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Key points – Heart Failure within Bradford 2011

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Order of slides1. Prevalence – diagnosed 2. Prevalence – undiagnosed3. Other risk factors4. QOF achievement 5. Incidence6. AdmissionsSummary in numbers

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• Point 1 Prevalence of Heart Failure

4

0.60

0.65

0.70

0.75

0.80

0.85

0.90

2006/07 2007/08 2008/09 2009/10

Prev

alen

ce (%

)

Heart failure prevalence, 2006/07 to 2009/10

Bradford Yorkshire & Humber England

• Prevalence and total numbers of registered patients have fallen over the last 4 years• Trends within Bradford are following national and regional trends• Prevalence is currently 0.77% (4,129 cases), which is higher than the national average (0.72%)

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• Prevalence of Heart Failure varies across NHSBA practices, between 0.2% and 1.5%• Older practices (proportion register >65yrs) show higher prevalence

R² = 0.5365

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

0% 10% 20% 30% 40%

Pre

vale

nce

% practice population >65yrs

Relationship between prevalence and age of practice

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• Point 2Underdiagnosis of Heart Failure

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• There are undiagnosed cases. We don’t know the true number, but can estimate it• Estimated true prevalence is 1.2%, with approximately 2,500 undiagnosed* cases within Bradford• Majority of unfound cases can be found in South & West and BANCA alliances

* based on NHS Doncaster QOF Benchmarking model - As used in Ellis C, Gnani S and Majeed A (2001) Prevalence and management of heart failure in General Practice in England and Wales, 1994-1998. Health Statistics Quarterly 11: 17-24.

Alliance Population RegisterObserved

prevalenceExpected

HF registerExpected

prevalence

Potential undiagnosed

patientsAiredale 99,691 967 1.0% 1,569 1.6% 602BANCA 120,941 1,059 0.9% 1,822 1.5% 763City Care 149,608 756 0.5% 960 0.6% 204Independent 13,063 107 0.8% 229 1.8% 122S&W 163,125 1,240 0.8% 2,060 1.3% 820

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• Estimated that 62% of true prevalent cases have been diagnosed through QOF• Number of unfound cases range between -11 and 150 per practice (mean = 30)

Diagnosed, 4,129, 62%

Potentially undiagnosed, 2,511, 38%

Number of diagnosed and potentially undiagnosed Heart Failure patients in the PCT

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• Point 3 Other risk factors

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• For other risk factors, including Atrial Fibrillation, Chronic Heart Disease and Hypertension, Bradford has shown similar trends to all Yorkshire and Humber PCT’s and it’s most similar ONS PCT’s• Over the last 4 years, CHD prevalence has fallen, whilst Hypertension and AF prevalence have risen

Changes between 2006/07 and 2009/10Yorkshire & Humber PCT's

PCT code PCT namePractice registers

HF register

HF prevalence

AF prevalence

CHD prevalence

Hypertension prevalence 0-19yrs 20-64yrs 65+yrs

5JE BARNSLEY PCT 3,690 55 0.01% 0.20% -0.08% 2.3% -0.5% 1.7% 3.9%5NY BRADFORD & AIREDALE PCT 4,937 -253 -0.06% 0.10% -0.06% 1.2% 2.1% 4.3% 0.4%5J6 CALDERDALE 4,609 -83 -0.06% 0.10% -0.20% 0.8% 0.6% 2.6% 4.3%5N5 DONCASTER PCT -110 -495 -0.16% 0.16% -0.32% 1.2% -1.7% 0.8% 3.1%5NW EAST RIDING OF YORKSHIRE PCT 3,071 -44 -0.02% 0.19% 0.05% 1.5% -1.1% 0.8% 7.6%5NX HULL TEACHING PCT 4,048 -216 -0.08% 0.11% -0.06% 1.3% -4.2% 4.1% -1.4%5N2 KIRKLEES PCT 9,555 -12 -0.02% 0.17% -0.17% 1.5% 0.5% 2.7% 3.5%5N1 LEEDS PCT 26,207 -330 -0.06% 0.06% -0.21% 0.7% -0.6% 5.3% 1.4%TAN NORTH EAST LINCOLNSHIRE CARE TRUST PLUS -343 -71 -0.04% 0.07% -0.10% 1.5% -4.8% 1.1% 1.8%5EF NORTH LINCOLNSHIRE PCT 2,225 -67 -0.05% 0.07% -0.01% 1.2% -0.3% 1.0% 5.2%5NV NORTH YORKSHIRE AND YORK PCT 13,006 -481 -0.07% 0.15% -0.04% 0.8% -0.3% 2.8% 6.0%5H8 ROTHERHAM PCT 1,503 -344 -0.14% 0.06% -0.24% 1.1% -0.9% 0.5% 3.9%5N4 SHEFFIELD PCT 11,737 -519 -0.11% 0.11% -0.17% 1.0% 0.4% 4.9% 1.6%5N3 WAKEFIELD DISTRICT PCT 4,543 -381 -0.12% 0.14% -0.16% 1.5% -1.4% 0.9% 4.1%ONS most similar PCT's

