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

Every year, thousands of Australians are admitted to hospital for heart failure. 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.

This 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. Patient pathways were explored for a year after their hospitalisation, focusing on community-based health care use, medication use, and health outcomes. These findings can help improve health care planning and coordination for people living with heart failure.

The study identified nearly 71,500 people who survived a hospitalisation in 2019 related to heart failure (their index hospitalisation):

• 60% were aged 75 or over
• 29% were aged 85 or over
• 52% were male
• 63% lived in Major cities
• 1.3% lived in Remote and very remote areas.

Those who identified as Aboriginal and Torres Strait Islander (First Nations) people represented 4.0% of the cohort (2,877 people). However, this proportion was substantially higher among those aged under 50 years (14% or 590 people).

When compared to the general population, a greater proportion of people hospitalised with heart failure were aged over 75 years, lived outside of Major cities and identified as First Nations Australians.

The study highlighted the complex health needs of people hospitalised with heart failure. Heart failure frequently occurred in people who had another health condition, had high levels of frailty, and were using 5 or more medications regularly (polypharmacy).

• One in 3 (32%) patients had an index hospitalisation that lasted 10 or more days.
• Almost all (94%) had an additional cardiovascular disease diagnosis other than heart failure, including 63% who had a diagnosis of coronary heart disease (CHD). More than half (53%) of the cohort had chronic kidney disease, 41% had type 2 diabetes and 31% had chronic obstructive pulmonary disease.
• When leaving hospital, almost half of those aged 75 and over had high levels of frailty. This was more common among women than men (48% and 43%, respectively).
• More than three-quarters (78%) of the cohort were regularly dispensed 5 or more medications in the year after their hospitalisation. Among those aged 75 and over, 83% had 5 or more regular medications. This is more than double the estimated proportion in the Australian population for this age group (40%, Australian Commission on Safety and Quality in Health Care, 2021).

The National Strategic Action Plan for Heart Disease and Stroke outlines the need to improve the transition of care from hospital to the community, and post discharge support services, for those living with heart disease. This study shows high use of community health services after discharge from hospital:

• Six in 10 (61%) people visited a general practitioner (GP) within one week of being discharged from hospital. Sixty-five per cent accessed enhanced primary care services that allow GPs to plan and coordinate the health care of patients with chronic conditions.
• Nearly 4 in 10 (38%) people visited a GP more than twice a month (on average) in the year after their hospitalisation. This was highest among those aged 85 years and over (48%).
• Use of community-based services varied by where people lived. People living in Remote and very remote areas were less likely to see a GP within 30 days of hospital discharge, were less likely to regularly see the same GP, and less likely to see a GP one or more times per month (on average), than those living in Major cities.

A large proportion of the cohort returned to hospital or died within a year of their index hospitalisation.

• Around 3 in 5 (58%) people were readmitted within one year and 1 in 5 (20%) were readmitted within 30 days for an emergency (non-elective) hospitalisation. Readmissions within a year were higher among people aged 75 and over (61% or 26,300 people), First Nations people (64% or 1,900 people), those living in Remote and very remote areas (61% or 580 people), and people age 75 and over with high levels of frailty (67% or 13,200 people).
• Nearly 2 in 3 (65%) people had an emergency department visit within one year and 1 in 4 (26%) had a visit within 30 days. This suggests many people were unable to manage in the community.
• Almost 1 in 4 (24%) died within 1 year. Two in 5 (41%) deaths were due to cardiovascular disease.

The web report is accompanied by: 

• detailed supplementary data tables
• a data visualisation that shows key results by population groups, see Explore the data
• a fact sheet highlighting several priority areas identified in the study, including gaps in current understanding that require additional data or research, see Informing care pathways: linked data insights into heart failure.