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QOF not behind falling heart failure admissions, claim researchers

Hospital admissions for heart failure have dropped since the advent of the new GP contract, but are not associated with improving QOF scores for the disease, claim UK researchers.

The study

The researchers studied practice-level admissions rates in England for heart failure between 2004 and 2011. They then correlated this with population factors such as deprivation, race, smoking and CHD prevalence, as well as primary care factors such as practice size, GP supply, access and QOF scores. The heart failure hospital admission data were extracted from the Hospital Episode Statistics (HES) database. Practice level QOF data were obtained from the NHS Information Centre.

The findings

During the seven-year period, the average rate of heart failure admissions were significantly reduced from 6.96 per 100,000 patient population in 2004, to 5.06 per 100,000 in 2010. Increasing deprivation score and practice HF prevalence were associated with increased risk of admission. GP supply was associated with a small reduced risk of admission, with 0.9% reduction in admission rate for each extra GP full-time equivalent/100,000 population. There was a 0.2% reduction in admission rate for every percentage increase in score on the QOF patient experience indicators. QOF attainment on the HF3 indicator did not significantly affect admission risk, nor did smoking prevalence.

What it means for GPs

The authors said their study was the first to explore the reason behind trends in heart failure admission rates. They concluded: ‘Deprivation and high practice prevalence increase the risk of admission for heart failure, whereas a greater GP supply and better access to GPs reduce the risk of admissions. However, despite statistical significance, these effects are small in clinical terms.’ The authors concluded that ‘this study does not provide any support for the hypothesis that in the UK heart failure admissions are sensitive to primary care quality, as currently measured.’

Eur J Heart Failure 2013, online 11 July


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