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Admission rates for heart failure in England 2004–2011

Heart failure is an important clinical problem. Expert consensus has defined heart failure as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. In a paper published in the European Journal of Heart Failure, Rachel Brettell and colleagues analysed time trends in Heart failure admission rates in England and risk and protective factors for admission.

They used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004–2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality (‘Quality and Outcomes Framework’ indicator.) There were 327,756 Heart failure admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100 000 in 2004 to 5.60/100 000 in 2010. Deprivation and  (P < 0.001) prevalence were risk factors for admission. GP supply and access protected against admission. However, these effects were small and did not explain the large and highly significant annual trend in falling admission rates.

Rachel Brettell and collagues concluded that the observed fall in admissions over time cannot be explained by the primary care covariates we included. The analysis suggests that the potential for further significant reduction in emergency heart failure admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions.

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