Management of heart failure in primary health care: A retrospective study on electronic patient records in a registered population

Abstract

Objective - To study the prevalence, patient characteristics and management of patients with heart failure, and the feasibility of using everyday electronic patient records for research. Design - A 4-year retrospective database study. Setting - Primary health care in Stockholm. Subjects - Forty-six general practitioners, with a registered population of 100 222 inhabitants. Main outcome measures - Number of patients with heart failure, frequencies of their comorbidity, investigations and treatments. Results - Out of the registered population, 667 (0.7%) patients had the diagnosis heart failure and fulfilled the diagnostic criteria in our study, and 98.7% had a comorbidity. The most frequent were ischaemic heart disease (37.2%), hypertension (27.3%), chronic atrial fibrillation (23.7%) and diabetes (22.3%). Major investigations were chest radiograph (66.3%) and echocardiograph (16.9%). Frequent pharmacological treatments were diuretics (90.9%), cardiac glycosides (48.1%), platelet aggregation inhibitors (32.7%), vasodilators (31.6%), angiotensin-converting enzyme inhibitors (27.4%) and beta blockers (14.5%). Diuretics were more frequent for females (p = 0.016) and angiotensin-converting enzyme inhibitors for males (p < 0.001). Conclusion - Heart failure was common among the elderly and constituted a complex clinical problem. It seemed that these patients could have been managed more adequately. There were gender differences concerning comorbidity and management. Electronic patient records were feasible for research, although several areas needed improvement.