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

This section focuses on the use of community health care as people transitioned from hospital into the community. 

Note, this analysis includes Medicare Benefits Schedule (MBS) subsidised services only and focuses on services (including telehealth) provided by general practitioners, specialists and nurse practitioners. For information on community health care data gaps, see Technical notes: limitations. 

The measurement period includes 2020 in which Australia’s health system was affected by the COVID-19 pandemic. For more information about how this may impact the results of the study, see Technical notes: limitations.  

For more detailed data relating to community care before the index hospitalisation, see tables S4.2, S4.5, S4.7 in the supplementary data tables.

Community health care after index hospitalisation

Time till first GP visit

Timely review by a medical professional after leaving hospital is promoted as an important step in the Heart Foundation’s Safe Heart Failure Discharge (Heart Foundation 2022).  

After leaving their index hospitalisation 17% of this study cohort visited a general practitioner (GP) within 1 day, 61% visited a GP within 1 week, and almost all visited a GP within 1 month (87%).

There was some variation by population group. The proportion of surviving people who visited a GP within 30 days of discharge: 

• increased with increasing age (78% of those aged under 50 compared to 88% of people 50 and older) 
• was higher among those living in Major cities (87%) compared to those living in Remote and very remote areas (79%).

Types of services accessed

Almost everyone (97%) who survived the year following their index hospitalisation visited a GP (Figure 9). This was similar to the proportion who visited a GP in the 1 year prior to the index hospitalisation (96%).

In the 1 year following the index hospitalisation, almost two-thirds (65%) had an enhanced primary care visit with a GP, including chronic disease management plans (53%), health assessment visits (22%) and medication reviews (10%). This was similar to the proportion who accessed enhanced primary care in the year prior to the index hospitalisation (enhanced primary care: 65%, chronic disease management plan: 53%). 

Almost half (48%) visited a cardiologist and 77% saw a specialist of any type. Contact with a cardiologist was slightly higher among males (52%) than females (44%), and higher when compared to the year before the index hospital admission (males: 48% and females: 31%).

Contact with a cardiologist in the year following the index hospitalisation varied by clinical and demographic characteristics. It was higher among: 

• those who had cardiovascular disease related procedures and investigations during the index hospitalisation (65% compared to 44% of people who did not)
• people living in Major cities (50%) compared to those living in Remote and very remote areas (38%) (Figure 9)
• people who lived in the lowest socioeconomic areas (most disadvantaged) when compared to those who lived in the highest socioeconomic areas (least disadvantaged areas) (56% compared to 45%, respectively).

Frequency of GP contact

Many people in the study cohort were high frequency users of general practice care. Of people who survived at least one month following their index hospitalisation, 38% visited a GP more than twice a month (on average) over their follow up period. The proportion increased with age (45% among those 75 years and older).

People who lived in Major cities were more likely to have a high frequency of general practice care. Two in 5 visited a GP more than twice a month (on average) compared to people who lived in Remote or very remote areas (1 in 4 visited a GP more than twice a month on average). 

Continuity of care

Continuity of care is a measure of whether a patient consistently sees the same GP over time. In this study, high continuity of care is defined as seeing the same GP at 75% of visits or more. High continuity of care is associated with a stronger doctor patient relationship, reduced hospitalisations and emergency department use, mortality and health care costs (Youens et al 2021). Continuity of care was measured in people who had 4 or more visits in the year following the index hospitalisation.

Among people who visited a GP 4 or more times, 58% had high continuity of care. This varied by age and population group. High continuity of care was lower for people under the age of 50 (44%) compared to people aged 50–74 (57%), and people aged 75 and older (60%).

Aboriginal and Torres Strait Islander (First Nations) people were less likely to have high continuity of care when compared to other Australians (43% or 990 people compared with 59% or 34,200 people, respectively). 

People who lived in Remote and very remote areas were much less likely to have high continuity of GP care. Only 26% of people from Remote and very remote areas had high continuity of care, compared with 61% of people who lived in Major cities, 56% who lived in Inner regional areas and 52% who lived in Outer regional areas (Figure 10).

Residential aged care

The proportion of people accessing residential aged care services was higher after the index hospitalisation when compared to before. In the year following hospital discharge, 22% of people accessed residential aged care (respite and/or permanent). Before the index hospitalisation, 14% of the cohort spent time in respite and/or permanent residential aged care. This was substantially higher among those aged 75 and older compared with those aged less than 75 (20% and 3% respectively). 

The proportion accessing aged care services after the index hospitalisation was highest among females aged 75 and over (37%) compared with males in the same age group (28%). 

Medication use

Medications are often prescribed for the management of heart failure, although specific recommendations vary with the type of heart failure. For people with heart failure with reduced ejection fraction, treatment with medication from 4 classes is recommended – often referred to as the 4 pillars of pharmacological care (Queensland Health, 2024). Many people will also be prescribed medications to manage other conditions and risk factors they experience. The management of multiple conditions, and the associated use of multiple medications, adds to the complexity of managing heart failure (Atherton JJ et al 2018).

In the 40 days after their index hospitalisation, 98% of people had at least one type of medication supplied to them.

• Half (52%) of the cohort had 5–9 different medications supplied and 28% had 10 or more supplied. 
• For 92% of people, this included at least one medication which may have been prescribed for the management of heart failure (Figure 11).

In the year after their index hospitalisation, 97% of people who survived had at least one medication supplied to them regularly (at least 4 times in the year). 

• Half (50%) had 5–9 different medications supplied regularly and 27% had 10 or more. 
• For 92% of people, this included at least one regular medication which may have been prescribed for the management of heart failure. More than half (55%) of people had 3 or more regular medications which may have been prescribed for the management of heart failure.

A lower proportion of people aged 85 and older had 15 or more medications supplied regularly than people aged 75 to 84. People younger than 50 (only 5.8% of the cohort) were more likely to have no medications supplied regularly in the year after the index hospitalisation (14% of males and 21% of females) when compared to people aged 50–74 (2.7% of males and 2.6% of females) and 75 and older (1.1% of males and 0.9% of females). 

This may reflect the different clinical profile of this younger group, who were more likely than the older age groups to have been selected into the cohort from a hospitalisation with a heart failure related cardiomyopathy diagnosis rather than heart failure specific classifications. For details, see Characteristics of people hospitalised with heart failure: Age and sex and table S2.1b in supplementary data tables.

Polypharmacy  

Polypharmacy is defined as using 5 or more medications concurrently. This is more common among older people with higher disease burden. Polypharmacy can increase the risk of medication related harms due to mistakes or medication interactions. Around 40% of Australian adults aged 75 and older were supplied 5 or more PBS medicines in 2018–19 (Australian Commission on Safety and Quality in Health Care 2021).

Of the heart failure cohort, 78% had 5 or more medications dispensed within the one-year post index hospitalisation. Among those aged 75 and older, 83% had 5 or more medications, which is twice the Australian estimate. Of those with polypharmacy and aged 75 and older, 24% of the heart failure cohort were supplied 11 or more medications, which is substantially higher than the Australian population estimate (13%) (Figure 12).

Notes on medication measures