Hospital to community: How Australians with heart failure receive health care

This study focuses on 71,494 people who survived a heart failure related hospitalisation in 2019. The first acute care hospitalisation with a diagnosis of heart failure in 2019 is referred to as the person’s index hospitalisation. 

This section describes the demographic and clinical characteristics of this cohort of people at the time they were discharged from their index hospitalisation. Information on the cohort’s comorbidities captured at any time during the study period are also included. 

Age and sex

Three in 5 (60%) were aged 75 and older and 29% were aged 85 and older. Slightly more than half of the cohort were male (52%). The sex distribution varied by age group, with a higher proportion of males among those aged less than 75, and a higher proportion of females among those aged 85 and older (Figure 2).

While most people with heart failure were older, more than 500 people were younger than 25 at their index hospitalisation (0.7% of the cohort). 

The clinical profile of the cohort at index hospitalisation varied by age. People younger than 50 were more likely than the older age groups to have been selected into the cohort with a heart failure related cardiomyopathy classification (39% of people younger than 25, 46% aged 25–49, 25% aged 50–74 and 7.6% aged 75 and older). While the older age groups were more likely to have a heart failure specific classification coded at index hospitalisation (71% of people younger than 25, 71% aged 25–49, 84% aged 50–74 and 96% aged 75 and older). The overlap represents people who had both types of classification at index hospitalisation. 

Population groups

Aboriginal and Torres Strait Islander (First Nations) people made up 4% of the cohort (2,900 people). However, among those aged less than 50 years, 13% of males (305 people) and 17% of females (285 people) were First Nations people (Figure 3).  For comparison, First Nations people comprise 3.4% of the total population of the in-scope states and territories, and 4.2% of the population aged less than 50 years old. 

One in three people (34%) were born outside of Australia, most commonly southern and eastern Europe (12% of cohort). This is similar to the proportion of the general Australian population (30%) in 2019 born outside of Australia in 2019 (ABS, 2024)

At the time of their index hospitalisation, 63% of the cohort lived in Major cities and 1.3% lived in Remote or very remote areas. The cohort was less likely to live in Major cities than the general population of the in-scope states and territories, of which 72% resided in Major cities. 

Thirty-one percent lived in the most socioeconomically disadvantaged 20% of areas and 11% lived in the least disadvantaged 20% of areas.

Other health conditions experienced in the study period

People with heart failure often live with other related or coinciding health conditions. Heart failure can result from a variety of diseases and conditions that impair or overload the heart. Concurrently experiencing other health conditions, known as having comorbidities, can have a negative impact if left untreated, on the health outcomes of people with heart failure. Both cardiovascular and non-cardiovascular comorbidities are common in people with heart failure (Lee et al 2023). 

Diagnoses of selected health conditions were identified from the hospital records that people had in their full study period (including before, after and during their index hospitalisation). It is important to note, as the identification is limited to hospitals (admitted patient care) data, it is likely an underestimate of these health conditions in the cohort. 

Other cardiovascular disease (CVD)

Cardiovascular conditions, other than heart failure, were identified in 94% of the study cohort. This included: 

• 63% who had coronary heart disease (CHD)
• 53% who had atrial fibrillation or flutter 
• 53% who had hypertension.

Non-cardiovascular disease (CVD) conditions

More than half the cohort (53%) had chronic kidney disease identified at a hospitalisation. The cohort experienced other non-CVD conditions, including:

• 49% who had pneumonia 
• 41% who had type 2 diabetes 
• 32% who had anaemia
• 31% who had chronic obstructive pulmonary disease (COPD).

Variation by age

The identification of most conditions increased with age (see Figure 4, filter by age group). Conditions more common among the people aged younger than 50 included:

• Chronic liver disease  
• Inflammatory heart disease 
• Congenital heart disease 
• Type 1 diabetes.

Down syndrome, a chromosomal condition linked to congenital heart disease, was identified in the hospital records of 73 people, 0.1% of the study cohort. Half (37 people) were younger than 50 at their index hospitalisation. 

Frailty

Frailty is a condition characterised by a loss of physical and cognitive reserves and typically increases with age. High levels of frailty have been shown to be associated with greater health care usage, increased risk of hospital readmissions and death. Australian Heart Failure Guidelines 2018 advise an assessment of frailty may provide benefit for people with heart failure. However, the Guidelines do not identify a tool to assess frailty in this population (Atherton et al, 2018).

The Hospital Frailty Risk Score was used to calculate a measure of frailty based on diagnoses identified in hospitalisation records in the 5 years prior to, and during, the index hospitalisation. The score was used to categorise the cohort into no/low, intermediate or high frailty (Gilbert et al 2018). The frailty results are presented for the 60% of the cohort who are aged 75 and older, the age group the tool was validated in. 

Results for the whole cohort are presented in tables S2.20–S2.24 in supplementary data tables. Results for the cohort 18 years and older are included for the purpose of cross study comparison.

Of the cohort aged 75 and older at their index hospitalisation (Figure 4):

• 19% were classified as having no or low frailty
• 35% had intermediate frailty 
• 46% had high frailty.

High frailty was more common among:

• People aged 85 and older (50%) compared with those aged 75 to 84 (42%).
• Women (48%) compared with men (43%).
• People who lived in Major cities (49%) compared to those living in Remote and very remote areas (33%).

Note that women and people who lived in Major cities were also more likely to be aged 85 and older. This cohort trend reflects that of the general population (AIHW, 2024; AIHW, 2025) (see supplementary tables (Table 1.1 – Table S1.4a) for cohort demographics by population group). As the Hospital Frailty Risk Score is based on hospital diagnosis data, it is reliant on complete capture of relevant diagnosis codes and may be impacted by the number of hospitalisations captured in the dataset.

High frailty in this cohort (aged 18 and older) was almost twice as common as reported for an Australian cohort of adults hospitalised with stroke and transient ischaemic attack (TIA) (40% and 22%, respectively) (Kilkenny M, 2021).