Route to heart failure diagnosis in English primary care: a retrospective cohort study of variation

BackgroundDespite the existence of evidence-based guidelines supporting the identification of heart failure (HF) in primary care, the proportion of patients diagnosed in this setting remains low. Understanding variation in patients’ routes to diagnosis will better inform HF management.AimTo identify the factors associated with variation in patients’ routes to HF diagnosis in primary care.Design and settingA retrospective cohort study of 13 897 patients diagnosed with HF between 1 January 2010 and 31 March 2013 in English primary care.MethodThis study used primary care electronic health records to identify routes to HF diagnosis, defined using the National Institute for Health and Care Excellence (NICE) guidelines, and adherence to the NICE-recommended guidelines. Multilevel logistic regression was used to investigate factors associated with the recommended route to HF diagnosis, and funnel plots were used to visualise variation between practices.ResultsFew patients (7%, n = 976) followed the recommended route to HF diagnosis. Adherence to guidelines was significantly associated with younger age (P = 0.001), lower deprivation level (P = 0.007), HF diagnosis source (P<0.001), not having chronic pulmonary disease (P<0.001), receiving further consultation for symptom(s) suggestive of HF (P<0.001), and presenting with breathlessness (P<0.001). Route to diagnosis also varied significantly between GP practices (P<0.001).ConclusionThe significant association of certain patient characteristics with route to HF diagnosis and the variation between GP practices raises concerns about equitable HF management. Further studies should investigate reasons for this variation to improve the diagnosis of HF in primary care. However, these must consider the complexities of a patient group often affected by frailty and multiple comorbidities.

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Statins in heart failure: Retrospective cohort study using routine primary care data

Annals of Medicine ◽

10.1080/07853890903022819 ◽

2009 ◽

Vol 41 (7) ◽

pp. 490-496 ◽

Cited By ~ 5

Author(s):

Ronan P. Ryan ◽

Richard J. McManus ◽

Jonathan Mant ◽

John A. A. Macleod ◽

F. D. Richard Hobbs

Keyword(s):

Heart Failure ◽

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Primary Care Data

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Association of depression and anxiety with adherence in primary care patients with heart failure—cross-sectional results of the observational RECODE-HF cohort study

Family Practice ◽

10.1093/fampra/cmaa042 ◽

2020 ◽

Vol 37 (5) ◽

pp. 695-702 ◽

Cited By ~ 1

Author(s):

Marion Eisele ◽

Malte Harder ◽

Anja Rakebrandt ◽

Sigrid Boczor ◽

Gabriella Marx ◽

...

Keyword(s):

Heart Failure ◽

Primary Care ◽

Cohort Study ◽

Psychological Distress ◽

Medication Adherence ◽

Failure Diagnosis ◽

Cross Sectional ◽

Factors Associated ◽

Patients With Heart Failure ◽

Heart Failure Diagnosis

Abstract Background Psychological distress has a negative impact on the prognosis and quality of life for patients with heart failure. We investigated the association between psychological distress and the patients’ adherence to medical treatment (medication adherence) and self-care advice (lifestyle adherence) in heart failure. We further examined whether there are different factors associated with low medication compared to low lifestyle adherence. Method This secondary analysis of the RECODE-HF cohort study analyzed baseline data of 3099 primary care heart failure patients aged 74 ± 10 years, 44.5 % female. Using multivariable regression, factors relating to medication and lifestyle adherence were investigated in order to estimate the extent to which these factors confound the association between psychological distress and adherence. Results Psychological distress was significantly associated with poorer medication adherence but not with lifestyle adherence after controlling for confounders. We identified different factors associated with medication compared to lifestyle adherence. A higher body mass index, a less developed social network, living alone, fewer chronic co-morbidities and unawareness of the heart failure diagnosis were only related to lower lifestyle adherence. Higher education was associated with poorer medication adherence. Male sex, younger age, lower self-efficacy and less familiar relation with the general practitioner were common factors associated with both lower medication and lifestyle adherence. Conclusion Promising factors for increasing medication adherence (reduction of psychological distress) and lifestyle adherence (explaining the patient his/her heart failure diagnosis more than once and increase in the patients’ self-efficacy), which were found in this cross-sectional study, must be further investigated in longitudinal studies.

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Factors Associated with Attempted External Cephalic Version for Fetal Malpresentation at Term

American Journal of Perinatology Reports ◽

10.1055/s-0039-1695748 ◽

2019 ◽

Vol 09 (04) ◽

pp. e323-e327

Author(s):

Meghana Limaye ◽

Najma Abdullahi ◽

Phinnara Has ◽

Valery A. Danilack ◽

Rosemary Froehlich ◽

...

Keyword(s):

Body Mass Index ◽

Cohort Study ◽

Adverse Events ◽

Vaginal Delivery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Clinical Characteristics ◽

Patient Characteristics ◽

External Cephalic Version ◽

Factors Associated

Objective To assess differences in patient characteristics between women who did and did not undergo attempted external cephalic version (ECV) for fetal malpresentation at term. Study Design This was a retrospective cohort study of women with a singleton gestation and noncephalic presentation at > 37.0 weeks between October 2014 and October 2015. We compared demographic and clinical characteristics of women who did and did not undergo attempted ECV and assessed the reasons that women did not attempt ECV. Results Among 215 women, only 51 (24%) attempted ECV. There were no differences in age, race, insurance type, or body mass index between women who underwent attempted ECV and those who did not. Women who underwent ECV were significantly more likely to have had a prior vaginal delivery (69 vs. 36%, p < 0.001). Seventy-six women (46%) declined ECV. Women who declined ECV were more likely to be nulliparous than those who accepted the procedure (66 vs. 29%, p < 0.001). Among women who had ECV, the success rate was 55%. There were no adverse events after attempted ECV in this cohort. Conclusion Among women with fetal malpresentation at term, those without a prior vaginal delivery were significantly less likely to undergo attempted ECV.

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Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study

BMJ ◽

10.1136/bmj.b2225 ◽

2009 ◽

Vol 338 (jun16 4) ◽

pp. b2225-b2225 ◽

Cited By ~ 60

Author(s):

C McCowan ◽

B Kidd ◽

T Fahey

Keyword(s):

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Factors Associated

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Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-050131 ◽

2021 ◽

Vol 11 (5) ◽

pp. e050131

Author(s):

Lauren J Scott ◽

Mairead Murphy ◽

Sarah Price ◽

Rhys Lewis ◽

Rachel Denholm ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Signs And Symptoms ◽

Patient Characteristics ◽

Face To Face ◽

Number Of Patients ◽

Potential Cancer ◽

Remote Consultations

ObjectivesTo investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.Design, setting and participantsA retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020.Main outcome measuresPotential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12).ResultsDuring April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014).ConclusionThe number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues.

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