Incident heart failure: comparing management and outcome in primary and hospital settings in Western Sweden 2008-2017

Aim: Heart failure (HF) is a highly prevalent condition managed in both primary care (PC) and hospital care (HC)-based settings. HF patients managed in these two settings may differ in their demography, comorbidities and outcomes, so we aimed to compare the patient management in PC and HC in the Västra Götaland Region (VGR) in Sweden.

Methods: The VEGA database is an administrative database that includes all patients living in VGR. Patients with a first principal or contributory diagnosis of HF (I50) ≥18 years old between 2008 and 2017 were included. One-year mortality was used as the outcome.

Results: In total, 35 375 new-onset HF cases were included with 18 722 identified only in PC and 16 651 in HC. HF patients in PC were older (80.7 ± 10.9 vs. 76.1 ± 13.6), more women (57.1% vs. 44.9%), with more hypertension, musculoskeletal and mental disorders, but less myocardial infarction. Patients in HC had almost 4 times higher all-cause 1 year mortality [3.92 (3.77-4.08), P < 0.0001] compared with PC after adjustment for age and sex. Over a 10 year period, despite decreasing mortality in both settings, hazard ratios for HC versus PC were significantly increased for all patients (P for interaction 0.0004), which was more marked in female and for 70-80 years old patients.

Conclusion: Over a 10 year period, we demonstrated the differences in demography, comorbidities and outcomes between heart failure patients managed in hospital care versus primary care.