Key result
A hospital-based diagnosis of heart failure was associated with higher 4-year mortality (33% vs. 15%, p<0.05) and greater morbidity compared to a general practice-based diagnosis.
Why the study?
Are there differences in patient characteristics and outcomes between heart failure patients managed in general practice versus those with a hospital admission diagnosis?
Cross-Sectional (n=500)
Yes
Are there differences in patient characteristics and outcomes between heart failure patients managed in general practice versus those with a hospital admission diagnosis?
Absolute Event Rate: 33% vs 15%
p-value: p=<0.05
Heart failure patients diagnosed during hospital admission have significantly higher morbidity and mortality compared to those managed solely in general practice, highlighting distinct phenotypic differences between these populations.
AIM: To compare patients treated for heart failure in relation to the management in general practices versus hospital admission. METHODS AND RESULTS: Twelve randomly selected general practices (GP) were screened for patients receiving ACE-inhibitor, digoxin, or loop diuretic treatment. The first 500 volunteers of 959 potential subjects were invited to a cardiac examination after exclusion of 235 frail, physically or mentally disabled patients. A diagnosis of heart failure during hospital admission (Hospital-HF, n = 102) was more related (p < 0.05) to male sex (45% vs. 21%), advanced age (73 vs. 70 years), breathlessness (75% vs. 62%), LV systolic dysfunction (47% vs. 20%), objective cardiac abnormality (92% vs. 65%) and higher 4-year mortality (33% vs. 15%) than patients taking loop diuretics due to signs and symptoms of heart failure in GP (GP-HF). Patients without clinical heart failure (n = 301) had the same survival but less symptoms and cardiac abnormalities than GP-HF patients. CONCLUSION: A surplus morbidity and mortality was related to a hospital-based rather than a GP based diagnosis of HF. Patients managed in GP were different from patients entering previous clinical trials of heart failure. We estimate that the pool of patients hospitalised with systolic heart failure would be increased from 1.3 to 1.4 more if all patients from primary care were included.
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Nielsen et al. (2004) conducted a cross-sectional in Heart failure (n=500). Hospital-based diagnosis of heart failure vs. General practice-based diagnosis of heart failure was evaluated on 4-year mortality (p=<0.05). A hospital-based diagnosis of heart failure was associated with higher 4-year mortality (33% vs. 15%, p<0.05) and greater morbidity compared to a general practice-based diagnosis.
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