Abstract
BackgroundWe aimed to classify patients with heart failure (HF) by the style of primary care they receive.Methods and ResultsWe used the claim data (SNIIRAM: Système National d’Information Inter-Régime de l’Assurance Maladie) of patients living in a French region. We evaluated three concepts. First, baseline clinical status with age and Charlson index. Second, primary care practice style with mean delay between consultations, quantity of nursing care, and variability of diuretic dose. Third, clinical outcomes with death during follow-up, readmission for HF, and rate of unforeseen consultations. The baseline clinical status and the clinical outcomes were included to give an insight in the reasons for, and performance of, primary care practice style. Patients were classified using a hierarchical ascending classification based on principal components. A total of 2,751 patients were included in this study and were followed for a median of 22 months. The mean age was 78 y (SD: 12); 484 (18%) died, and 818 (30%) were readmitted for HF. We found three different significant groups characterized by their need for care and the intensity of practice style: group 1 (N = 734) was “low need-low intensity”; group 2 (N = 1,060) was “high need-low intensity”; and group 3 (N = 957) was “high need-high intensity”. Their readmission rates were 17%, 41% and 28%, respectively.ConclusionsThis study evaluated the link between primary care, clinical status and main clinical outcomes in HF patients. In higher need patients, a low-intensity practice style was associated with poorer clinical outcomes.
Highlights
Heart failure (HF) affects 1–2% of the general population and 10% of Western inhabitants older than 75 y [1], and it is associated with increased levels of morbidity and mortality, decreased quality of life and increased costs [2]
The baseline clinical status and the clinical outcomes were included to give an insight in the reasons for, and performance of, primary care practice style
We found three different significant groups characterized by their need for care and the intensity of practice style: group 1 (N = 734) was “low need-low intensity”; group 2 (N = 1,060) was “high need-low intensity”; and group 3 (N = 957) was “high need-high intensity”
Summary
Heart failure (HF) affects 1–2% of the general population and 10% of Western inhabitants older than 75 y [1], and it is associated with increased levels of morbidity and mortality, decreased quality of life and increased costs [2]. The extent of the impact of these determinants is related to pathology [9]; HF is an ambulatory care–sensitive condition [10] Avoiding these admissions by improving the access to and effectiveness of primary care could result in a substantial decrease in costs and could enhance patient outcomes [11]. Among studies assessing the role of primary care features, ecological analyses are prone to bias [13], and patient-level studies have yielded inconsistent results, possibly because they do not take into account the content of primary care This content depends on practice style [14] and should be adapted to the patient’s health status. We aimed to classify patients with heart failure (HF) by the style of primary care they receive
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