Congestive Heart Failure in Daily Practice: A Review of Recent, General Practice- and Community-Centred CHF Epidemiology

Abstract

Purpose: Congestive heart failure (CHF) is a prevalent cardiovascular disorder with a large global impact, characterised by heterogeneous presentation and generally separated into three major categories: heart failure with reduced (HFrEF), mid-range (HFmEF), and preserved ejection fraction (HFpEF). Although research generally utilises randomised control trials and often focuses on hospitalised patient populations, a large proportion of patients with CHF are treated in general practice, so it is important to understand patient population, management, and prognosis of CHF in this setting. Previous reviews focused on CHF in general practice were published upwards of 20 years ago, so this review looked at recent studies in order to understand the epidemiology of CHF in general practice in a contemporary context. Findings: Findings highlight a decline in incidence and an increase in prevalence, with a higher prevalence and incidence among men and older patients. Common comorbidities include hypertension, atrial fibrillation, and ischemic heart disease, but there are differences in comorbidities associated with ejection fraction and sex. Low rates of test availability as well as practitioners’ confidence in interpretation of results may both be factors in overall low rates of diagnostic testing before diagnosis in general practice. Common medications prescribed by general practitioners included beta-blockers, diuretics, mineralocorticoid receptor antagonist medications, and renin-angiotensin system inhibitors, but guideline adherence was generally low, and general practitioners found guidelines much more helpful in the management of HFrEF compared to HFpEF. Mortality is decreasing overall, and this is mostly driven by decreases particularly among men and patients with HFrEF. Hospitalisation accounts for the largest proportion of healthcare costs associated with CHF, even among patients treated within general practice. Conclusion: This review emphasises the need for future research which distinguishes between EF categories, accounts for sex differences, and is conducted in more varied countries. It identified a gap between practice and guidelines in both diagnosis and treatment, and showed electronic health records and administrative data provide valuable resources for studying CHF in general practice.