Primary care heart failure service identifies a missed cohort of heart failure patients with reduced ejection fraction

• Published in: European heart journal 2022-02, Vol.43 (5), p.405-412
• Main Authors: Kahn, Matthew, Grayson, Antony D, Chaggar, Parminder S, Ng Kam Chuen, Marie J, Scott, Alison, Hughes, Carol, Campbell, Niall G
• Format: Article
• Language: English
• Subjects: Clinical Research; Heart Failure - drug therapy; Heart Failure - therapy; Humans; Primary Health Care; Prospective Studies; Retrospective Studies; State Medicine; Stroke Volume; Ventricular Dysfunction, Left - therapy
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehab629

Abstract Aims We explored whether a missed cohort of patients in the community with heart failure (HF) and left ventricular systolic dysfunction (LVSD) could be identified and receive treatment optimization through a primary care heart failure (PCHF) service. Methods and results PCHF is a partnership between Inspira Health, National Health Service Cardiologists and Medtronic. The PCHF service uses retrospective clinical audit to identify patients requiring a prospective face-to-face consultation with a consultant cardiologist for clinical review of their HF management within primary care. The service is delivered via five phases: (i) system interrogation of general practitioner (GP) systems; (ii) clinical audit of medical records; (iii) patient invitation; (iv) consultant reviews; and (v) follow-up. A total of 78 GP practices (864 194 population) have participated. In total, 19 393 patients’ records were audited. HF register was 9668 (prevalence 1.1%) with 6162 patients coded with LVSD (prevalence 0.7%). HF case finder identified 9725 additional patients to be audited of whom 2916 patients required LVSD codes adding to the patient medical record (47% increase in LVSD). Prevalence of HF with LVSD increased from 0.7% to 1.05%. A total of 662 patients were invited for consultant cardiologist review at their local GP practice. The service found that within primary care, 27% of HF patients identified for a cardiologist consultation were eligible for complex device therapy, 45% required medicines optimization, and 47% of patients audited required diagnosis codes adding to their GP record. Conclusion A PCHF service can identify a missed cohort of patients with HF and LVSD, enabling the optimization of prognostic medication and an increase in device prescription. Graphical Abstract Graphical Abstract A primary care heart failure service can identify a cohort of patients in the community with heart failure and left ventricular systolic dysfunction who are not medically optimized and have not been offered an implantable cardioverter defibrillator or cardiac resynchronization therapy. ECG, electrocardiogram; GP, general practitioner; MRI, magnetic resonance imaging.