Characterization of heart failure patients at UCLA Health to assess the number of interactions between heart failure patients and their primary care physicians and if this affects the percentage of evidence-based care gaps (i.e. medication adherence, blood pressure management, diet, weight, regular follow-up).
There are at least 5.7 million adults living with heart failure in the United States with 550,000 new cases each year (CDC, 2016). The annual healthcare costs are estimated to be in the billions. Evidence-based approaches, such as the frequency of touch points with health care providers and optimization of evidence-based guidelines have shown to decrease mortality and improve outcomes in patients with heart failure (Yancy et al., 2013). However, it is not known to what extent individuals with heart failure actually receive these interventions in the primary care setting. The purpose of this study is to summarize the current state of heart failure management in primary care settings at UCLA Health.
This study is a secondary analysis of a heart failure database that is used in tracking patients who have two or more diagnosis of heart failure and have seen at one of the clinics or hospitals at UCLA Health from May 2013 to April 2018. The data elements were obtained through a registry that pulls information from the electronic health record (i.e. CareConnect). Descriptive statistics and logistic regression were performed. The study sample is 22985 patients, 12092 males (52.6%) and 10892 females (47.4%), with a mean age of 72.8 (SD 17.2). The dependent variable is the count of most recent ejection fraction (EF) score and covariates include demographic and clinical characteristics of the sample, such as age, gender, race/ethnicity, diagnosis of depression, and count of emergency department (ED) and hospital admissions in the last 6 months.
In a sample of 22985 cases, the count of most recent EF score was identified in 10137 cases (44.1%). From the patients who had an EF on file, there were differences noted between race/ethnicity. The following race/ethnicity categories were tracked: Non-Hispanic White or Caucasian (5590, 53.7%), Hispanic (1241, 10.08%), Black or African American (1248, 9.28%), Asian (798, 7.19%), Native Hawaiian or Pacific Islander (27, 0.22%) and Other (1233, 19.50%). From the total population, 5588 (24.3%) were admitted in the ED and 2829 (12.3%) were admitted to the hospital in the last 6 months.
As the number of heart failure cases increases with the aging population, primary care practices are left with the majority of the responsibility of managing and coordinating care for these patients. Understanding the current evidence-based approaches in primary care settings can improve management and outcomes for patients with heart failure.