Frailty and co-morbidity in patients with heart failure in primary care: predicting risk of hospitalisation

Problem

Admission of patients with heart failure to hospital for any reason is a marker of poor prognosis, with high risk of subsequent readmission and mortality. Identification of those patients at greatest risk of hospitalization therefore is of key importance in primary care, but little evidence exists currently to inform such predictions.We therefore sought to establish key predictors, available to GPs, of hospitalization risk in patients with heart failure.

Approach

We used linked primary and secondary care data (the Clinical Practice Research Datalink) to identify patients diagnosed with heart failure between 2010 and 2013. We examined records for first hospital admission following diagnosis, and compared the effects of patients’ characteristics, including frailty calculated using the electronic frailty index (eFI).

Findings

6360 patients diagnosed with heart failure in primary care met our inclusion criteria. 2469 had a hospitalization for any cause within a year of heart failure diagnosis (591 were admitted for heart failure). Key predictors of heart failure admission were greater age, higher serum creatinine and not being treated with a beta-blocker. Admission for any cause was predicted by age, comorbidity, frailty, prior admission, not being on a beta-blocker, lower haematocrit, and living alone.

Consequences

Frailty and co-morbidities are important predictors of all cause hospitalization in patients with heart failure. Given the significant implications of hospital admission for patients and the NHS, primary care professionals should assess patients with heart failure for frailty, as well as considering other key risk factors, in order to identify those at greatest need of intervention to avoid admission.