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Published on: June 10, 2025
Resource utilisation and outcomes of people with heart failure in England: a descriptive analysis of linked primary
Stephan Linden1, Nicholas D Gollop1, Ruth Farmer2
1Boehringer Ingelheim International GmbH, Ingelheim, Germany.
Insights
Heart failure (HF) patients face high mortality and resource use. Patients with unknown HF subtypes experienced the highest mortality rates, underscoring the need for accurate diagnosis and timely treatment.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Heart failure (HF) significantly impacts healthcare resource utilization and patient mortality in the UK.
- Previous studies lacked comprehensive comparisons of outcomes between HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF) in large populations.
Purpose of the Study:
- To investigate and compare healthcare resource utilization and mortality rates among patients diagnosed with HF in England.
- To analyze outcomes stratified by HF subtype (HFrEF and HFpEF) and compare them to patients with unspecified HF subtypes.
Main Methods:
- A non-interventional cohort study utilizing linked data from the Clinical Practice Research Datalink, Hospital Episode Statistics, and UK Office for National Statistics mortality data.
- Inclusion criteria involved patients with recorded HF diagnoses (incident or prevalent) between 2015 and 2019, based on clinical codes or ejection fraction measures.
Main Results:
- The study identified 383,896 HF patients, with 26% having a recorded subtype (69% HFrEF, 31% HFpEF).
- Hospitalizations for HF occurred at approximately 80/1000 person-years, with higher rates in HFrEF and unknown HF subtypes.
- All-cause mortality was 132/1000 person-years, with the highest 1- and 5-year mortality observed in patients with unknown HF subtype (20% and 48%, respectively).
Conclusions:
- HF is linked to substantial healthcare resource use, mortality, hospitalizations, and comorbidities.
- Early and guideline-directed therapies for HF and associated conditions are crucial for improving patient outcomes.
- Accurate HF subtype classification and management are essential to reduce the overall burden of HF on the healthcare system.
Background:
Heart failure (HF) is associated with high levels of resource use and mortality, but prior UK studies have not compared outcomes by HF subtype (HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF)) in large patient populations. This study investigated healthcare resource utilisation and mortality in patients with HF in England, overall and by HF subtype.
Methods:
This non-interventional cohort study linked data from the Clinical Practice Research Datalink database to Hospital Episode Statistics inpatient and UK Office for National Statistics mortality data. Patients with a recorded HF diagnosis (new (incident) or existing (prevalent)) based on clinical codes or measures of ejection fraction between 2015 and 2019 were included.
Results:
Of 383 896 patients identified with HF, 100 224 patients (26%) had a recorded subtype: 68 780 patients with HFrEF (69%) and 31 444 patients (31%) with HFpEF. In total, 918 553 person-years (PY) were included (median follow-up: 2.1 years): 625 619 PY (68%) for unknown HF subtype, 204 862 PY (22%) for HFrEF and 88 017 PY (10%) for HFpEF. Overall, 11% of patients experienced ≥1 HF hospitalisation. After age and sex adjustment, hospitalisations for HF (HHF; including recurrent hospitalisations) and HF-related general practitioner consultations occurred at rates of approximately 80/1000 and 124/1000 PY, respectively, and were highest for patients with HFrEF and unknown subtype. Overall, all-cause and cardiovascular mortality rates were 132/1000 and 49/1000 PY, respectively. Patients with unknown subtype had the highest 1-year and 5-year mortality (20% and 48%), followed by HFrEF (8% and 35%) and HFpEF (6% and 25%).
Conclusions:
HF is associated with high levels of healthcare resource use, mortality, HHF and comorbidities. Ensuring that patients receive early and appropriate guideline-directed therapies to manage HF and associated comorbidities is likely to improve patient care and reduce the burden of HF on the English healthcare system.
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