The epidemiology of heart failure in the general Australian community - study of heart failure in the Australian primary carE setting (SHAPE): methods

Abstract

Background: There is a paucity of information on the epidemiology of heart failure (HF) in Australia. The Study of Heart failure in the Australian Primary carE setting (SHAPE) study aims to estimate the prevalence and annual incidence of HF in the general Australian community and to describe the demographic and key clinical profile of Australians with HF. Methods: We undertook a retrospective cohort study based on analysis of non-identifiable medical records of adult patients cared for at 43 general practices between 1 July 2013 and 30 June 2018. Data were extracted from coded (diagnosis, pathology and prescription fields) and uncoded fields (clinical notes) in the medical records. The latter searches of free text looked for common synonyms relevant to HF. The population was stratified into three groups based on a hierarchy of selection criteria: (1) definite HF, (2) probable HF and (3) possible HF. The prevalence and annual incidence of HF were calculated, along with 95% confidence intervals. Results: The practices provided care to 2.3 million individual patients over the five-year study period, of whom 1.93 million were adults and 1.12 million were regular patients. Of these patients 15,468 were classified as having 'definite HF', 4751 as having 'probable HF' and 33,556 as having 'possible HF'. A further 39,247 were identified as having an aetiological condition associated with HF. A formal HF diagnosis, HF terms recorded as text in the notes and HF-specific medication were the most common methods to identify 'definite' HF patients. Typical signs and symptoms in combination with a diuretic prescription was the most common method to identify 'probable HF' patients. The majority of 'possible' HF patients were identified by the presence of 2 or more of the typical signs or symptoms. Dyspnoea was the commonest recorded symptom and an elevated jugular venous pressure the commonest recorded sign.

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

“…The key word search was conducted on the medical records of 1.93 million adult Australiansover 10% of the adult population. 13 For the active patients with definite or probable HF the median age was 72.0 years, 51% were male, median age at diagnosis of HF was 68.0 years, median body mass index was 30.1 kg/m 2 , 48.7% were obese or overweight, 21.5% were smokers, 27% were ex-smokers and 1.6% were classified as Aboriginal or Torres Strait Islander. 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%).…”

Epidemiology of heart failure: Study of Heart failure in the Australian Primary carE setting (SHAPE)

“…Only HF-specific medications were used to derive an HF diagnosis. 6 In Australia, HF-specific medications have a 'Restricted Benefit' in the Pharmaceutical Benefits Scheme (Australia's list of subsidized medications) for 'moderate to severe heart failure'. The restriction stipulates that patients must be stabilized on conventional therapy, which must include an angiotensin converting enzyme inhibitor or angiotensin II antagonist, if tolerated.…”

“…Among patients aged ≥18 years, HF was identified by (i) a specified diagnosis of HF, or (ii) ongoing treatment with a HF‐specific medication, or (iii) clinical features of HF, or (iv) pathology test results indicative of HF. Details of these selection criteria are provided in Parsons et al 6 . The population was then stratified into three groups on the basis of a hierarchy of selection criteria into ‘definite HF’, ‘probable HF’, and ‘possible HF’, as specified in Table 1 .…”

“…Medications prescribed subsequent to the diagnosis of HF were also reviewed. Only HF‐specific medications were used to derive an HF diagnosis 6 . In Australia, HF‐specific medications have a ‘Restricted Benefit’ in the Pharmaceutical Benefits Scheme (Australia's list of subsidized medications) for ‘moderate to severe heart failure’.…”

Development and validation of the self‐volume management behaviour questionnaire for patients with chronic heart failure

“…Chronic heart failure (CHF) is a persistent state of heart failure. Approximately 64.3 million individuals worldwide suffer from CHF, and the incidence has been rising recently, especially among the elders 1,2 . Patients with CHF are often repeatedly admitted to the hospital due to insufficient symptom management skills, which seriously affects the quality of life of patients, brings greater economic and care giving burdens to their families, and causes greater pressure on public health management 3,4 …”