New study reveals missing signals on heart failure

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A new study has found fewer than one-in-five Australians with heart failure have the condition captured in the diagnosis section of their medical records.

The Retrospective Cohort Study of Heart Failure in the Australian Primary Care Setting (SHAPE), which was funded by Novartis Pharmaceuticals, is Australia’s largest-ever heart failure observational study.

The study analysed the prevalence and clinical characteristics of people with heart failure. It examined the de-identified health records of 1.93 million adult patients in Australia.

Of the patient records analysed, 21,803 patients were classified as having 'definite' or 'probable' heart failure, indicating the condition is likely to affect more than 270,000 Australians.

According to the company, the most concerning finding was that only 18.9 per cent of patients stratified into the 'definite' heart failure subgroup had the condition noted in the diagnosis section of their medical records.

The study's lead author, Professor Andrew Sindone, said, “This is important research that highlights how often heart failure is present, but invisible in primary care.

“These patients often have multiple co-morbidities and may not report potential heart failure symptoms to the GP, making it hard for GPs to manage these patients proactively.

“It is of the utmost importance that GPs suspect heart failure in older patients, ask their patients about possible symptoms, investigate, diagnose, and proactively manage the condition,” said Professor Sidone.

The study found that heart failure medications had low rates of prescribing, while medications that may worsen heart failure symptoms had relatively high prescribing rates in these patients.

Heart failure specific beta-blockers and spironolactone were prescribed to only 34 per cent and only 14 per cent of the patients with definite or probable heart failure despite being proven effective in the management of heart failure.

In contrast, the use of NSAIDS, systemic corticosteroids and tricyclic anti-depressants – medications that may worsen the symptoms of heart failure – were prescribed to 23 per cent, 24 per cent and 14 per cent of patients in this same cohort.

Professor Danny Liew, a co-investigator in the study, said the prescribing pattern was concerning but not surprising given the diagnosis may not be front-of-mind for GPs.

“It is concerning that GPs seem to under-utilise disease modifying therapies in patients who have heart failure,” he said.

“Diuretics are the most commonly prescribed medications, but these do not improve the underlying condition nor reduce mortality in people with chronic heart failure.

“Sub-optimal medical management may be a result of the diagnosis being missed or not being front-of-mind, or because GPs perceive heart failure to be the responsibility of a specialist. However, GPs have a pivotal role to play in identifying and managing heart failure as they see patients far more frequently than specialists,” he added.