20 November 2019

GP heart failure plans underutilised – SHAPE study

Cardio Research

Patients with heart failure see their GPs 14 times a year on average, but, despite this, regular GP management plans and medication reviews are not common, a study shows.

The SHAPE study retrospectively examined around 20,000 patients with definite or probable heart failure who attended 43 general practices across Australia between 2013 and 2018.

The study revealed that around 60% of patients with heart failure had a GP management plan and only around 5.4% received a home medication review.

GP management plans should be reviewed regularly, but only around 3% of patients with heart failure had their plan reviewed once a year or more.

Around 26% of patients had only one GP management plan over the five-year study period. 

Associate Professor Ralph Audehm, a GP based in Melbourne, the lead author of the study and a member of the heart failure guidelines working group, said GPs had a real opportunity to improve outcomes for patients with heart failure by delivering “wrap around care”.

“Heart failure is a dreadful disease,” he said. “The important thing is that we have classes of drugs that actually make a huge impact on mortality and morbidity in people with heart failure, specifically the heart failure with the reduced ejection fraction.”

In his practice, Professor Audehm generally follows up with patients who have been diagnosed with heart failure after three months to review their medication and then at regular intervals after that.

Patients with heart failure and a reduced ejection fraction were generally prescribed beta blockers, ACE inhibitors (or angiotensin receptor blockers) and spironolactone at the highest dose they could tolerate without affecting their blood pressure or potassium, he said.

“So, you just keep pushing it up until you get to the maximum dose and if you get there and they are well, you just leave them there,” he said.

In the SHAPE study, 47% of patients were referred to a cardiologist from within 30 days of heart failure diagnosis, which was slightly lower than the ideal referral rate, Professor Audehm said.

All patients with heart failure associated with a reduced ejection fraction should be seen by a cardiologist at least once, he said.

As for patients with heart failure associated with a preserved ejection fraction, there were currently no treatments that made a real difference apart from managing their risk factors and getting them active, Professor Audehm said.

“[However], with [heart failure with a preserved ejection fraction] … sometimes a review from a cardiologist is appropriate if we’re having trouble keeping them out of hospital or they seem to be very symptomatic,” he said.

There was probably a whole myriad of reasons patients didn’t get referred to a cardiologist, including cost and accessibility, he said. But there was evidence that sharing care between a GP and a cardiologist improved outcomes for patients with heart failure.

There were some specific things that cardiologists could do, even above medication prescribing that could actually improve outcomes for people with heart failure, he said.

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