Trends in heart failure care: has the incident diagnosis of heart failure shifted from the hospital to the emergency department and outpatient clinics?

Abstract

Aims Studies of heart failure (HF) incidence and prevalence frequently rely on hospitalization to identify patients. Our objective was to describe the incidence, prevalence, or outcomes for HF patients diagnosed in the outpatient or emergency department (ED) setting. Methods and results In a population‐based study of 82 323 HF patients in a single‐payer health‐care system in Alberta, Canada from 1999 to 2007, we examined trends over time and clinical outcomes. Heart failure patients were first diagnosed in a general outpatient clinic (45.7%), a specialty outpatient clinic (4.0%), the ED (13.7%), or in hospital (36.6%). From years 2000 to 2006, the age‐standardized incidence (per 100 000 population) decreased from 538 to 403, whereas the overall prevalence increased from 1585 to 2510. One‐year mortality was significantly different among patients first diagnosed in a general outpatient clinic (6.6%), a specialty outpatient clinic (7.5%), ED (19.1%), and hospital (29.8%). Patients initially diagnosed at the time of hospitalization had the fewest median days alive and out of hospital [347, inter‐quartile range (IQR): 136–363] over the next year compared with patients in the ED (354, IQR 313–365), specialty outpatient clinic (365, IQR 355–365), and general outpatient clinics (365, IQR: 359–365, P < 0.0001). Patients in the ED had the highest rate of subsequent ED visits, and all‐cause, cardiovascular, or HF hospitalization. Conclusions Over time, more patients were diagnosed as outpatients compared with a hospital setting. The trends observed in incidence, prevalence, and outcomes for patients with HF differ substantially depending on the location of initial diagnosis. Additionally, efforts to study patients with HF in the ED should be a priority.

Community Care in England

“…The steady decline in HF incidence is consistent with recent studies from Scotland, 3 Sweden, 17 Australia, 18 New Zealand, 19 Canada, 20 and the United States. 21 Although the magnitude of decline in England exceeds these studies, our analysis is more contemporary and involves community as opposed to hospitalized patients.…”

Frequency of Care and Mortality Following an Incident Diagnosis of Peripheral Artery Disease in the Inpatient or Outpatient Setting: The ARIC (Atherosclerosis Risk in Communities) Study

“…Previous studies have suggested that diagnosis of CVD in the inpatient setting, compared with the outpatient setting, portends worse outcomes 30, 31. Results of the current study extend this observation to PAD.…”

Trends in the incidence and outcomes of heart failure in Ontario, Canada: 1997 to 2007

“…[29][30][31] More recently, however, reductions in admissions because of heart failure appear to reflect an actual decline in the incidence of heart failure. 28,32 Our study is the largest and most recent population-based study to address this issue and provides strong evidence that the incidence of heart failure is decreasing.…”

“…[16][17][18][19][20][21] However, incident and total admission rates decreased steadily thereafter. [22][23][24][25][26][27][28] Studies that examined population-based trends in the incidence of heart failure in the decades leading up to the 1990s showed weak correlation with hospital admission trends. [29][30][31] More recently, however, reductions in admissions because of heart failure appear to reflect an actual decline in the incidence of heart failure.…”