Reducing heart failure admission rates in England 2004-11 are not related to changes in primary care quality: national observational study

Background: Heart Failure (HF) may result in emergency hospital admission. Expert consensus has defined HF as a primary care sensitive condition i.e. admission risk may be cut by high quality primary care, but there is little evidence. Method: We analysed time trends in HF admissions and risk factors. We produced indirectly standardised HF admission rates for all general practices in England for 2004-11. We used clustered negative binomial regression to produce admission risk ratios and assess covariate significance. Results: 327,756 HF admissions occurred in 8,405 GP practices. There was a significant reduction in admissions over time, from 6.96/100,000 (2004) 5.60/100,000 (2010). Deprivation and HF prevalence were risk factors, GP supply and better patient access protected against admission. These effects were small compared to the decrease in admission rates. View this table: Multivariate analysis of HF admissions Conclusion: The fall in admissions cannot be explained by primary care covariates we used including drug treatment. The potential for further reductions in HF admissions by improving quality of primary care may be small. Other non-pharmacologic factors-better stabilisation, outreach and follow-up- may be important. Further work is required to identify the reasons using longitudinal analysis of patient-level data.