RT Journal Article
SR Electronic
T1 Health service use by patients with heart failure living in a community setting: a cross-sectional analysis in North West London
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e563
OP e572
DO 10.3399/bjgp20X711749
VO 70
IS 697
A1 Dani Kim
A1 Benedict Hayhoe
A1 Paul Aylin
A1 Martin R Cowie
A1 Alex Bottle
YR 2020
UL http://bjgp.org/content/70/697/e563.abstract
AB Background The complex nature of heart failure (HF) management, often involving multidimensional care, is widely recognised, but overall health service utilisation by patients with HF has not previously been described.Aim To describe overall health service use by adults with HF living in a community setting.Design and setting Cross-sectional analysis of prevalent HF cases from January 2015 to December 2018 using an administrative dataset covering primary and secondary care, and ‘other’ (community, mental health, social care) services in North West London.Method Healthcare use of each service was described overall and by individual components of secondary care (such as, outpatient appointments), and ‘other’ services (such as, nursing contacts). Usage patterns were identified using k-means cluster analysis, using all distinct contacts for the whole study period, and visualised with a heatmap.Results A total of 39 301 patients with a prevalent diagnosis of HF between 1 January 2015 and 31 December 2018 were found. Of those, approximately 90% used health services during the study period, most commonly outpatient services, GP consultations, unplanned accident and emergency visits, and community services. Use of cardiology-specific services ranged from around 3% (cardiology-related community care) to around 20% (outpatient cardiology visits). GP consultations decreased by 11% over the study period. Five clusters of patients were identified, each with statistically significantly different care usage patterns and patient characteristics.Conclusion Patients with HF make heavy but heterogeneous use of services. Relatively low and falling use of GP consultations, and the apparently low uptake of community rehabilitation services by patients with HF, is concerning and suggests challenges in primary care access and integration of care.