2.2 Heart failure

Heart failure is when the heart becomes weaker so it cannot pump blood around the body as well as it should. Heart failure affects about 1% to 2% of people in Australia. They often go to hospital many times. Around 50% to 75% of people with heart failure die within 5 years of diagnosis.

Hospital care is appropriate for people with severe heart failure. But more coordinated health care can keep people well enough so that they do not need to go to hospital as often.

In 2017–18:

• There were 62,554 hospitalisations for heart failure, representing 201 hospitalisations per 100,000 people of all ages (the Australian rate)
• The number of hospitalisations for heart failure across 325 local areas ranged from 91 to 531 per 100,000 people
• The rate of hospitalisation was 5.8 times as high in the area with the highest rate compared with the area with the lowest rate
• Rates of hospitalisation for heart failure were much higher in remote areas than in other areas
• Rates increased with socioeconomic disadvantage in major cities, and inner regional and remote areas
• The rate for Aboriginal and Torres Strait Islander people (462 per 100,000 people) was 2.3 times as high as the rate for other Australians.

Between 2014–15 and 2017–18:

• The rate of heart failure hospitalisation  nationally increased by 4%
• For Aboriginal and Torres Strait Islander people, the rate of heart failure hospitalisation  decreased by 4%.

Rates are standardised to remove age and sex differences between populations.

Variation in rates of heart failure hospitalisations is likely to be due to differences in:

• Clinical factors – this includes variability in clinician use of management guidelines
• Access to services – heart failure rehabilitation programs and disease management programs after hospital discharge may not be available in all areas. Aboriginal and Torres Strait Islander people may not have access to culturally appropriate care
• Prevalence of risk factors for heart failure – some population groups have higher prevalence of risk factors, including coronary heart disease, diabetes, hypertension, smoking and obesity
• Severity of heart failure and comorbidities – these differ in different population groups
• Socioeconomic disadvantage – heart failure is more common in people living in lower socioeconomic areas
• Medication-related reasons – people may differ in their ability to follow instructions for taking medicines
• Quality of care, and of integration of care, in the community, primary care and hospitals
• Access to dialysis for Aboriginal and Torres Strait Islander people – inadequate access to dialysis for kidney disease may worsen heart failure and increase hospitalisation rates.

Heart failure hospitalisations could be reduced by:

• Implementing major system changes that support evidence-based, multidisciplinary models of care. For example, ensuring there is an outpatient clinic review within 30 days of hospital admission may improve survival
• Reducing the risk factors for heart failure, such as high blood pressure, diabetes, smoking and obesity
• Implementing programs for medication management and rehabilitation
• Better integrating community health care with hospital care to improve outcomes for people with heart failure. GPs have an important role in managing people with heart failure in the community
• Empowering consumers to self-manage their condition
• Improving the use of medicines – current prescribing for the recommended triple therapy medication for people with heart failure is suboptimal
• Addressing the health inequities between Aboriginal and Torres Strait Islander people and other Australians, especially for people living in remote areas.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

2a. Consistent with the commitments made under the National Health Reform Agreement and building on the activities set out in the 2017 Bilateral Agreement on Coordinated Care, Local Hospital Networks, Primary Health Networks and the Aboriginal Community Controlled Health Service sector to implement the following principles in developing chronic disease management programs consistent with the National Strategic Framework for Chronic Conditions:



i. Patients, families and carers as partners in care, where patients are activated to maximise their knowledge, skills and confidence to manage their health, aided by technology and with the support of a healthcare team



ii. A risk stratification approach that supports identification of patients with high coordination and multiple provider needs, to ensure personalisation of service provision 



iii. Flexible service delivery and team-based care that supports integrated patient care across the continuum of the health system through shared information and care planning



iv. A commitment to care that is of high quality and safe, including care planning and clinical decisions that are guided by evidence-based patient healthcare pathways, appropriate to the patient’s needs 

v. Data collection and sharing by patients and their healthcare teams to measure patient health outcomes and improve performance.

2b. The Commission, the Independent Hospital Pricing Authority and the Administrator of the National Health Funding Pool to identify and develop alternative approaches to funding for chronic disease and infection that could be applied to the National Health Reform Agreement Pricing and Funding model so that pricing and funding are aligned with best-practice guidelines. The alternative models could include bundled payments, capitation payments or regionally coordinated service responses.

Heart Failure

2d. Local Hospital Networks, Primary Health Networks and the Aboriginal Community Controlled Health Service sector to implement process improvement for the effective management of people with heart failure, including:

i. Multidisciplinary care across the acute and primary care sectors

ii. A combination of strategies, including non-pharmacological approaches such as physical activity programs and fluid or dietary management, and pharmacotherapy.

Download the heart failure section of the Atlas, to read more about the context, data, key findings, interpretation, and addressing of variation for this clinical item:

Contents:

Context

• Prevalence
• Heart failure in Aboriginal and Torres Strait Islander people
• Management

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by Aboriginal and Torres Strait Islander status
• Trends over time

Interpretation

• Non-concordance with guidelines
• Readmissions

Addressing variation

• Primary prevention
• Primary care
• Transition to community care
• Integrated care
• Consumer enablement
• Improving use of medicines
• Exercise and cardiac rehabilitation
• Improving heart failure outcomes in in Aboriginal and Torres Strait Islander people

Resources

Australian initiatives

References