Heart failure

Poor blood pressure management driving heart failure admissions


Decades of inadequately treated blood pressure are contributing to rising heart failure hospitalisation rates among the elderly, an expert says.

Speaking to the limbic Professor Andrew Boyle, from the University of Newcastle’s School of Medicine and Public Health, who has investigated heart failure hospital admission rates over the last 10 years in the Hunter New England area, said that while there was a reduction in admissions from 2005 to 2010 that decline appears to have levelled off with rates increasing from 2010 to 2014.

And people aged 75 years and older are contributing to the majority of hospitalisations, he says.

“We have made no gains in heart failure mortality and very little gains in hospital admission rates in recent years in one of the most expensive and labour intensive diagnosis related groups there is,” he told the limbic in an interview.

Professor Boyle says that as more people survive their heart attack more go on to live with heart failure.

He also argues that there are gains to be made with more aggressive risk factor treatment in earlier life.

“As well as the burden of age, I think what we’re seeing here is decades of under treated hypertension contributing to this trend in heart failure hospitalisations – not enough people are on treatment and for those who are on treatment, we’re not getting them to those [lower] targets,” he said referring to the SPRINT trial, which showed that the lower blood pressure target of 120 mmHg resulted in fewer heart failure admissions over three years.

“If you translate a lifetime, or certainly decades, of exposure to inadequately treated blood pressure – and that’s the difference between 140 mmHg vs 120 mmHg as a target – that minor difference translates to a reduced number of heart failure admissions.”

According to the study conducted by Professor Boyle and colleagues, there were 21,909 hospitalisations for heart failure in the Hunter New England area between 2005 and 2014.

While overall heart failure hospitalisation declined by 1% per year (95% CI, 0.6–1.3,P<0.001) during the entire study period, there was a clear point where the downward trend changed.

From 2005-2010, HF hospitalisation declined by 2.3% per year (95%CI, 1.4–3.3%, P<0.001), while after 2010 there was an increase by 1.2% per year (95%CI,0.2–2%, 71 P=0.014).

Meanwhile, patients aged 75 years or more were responsible for 63% of cases.

 

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