5PG BIRMINGHAM EAST AND NORTH PCT 10060 -381 -0.1% 0.1% -0.21% 0.7% 0.9% 2.8% -0.7%5CC BLACKBURN WITH DARWEN PCT 4139 -140 -0.1% 0.1% -0.24% 0.4% -0.9% 0.6% 0.6%5J5 OLDHAM PRIMARY CARE TRUST 3715 -200 -0.1% 0.1% -0.19% 1.1% -0.5% 0.3% 2.8%5NQ HEYWOOD MIDDLETON & ROCHDALE PCT 3383 -17 0.0% 0.1% -0.15% 1.6% -1.8% 0.7% 2.4%

QOF Demographics

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• Point 4QOF achievement

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• When compared to all PCT’s, Bradford has low

achievement for QOF indicators HF02 (Heart

Failure confirmed by echocardiogram / specialist

assessment) and HF03 (ACE inhibitor therapy

for patients with heart failure due to left

ventricular dysfunction)

80

85

90

95

100

Bradford Yorkshire & Humber

England

Achie

vem

ent

(%)

HF02 & HF03 achievement, 2009/10

HF02 HF03

1378%

80%

82%

84%

86%

88%

90%

92%

94%

96%

98%

Ach

ieve

me

nt

ACE inhibitor therapy for patients with heart failure due to left ventricular dysfunction (HF03), 2009/10 - All PCT's

86%

88%

90%

92%

94%

96%

98%

100%

Ach

ieve

me

nt

Heart failure confirmed by echocardiogram / specialist assessment (HF02), 2009/10 -All PCT's

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• Point 5New incident cases of Heart Failure

15*Based on Bridging the quality gap: Heart Failure, Sutherland, March 2010

http://www.health.org.uk/publications/bridging-the-quality-gap-heart-failure/

• A practice with 10,000 patients would expect to diagnose approximately 10-13 new Heart Failure patients per year*• This would vary depending on the age, gender and other risk profiles of the practice• Based on an estimated incident rate of 1.3 per 1,000 population, there would be approximately 712 new incidents a year in Bradford (ranging between 1 and 28 new cases per practice)•Not possible to estimate the “actual” in Bradford as the QOF register is falling + not possible to discern new incidents from prevalent cases

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• Point 6 Elective and non-elective Heart Failure admissionsDataset is based on extracts from local admissions, 2009/10ICD-10 code I50 used

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• 633 admissions for Heart Failure in 2009/10 (primary diagnosis only). 28 elective (4.4%), 605 non-elective (95.6%)• Average of 8 admissions per practice, ranging between 0 and 30• Admission rates, based on per 1,000 patients on the HF QOF register, stand at 153 per 1,000• Rates range from 0 to 625 per 1,000 patients on the QOF register• 2,798 admissions where a primary or secondary diagnosis of Heart Failure is recorded. 315 elective (11.3%), 2,483 non-elective (88.7%)• Primary diagnosis of HF accounts for 22.6% of these admissions

Ambulatory Care Sensitive Conditions are relatively stable statistically speaking. 2006/

07 2007/

08 2008/

09 2009/

10 2010/

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2011/12 YTD M3

2011/12

FOT %

CAGR 06-11

Heart Failure 537 598 580 564 539 113 452 4.5% 0.1%

Bradford hospital admission rates for Heart Failure, 2007-2010

0.0

1.0

2.0

3.0

4.0

5.0

6.0

2007/08 2008/09 2009/10

Adm

issi

ons

per

1,00

0

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Summary in numbers

• 4,129 patients on HF register (prevalence = 0.77%)• 6,640 estimated true number (prevalence = 1.2%)• Estimated 2,500 missing patients• 62% population diagnosed• 712 new incidents of HF per year• a practice with 10,000 patients can expect 10 – 13 patients diagnosed a year (depends on age profile)• 633 admissions with a primary diagnosis of HF 28 elective, 605 non-elective. Relatively stable• 2,798 admission primary or secondary diagnosis of HF 315 elective, 2,483 non-elective