Are there patients missing from community heart failure registers? An audit of clinical practice

Area of Science:

• Cardiology
• Primary Care Medicine
• Health Informatics

Background:

• UK general practitioners are financially incentivized to maintain heart failure registers.
• Recorded heart failure prevalence in primary care (0.7-1.0%) is lower than epidemiological estimates (3-5%).
• A significant gap exists between recorded and actual heart failure prevalence in the community.

Purpose of the Study:

• To identify patients 'missing' from primary care heart failure registers.
• To investigate the underlying mechanisms contributing to these omissions.
• To assess the impact of under-registration on patient outcomes and practice income.

Main Methods:

• An audit of clinical practice in a UK general practice (n=9390).
• Utilized audit software (ENHANCE-HF) for hierarchical searches of electronic health records.
• Heart failure status was confirmed by a specialist nurse, with two-year outcome data collected for non-heart failure patients.

Main Results:

• Baseline heart failure prevalence was 0.63%, increasing to 1.12% post-audit.
• Inaccurate electronic health record coding was the primary reason for missing patients.
• Among patients without heart failure on loop diuretics, 13% developed incident heart failure and 25% experienced death or hospitalization for heart failure within two years.

Conclusions:

• A substantial number of patients are missing from community heart failure registers, potentially impacting patient outcomes and practice revenue.
• Patients without diagnosed heart failure who are prescribed loop diuretics are at elevated risk for heart failure-related events.
• Improving the accuracy of primary care heart failure registers is crucial for effective patient management and resource allocation.