Clinical characteristics of people with heart failure in Australian general practice: results from a retrospective cohort study

Sindone, Andrew; Haikerwal, Deepak; Audehm, Ralph; Neville, A. Munro; Lim, Kevin; Parsons, Richard; Piazza, Peter; Liew, Danny

doi:10.1002/ehf2.13661

Cited by 18 publications

(29 citation statements)

References 15 publications

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“…Prevalence, clinical phenotype, and outcome About half of patients with HF has ID, [16][17][18] with specific prevalence estimates for ID in chronic HF ranging between 47 and 68% depending on the definition used for ID. 19 A slightly higher prevalence has been in general observed in HFpEF vs. HF with mildly reduced EF (HFmrEF) vs. HFrEF.…”

Section: Acute and Chronic Heart Failurementioning

confidence: 99%

Iron deficiency and cardiovascular disease

Savarese

Haehling

Butler

et al. 2022

European Heart Journal

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Iron deficiency (ID) is common in patients with cardiovascular disease. Up to 60% of patients with coronary artery disease, and an even higher proportion of those with heart failure (HF) or pulmonary hypertension have ID; the evidence for cerebrovascular disease, aortic stenosis and atrial fibrillation is less robust. The prevalence of ID increases with the severity of cardiac and renal dysfunction and is probably more common amongst women. Insufficient dietary iron, reduced iron absorption due to increases in hepcidin secondary to the low-grade inflammation associated with atherosclerosis and congestion or reduced gastric acidity, and increased blood loss due to anti-thrombotic therapy or gastro-intestinal or renal disease may all cause ID. For older people in the general population and patients with HF with reduced ejection fraction (HFrEF), both anaemia and ID are associated with a poor prognosis; each may confer independent risk. There is growing evidence that ID is an important therapeutic target for patients with HFrEF, even if they do not have anaemia. Whether this is also true for other HF phenotypes or patients with cardiovascular disease in general is currently unknown. Randomized trials showed that intravenous ferric carboxymaltose improved symptoms, health-related quality of life and exercise capacity and reduced hospitalizations for worsening HF in patients with HFrEF and mildly reduced ejection fraction (<50%). Since ID is easy to treat and is effective for patients with HFrEF, such patients should be investigated for possible ID. This recommendation may extend to other populations in the light of evidence from future trials.

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Section: Acute and Chronic Heart Failurementioning

confidence: 99%

Iron deficiency and cardiovascular disease

Savarese

Haehling

Butler

et al. 2022

European Heart Journal

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“…26 In a large Australian primary care study of patients with heart failure, the prevalence of iron deficiency, defined in the same way, was 39.7%, and among people with self-reported heart failure in NHANES (National Health and Nutrition Examination Survey 2017-2018), the prevalence of iron deficiency was 48.2% (95% CI, 36.8%-59.7%). 27,28 A recent study from the United Kingdom reported an even higher prevalence, with 61% in patients with HFrEF iron-deficient. 29 Conversely, using an alternative definition based on sTFR, we found a much lower prevalence of iron deficiency.…”

Section: Discussionmentioning

confidence: 99%

Iron Deficiency in Heart Failure and Effect of Dapagliflozin: Findings From DAPA-HF

et al. 2022

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Background: Iron deficiency is common in heart failure and associated with worse outcomes. We examined the prevalence and consequences of iron deficiency in the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure) and the effect of dapagliflozin on markers of iron metabolism. We also analyzed the effect of dapagliflozin on outcomes, according to iron status at baseline. Methods: Iron deficiency was defined as a ferritin level <100 ng/mL or a transferrin saturation <20% and a ferritin level 100 to 299 ng/mL. Additional biomarkers of iron metabolism, including soluble transferrin receptor, erythropoietin, and hepcidin were measured at baseline and 12 months after randomization. The primary outcome was a composite of worsening heart failure (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death. Results: Of the 4744 patients randomized in DAPA-HF, 3009 had ferritin and transferrin saturation measurements available at baseline, and 1314 of these participants (43.7%) were iron deficient. The rate of the primary outcome was higher in patients with iron deficiency (16.6 per 100 person-years) compared with those without (10.4 per 100 person-years; P <0.0001). The effect of dapagliflozin on the primary outcome was consistent in iron-deficient compared with iron-replete patients (hazard ratio, 0.74 [95% CI, 0.58–0.92] versus 0.81 [95% CI, 0.63–1.03]; P -interaction=0.59). Similar findings were observed for cardiovascular death, heart failure hospitalization, and all-cause mortality. Transferrin saturation, ferritin, and hepcidin were reduced and total iron-binding capacity and soluble transferrin receptor increased with dapagliflozin compared with placebo. Conclusions: Iron deficiency was common in DAPA-HF and associated with worse outcomes. Dapagliflozin appeared to increase iron use but improved outcomes, irrespective of iron status at baseline. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03036124.

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“…1 The most commonly recorded comorbidities were hypertension (41.1%), chronic obstructive pulmonary disease (COPD)/asthma (25.1%), depression/anxiety (18.4%), ischaemic heart disease (12.9%), diabetes (11.9%), osteoporosis (9.5%), renal impairment (4.0%) and atrial fibrillation (3.6%). 14 Patients with 'definite' or 'probable' HF attended their GP practice an average of 14.4 times per year (median 11.9), ranging from a mean of 11.7 (median 9.0) visits per annum for those with no recorded comorbidities to a mean of 27.2 (median 22.9) visits per annum for those with five or more comorbidities (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Healthcare services use by patients with heart failure in Australia: Findings from the SHAPE study

Audehm

Neville²,

Piazza³

et al. 2022

Aust J Gen Pract

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Background and objectiveGeneral practitioners (GPs) play a central role in healthcare, serving as the first point of contact, making appropriate referrals and coordinating care for chronic conditions such as heart failure (HF). We sought to determine healthcare use by people with HF in primary care. MethodsIn this Study of Heart failure in the Australian Primary carE setting (SHAPE), we analysed records of 1.93 million adult patients who attended a total of 43 practices between 1 July 2013 and 30 June 2018. We identified and examined the data of 20,219 patients with HF to describe the frequency of visits and use of Medicare Benefits Schedule items. ResultsPatients with HF saw GPs 14.4 times per annum on average; 59.5% had a General Practice Management Plan (GPMP), 2.9% of GPMPs were reviewed annually or more frequently, and 46.8% of patients had been referred to a cardiologist. A total of 3761 had coexisting anxiety or depression, and of these 37.1% had a mental health plan. DiscussionPatients with HF visit their GP frequently, with many not reaching guideline therapy nor referred to cardiologists. Low use of care planning and reviews presents an opportunity for GPs to improve care.

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Clinical characteristics of people with heart failure in Australian general practice: results from a retrospective cohort study

Cited by 18 publications

References 15 publications

Iron deficiency and cardiovascular disease

Iron deficiency and cardiovascular disease

Iron Deficiency in Heart Failure and Effect of Dapagliflozin: Findings From DAPA-HF

Healthcare services use by patients with heart failure in Australia: Findings from the SHAPE study

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