Heart failure hidden or undiagnosed by GPs

Only one-in-five heart failure patients are immediately recognised in general practice1 according to findings just released from the SHAPE heart failure observational study.

The study, ‘A Retrospective Cohort Study of Heart Failure in the Australian Primary Care Setting’ also found low use of medication which is proven to improve heart failure outcomes.2

The findings that fewer than one-in-five Australians with heart failure has the condition captured in the diagnosis section of their medical records1 has prompted concerns that thousands of patients are being lost to follow-up.

This is a key finding from Australia’s largest-ever heart failure observational study, which analysed the prevalence and clinical characteristics of people with heart failure and examined the de-identified health records of 1.93 million adult patients in Australia. 

However, the most concerning finding was that only 18.9 per cent of patients stratified into the “definite” heart failure subgroup had the condition noted in the diagnosis section of their medical records.

Of the nearly two million patient records analysed, 21,803 patients were classified as having “definite” or “probable” heart failure, indicating that, at a population level, the condition is likely to affect more than 270,000 Australians.

Lead author, Professor Andrew Sindone, said, “This is important research that highlights how often heart failure is present but invisible in primary care.

“These patients often have multiple co-morbidities and may not report potential heart failure symptoms to the GP, making it hard for GPs to manage these patients proactively.

“It is of the utmost importance that GPs suspect heart failure in older patients, ask their patients about possible symptoms, investigate, diagnose, and proactively manage the condition.”

The study found that medications proven to improve outcomes in patients with heart failure had low rates of prescribing, while medications that may worsen heart failure symptoms had relatively high prescribing rates in these patients.2

Heart failure specific beta-blockers and spironolactone were prescribed to only 34 per cent and only 14 per cent of the patients with definite or probable heart failure despite being proven effective in the management of heart failure.2

In contrast, the use of NSAIDS, systemic corticosteroids and tricyclic anti-depressants – medications that may worsen the symptoms of heart failure – were 23 per cent, 24 per cent and 14 per cent respectively in this same cohort.

“This study highlights the huge gap in proper recognition and management of heart failure which, if addressed, could improve the lives of thousands,” Professor Sindone said.

References

1. Sindone A, et al. A retrospective cohort study of heart failure in the Australian primary care setting (SHAPE) – method and demographic results Poster presented at CSANZ, Adelaide, August 8-11, 2019. 

2. Sindone A, et al. A retrospective cohort study of heart failure in the Australian primary care setting (SHAPE) – clinical characteristics of HF patients Poster presented at CSANZ, Adelaide, August 8-11, 2019.

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