1 Key points – Heart Failure within Bradford 2011

2 Order of slides 1.Prevalence – diagnosed 2. Prevalence – undiagnosed 3.Other risk factors 4. QOF achievement 5. Incidence 6.Admissions Summary in numbers

3 Point 1 Prevalence of Heart Failure

4 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%)

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

6 Point 2 Underdiagnosis of Heart Failure

7 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, Health Statistics Quarterly 11:

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

9 Point 3 Other risk factors

10 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

11 Point 4 QOF achievement

12 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)

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14 Point 5 New incident cases of Heart Failure

15 *Based on Bridging the quality gap: Heart Failure, Sutherland, March A practice with 10,000 patients would expect to diagnose approximately 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

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

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.

19 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