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

Heart failure occurs when the heart functions less effectively in pumping blood around the body. It can result from a variety of diseases and conditions that impair or overload the heart, including heart attack, high blood pressure, damaged heart valves or cardiomyopathy. Heart failure has a substantial impact on Australians and the health system.

The Hospital to community: How Australians with heart failure receive health care report is the first to use linked data from the National Health Data Hub (NHDH) to deepen our understanding of people hospitalised with heart failure in Australia. The results focus on patient characteristics, community-based health care use, medication use, and health outcomes in the year after the hospitalisation.

This fact sheet highlights several priority areas identified in the study, including gaps in current understanding that require additional data or research.

The management of heart failure occurs in a context of high and complex health needs

The Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018 highlight that the management of multiple conditions, and the associated use of multiple medications, adds to the complexity of managing heart failure (Atherton 2018). This was evident in this study.

• Nearly all (94%) had cardiovascular conditions other than heart failure, including 63% who experienced coronary heart disease (CHD).
• Many people also experienced significant non-cardiovascular disease comorbidities such as chronic kidney disease (53%), pneumonia (49%), type 2 diabetes (41%), anaemia (32%) and chronic obstructive pulmonary disease (31%).
• More than 4 in 5 (83%) of those aged 75 and over were taking 5 or more medications regularly (polypharmacy), which is more than twice the Australian estimate of 40% (Australian Commission on Safety and Quality in Health Care 2021).
• At discharge, 40% of those aged 18 and over had high levels of frailty. This is almost twice the level reported for an Australian cohort of adults hospitalised with stroke and transient ischemic attack (22%) (Kilkenny 2021).
• While complex needs increase with age, even among people age under 50, more than 85% had cardiovascular conditions (other than heart failure), 28% had chronic kidney disease, 44% were taking 5 or more medications regularly and 22% had high levels of frailty.

Community based health service use was high following the transition from hospital into the community

The National Strategic Action Plan for Heart Disease and Stroke (Department of Health, Disability and Ageing 2020) outlines the need to improve the transition of care from hospital to the community, and post discharge support services, for people living with heart disease. This report provides evidence of timely hospital-to-community transitions and high rates of community care use in the study population. However, there are geographical disparities.

• After leaving hospital, 61% visited a GP within 1 week, and 87% within 1 month.
• In the year after the index hospitalisation, 65% used enhanced primary care services that allow GPs to plan and coordinate the health care of patients with chronic conditions.
• Among people who visited a GP 4 or more times, 58% had high continuity of care (that is, at least 75% of visits were with the same GP).
• Almost 2 in 3 (64%) were readmitted to hospital within 1 year and 23% were readmitted within 30 days of their index hospitalisation.

Data gaps and priorities

• The lack of detailed primary health care information remains a significant gap in our understanding of community care. The AIHW is working to establish a National Primary Health Care Data Collection, which would improve our understanding of how heart failure is treated and managed, including for people with less severe heart failure who are managed in the community.
• This analysis did not capture services that are not in the Medicare Benefits Schedule. This includes cardiac rehabilitation and outpatient care provided by hospitals, which are important aspects of care as people transition from the hospital to the community.
• The classification used in the Australian hospitals data (ICD-10AM) does not differentiate between heart failure subtypes. The subtypes affect treatment decisions, including medication use. The analysis could not assess if medication use of the cohort aligned with the Australian Clinical Guidelines recommendations. Future classifications, such as ICD-11, may allow for this type of analysis.