Older patients with heart failure managed in primary care versus cardiology care: a register-based study

Abstract

Background: Adherence to guideline-recommended drug treatment for heart failure (HF) is lower among patients managed in primary care compared with cardiology care. Understanding more about the patient group managed in primary care only is important.

Aim: To compare the sociodemographic characteristics, comorbidities, care use, and drug dispensation of older patients with HF managed exclusively in primary care with those who are also managed in cardiology care.

Design and setting: A register-based study using real-world administrative data from Stockholm, Sweden.

Method: The study population comprised all individuals aged ≥60 years resident in Stockholm on 31 December 2022 with an HF diagnosis. The Total Population Register and several national health registers were linked, providing information on comorbidities, HF hospital admissions, primary care visits, and dispensed drugs. Individuals were categorised into those managed exclusively in primary care or those who were also managed in cardiology care by the absence/presence of an in-/outpatient appointment with a cardiologist during the past 5 years.

Results: HF was prevalent in 33 872 of 524 250 (6.5%) individuals of whom 50.4% (n = 17 067) were exclusively managed in primary care. Among patients also managed in cardiology care, two-thirds of HF drugs were prescribed by primary care. Primary care-managed patients were on average 3 years older, more often female, of lower socioeconomic status, had fewer comorbidities, received fewer guideline-recommended drugs, and had lower rates of admissions to hospital for HF than cardiology care-managed patients. Residing in a nursing home and having dementia were the factors most strongly associated with exclusive primary care management.

Conclusion: Primary care manages the majority of individuals with HF, who are typically older than those patients who are also managed in cardiology care. These characteristics may explain differences in drug use.

Keywords: Sweden; cardiology care; drug therapy; heart failure; primary health care; sociodemographic status.