Reducing heart failure admission rates in England 2004–2011 are not related to changes in primary care quality: national observational study

Abstract

AimsHeart failure (HF) is an important clinical problem. Expert consensus has defined HF as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. We analysed time trends in HF admission rates in England and risk and protective factors for admission. Methods and resultsWe used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004-2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality ('Quality and Outcomes Framework' indicator.) There were 327 756 HF admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100 000 in 2004 to 5.60/100 000 in 2010 (P , 0.001). Deprivation and HF prevalence were risk factors for admission. GP supply and access protected against admission. However, these effects were small and did not explain the large and highly significant annual trend in falling admission rates. ConclusionsThe observed fall in admissions over time cannot be explained by the primary care covariates we included. This analysis suggests that the potential for further significant reduction in emergency HF admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions.--

Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis

“…31,32 It also adds to the literature finding an association between increasing access to primary care and decreasing emergency admissions for other conditions. [18][19][20][21][22][23] The findings that some QOF indicators may not be related to outcome measures of care have also been reported in other studies examining emergency admissions 31,32 and premature mortality. 34 The study contrasts with an earlier study of all English practices that found emergency asthma admissions were higher in practices with a lower recording of diagnosis of asthma by spirometry.…”

“…17 Research using individual questions from the GP Patient Survey has demonstrated an association between improved measures of access to primary care services and a decrease in hospital admission rates for chronic obstructive pulmonary disease, heart failure, diabetes, stroke, cancer, and epilepsy. [18][19][20][21][22][23] Similar associations have been seen for access to primary care services and accident and emergency department use, and higher use of out-of-hours services. 24,25 It is hypothesised that better access to primary care is associated with reduced emergency admission rates for asthma.…”

“…29 Several of these access questions have been used in other research as proxies for markers of patient access to surgery, although the composite access score has not yet been used as a research tool. [18][19][20][21][22][23][24] Further independent variables that have been shown to be associated with variation in practice-level performance in previous studies in English primary care were identified. These were: the size of the practice measured in numbers of patients in 2010; and the GP Practice Index of Multiple Deprivation (IMD 2010, rank), which is estimated by taking a weighted average of the IMD scores for each Lower Super Output Area (LSOA) in which a given practice has registrations.…”

A case control study in BMC Sagar to identify the risk factors for heart failure in patients with recently diagnosed myocardial infarction

“…Heart failure is a global killer. [1][2][3][4] Heart failure result out of multiple cardiovascular diseases, which includes myocardial infarction, hypertension, diabetes, and chronic kidney disease. It carries a high mortality rate despite advancements in medical management.…”

“…There are gradual updates for developed nations. [2][3][4] There have been timely reporting for some other Asian countries like Japan and Malaysia. 8,9 Although no comparison of risk factors for heart failure has yet been made, mainly between men and women.…”