrating administrative data with other public data sources, can enable the development of low cost and high value population-based evaluations for improving public health and impacting public health policies.

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“…In order to perform the BIA, a research of epidemiological data was performed focusing on CHF patients with ID. Considering that the prevalence of CHF in Italy is 1.25% [22], that 78.8% of CHF patients belong to NYHA classes II and III [23] and that 42.5% of these patients present ID [24], the total number of prevalent CHF patients with ID in Italy was estimated to be 253,201. The current patients' distribution between the two strategies, FCM and placebo, was estimated by clinicians as 5 and 95%, respectively.…”

Section: Budget Impact Analysismentioning

confidence: 99%

Ferric carboxymaltose for patients with heart failure and iron deficiency in Italy: cost–effectiveness and budget impact

Rognoni

Gerzeli

2019

J. Comp. Eff. Res.

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Aim: To evaluate the cost–effectiveness of intravenous ferric carboxymaltose (FCM) versus placebo for the management of iron deficiency in patients with chronic heart failure in the Italian healthcare system and to estimate its impact on the national healthcare budget. Materials & methods: A Markov model was developed to project costs and health outcomes over 1 year, based on data from literature. Healthcare resources consumption was derived from an e-survey administered to clinicians. Costs were obtained from official tariffs. Results: Treatment with FCM represents a dominant strategy compared with placebo, leading to national budget annual savings of 20–97 million Euros, according to different increasing utilization rates. Conclusion: FCM is a cost-saving option for the treatment of chronic heart failure patients with iron deficiency in Italy.

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The Burden of Chronic Heart Failure in Primary Care in Italy

Abstract: This study provides an updated epidemiological scenario of CHF in a primary care setting in Italy. These data may be useful to weight the social and economic impact of CHF and to plan strategies for improving the clinical care of CHF in general practice.

Cited by 22 publications

References 32 publications

Heart failure epidemiology and treatment in primary care: a retrospective cross‐sectional study

Heart failure epidemiology and treatment in primary care: a retrospective cross‐sectional study

The CARPEDIEM Algorithm: A Rule-Based System for Identifying Heart Failure Phenotype with a Precision Public Health Approach

Ferric carboxymaltose for patients with heart failure and iron deficiency in Italy: cost–effectiveness and budget impact

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