Who are people who have heart failure as their first cardiovascular event in New Zealand

Abstract

Background: Heart failure (HF) has placed a great burden on the people of New Zealand (NZ) as well as its healthcare system. In NZ approximately 20% of first hospitalisations for CVD are due to HF, but the characteristics of those whose first presentation of CVD is for HF as opposed to another type of CVD are unclear. Aim: To compare the characteristics of people whose first CVD hospitalisation was due to HF with those presenting with other types of CVD. Method: A scoping review :was carried out to explore how previous studies have identified and defined people with HF and described their characteristics. In addition, a cohort study was undertaken of people without CVD who had CVD risk assessment using the PREDICT electronic decision support programme in NZ. Data from participants’ CVD risk assessment were linked using an encrypted National Health Identifier to data from regional and national health data collections. Participants who developed a CVD event during follow up were identified and were classified according to the type of CVD event and their characteristics at the time of CVD risk assessment compared. Among patients who had HF as their first CVD event during follow up, the proportion with subsequent coronary heart disease (CHD)-related admissions in the following year were estimated. Result: The scoping review found that a wide range of methods have been used to define HF and baseline characteristics. ICD codes and medical chart review were used most often to define HF, while clinical assessments, self-report information, EHR and administrative data were the sources used to define baseline characteristics. The cohort study found that, regardless of sex, people whose first presentation of CVD was due to HF were more likely to be of Māori or Pacific ethnicity, live in the most deprived areas, have obesity, diabetes, atrial fibrillation, valve disease or an implanted cardiac valve prosthesis or device, in comparison with those whose first presentation of CVD was due to a different type of CVD. The proportion of HF patients who had CHD-related subsequent admissions within a year was only 4.1%. Conclusion: Given the differences in characteristics at CVD risk assessment between patients whose first CVD presentation is HF as opposed to a different type of CVD, consideration should be given to the addition of HF-related factors to standard CVD risk assessment, particularly given the low proportion who subsequently present with CHD.