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

When interpreting the results from this report it is important to note the following limitations:

• The National Health Data Hub (NIHSI version 3.0) used in this study includes data from 6 of the 8 jurisdictions of Australia. Results may not be generalisable to Western Australia and the Northern Territory. Further, private hospital data for included states is limited, which may impact estimates of hospital readmissions. 
• The ICD-10AM classification used in the Australian admitted patient care (APC) data does not allow heart failure subtypes, heart failure with reduced left ventricular ejection fraction and heart failure with preserved ejection fraction, to be differentiated. As the subtypes impact treatment decisions, including medication use, this report cannot comment on the quality of care provided against the Australian Clinical Guidelines. 
• The use of community-based health care in this report is limited to MBS service use data. Other aspects of community-based health care (including hospital outpatient clinics, cardiac rehabilitation services and community health centre services), were unable to be captured. This may vary by state and territory, depending on how services are delivered and funded. In addition, the lack of clinical primary health care data impacts the understanding of treatment and management in the community. 
• Aged care data available for this analysis was limited to residential aged care captured in the National Aged Care Data Clearinghouse (NACDC). Other aged care services including Home Care Packages (HCP) or Commonwealth Home Support Programme (CHSP) services are not captured. Home care pathways may be particularly relevant to certain population groups, such as First Nations people (Department of Health, Disability and Ageing, 2025) 
• The analysis of medication use in this report is based on dispensing data from the PBS. This data does not include over the counter medications, private prescriptions and medications dispensed while in public hospitals.
• The ICD10-AM codes selected to identify the heart failure cohort for this study aimed to comprehensively capture people with the condition. The criteria included selected cardiomyopathy codes that are frequently associated with, or lead to, heart failure. The classification for Rheumatic heart disease, unspecified [I09.9] was also included to capture people with rheumatic heart failure, however a small number of people with rheumatic carditis may have also been selected into the cohort as a result. The impact of potential misclassification will be small, as only 115 people (0.16%) in total were selected into the cohort with a diagnosis at index hospitalisations of I09.9. 
• Comorbidity information is obtained from the APC data only. Diagnoses that are captured in the APC data are limited to those that are primarily responsible for the hospitalisation or require care during the episode. As a result, disease burden is underestimated in this population. 
• In this analysis, First Nations people included people who ever identified as Aboriginal or Torres Strait Islander in admitted patient care data. This includes people who had other admitted patient care episodes that recorded the person as non-Indigenous. The comparison group, ‘other Australians’ includes people who only had admitted patient care episodes that recorded them as non-Indigenous or the field was left blank. These results should be interpreted with caution. Additionally, this study was unable to examine how intersections between the First Nations population and other demographic or clinical characteristics may have influenced the reported outcomes. For example, First Nations people were more likely to live in Outer regional, Remote, and Very remote areas compared to other Australians in the cohort (35.0% and 11.5%, respectively).  Due to the cohort size, it was not feasible to report findings by multiple population characteristics. It is important to recognise these intersections when interpreting the results.
• The follow-up period in this study includes the period in which Australia’s population and health system was most affected by the COVID-19 pandemic. This may have influenced the health outcomes and health service use for the people in this cohort (AIHW 2024). At a national level there was a similar number of GP attendances in 2020 compared to the pre-pandemic trend. However, 9.8% of people aged 15 and over reported delaying or missing health care from a GP when needed due to COVID-19 in the Australian Bureau of Statistics (ABS) 2020–21 Patient Experience Survey (ABS 2021). The introduction of telehealth items for GPs attendance, including Chronic Disease Management (CDM) services, supported the continued availability of services and potential increased breadth of access (AIHW 2024). These MBS items are included in this analysis. The number of hospitalisations in Australia was lower in 2019–20 and 2020–21 than the previous years (2.8% and 2.1% lower, respectively), with elective surgery being heavily affected (AIHW 2024). The results for planned readmissions at one year should be interpreted within the context of the period. Key readmission results in this study are also presented for 30 days post index hospitalisation, a period before the COVID-19 pandemic effected Australia.