Heart failure

Most patients with HF not referred to a cardiologist by their GP


More than half of Australians with heart failure are not being referred to a cardiologist within a month of diagnosis and over 40% have no chronic disease management plan, troubling new figures show.

The industry-funded analysis of general practice records for 20,219 patients with HF also suggested that even among those with a care plan, it was most likely created for some other condition, a team of GP and cardiology researchers have reported.

They found that among the patients with definite HF, just 7,459 (48.2%) were referred to a cardiologist, while 11% received an endocrinologist referral and some 5% a referral to a renal physician.

Some 4750 patients with no formal diagnosis but typical signs and symptoms in combination with a diuretic prescription were identified as having probable HF.

This group were even less likely to be sent to a cardiologist, with just 42% receiving a referral, the researchers found.

Writing in the Australian Journal of General Practice, they reported HF patients were regular users of GP services, attending their GP practice 14 times per year on average.

“However, there was little use of MBS-funded care plans,” the researchers wrote (link here).

“Despite the complexity of managing HF, nearly half of patients with HF did not have a chronic disease management plan, only 35.3% had had their plan reviewed, and fewer than 3% had their item reviewed annually as is funded by Medicare.”

Even where a care plan existed, it was “probably implemented not for HF but for another chronic condition,” the team added, pointing to data showing the plans were more likely to be created and reviewed among patients with concomitant diabetes, osteoporosis and COPD or asthma.

“This finding is troubling because chronic HF is associated with a worse prognosis than these other conditions,” they wrote.

“There may be many reasons for this finding, which may include lack of formal diagnosis in the history fields, lack of clarity of role in HF management and the rapidly changing management guidelines.”

The researchers said fact that less than half the patients with HF were being referred to a cardiologist by their GP was possibly explained by poor recognition of their HF diagnosis.

“This finding is concerning because there is evidence that early collaborative care between a GP and a cardiologist are associated with improved outcomes in HF,” they said.

“The importance of this GP–cardiologist collaboration strengthens the case for wrap-around care and for patients with HF to be treated using chronic disease management plans.”

For the patients with definite or probable HF, the median age was 72 years, while 49% were overweight or obese.

The most commonly recorded comorbidities were hypertension (41.1%), COPD/asthma (25.1%), depression/anxiety (18.4%), ischaemic heart disease (12.9%), diabetes (11.9%), osteoporosis (9.5%), renal impairment (4.0%) and AF (3.6%).

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