Real-world evidence on heart failure: findings from 25 thousand patients in a portuguese primary care database

Background: Heart failure (HF) is a major health problem in developed coun- tries, accounting for a significant social and economic burden. Published estimates of costs associated with HF patients in the primary care setting are scarce. Purpose: To determine the clinical and demographic characteristics of adult patients with a HF diagnosis in a Portuguese primary care comprehen- sive administrative database and to estimate the associated annual costs per patient. Methods: Population-based study with real data covering a population of 3.6 million patients attending primary care services in a large health region in Portugal. All adult users coded for HF with at least one visit in 2014 were selected. We analyzed patients’ characteristics, comorbidities (anemia, diabetes, hypertension, cere- brovascular disease, atrial fibrillation, ischemic heart disease, cardiomyopathies, valve disease, chronic obstructive pulmonary disease, pulmonary embolism, alco- hol abuse), and resource use in 2014 related to medical tests and cardiovascular diagnostic procedures, visits and cardiovascular or anticoagulant medication. Unit costs estimates were based on national sources. Results: We identied 25,337 patients, with an estimated HF prevalence of 1.4%. This is approximately 30% of number expected according to a previously conducted national community-based epidemiological survey. The difference may be explained by both underdiagnosis and underregistration. Patients with HF are mostly women (58%) and on average 77 ± 11 years old. The large majority of patients (93%) had at least one of the selected comorbidities present, 70% had 2 or more and 38% had 3 or more. About two thirds of patients (65%) had at least one medical test or diagnostic procedure done during 2014. Blood tests, echocardiogram, elec- trocardiogram and chest x-ray were performed in 61%, 16%, 14% and 11% of patients, respectively. The majority of patients (56%) had at least four office visits during one year. Angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, beta-blockers, and aldosterone blockers were prescribed for 80%, 48% and 20% of patients, respectively. Only 12% of patients were prescribed all three drug classes. The average annual cost per patient was estimated at €552 ± 348, of which 54%, 40% and 6% was associated to medications, medical visits and medical tests or diagnostic procedures, respectively. Conclusions: This study provides a characterization of patients with HF in a large population in a primary care setting. Surprisingly 70% of the expected number of patients are either not diagnosed or not registered. HF patients are old, mostly women and characterized by multimorbidity. The average annual cost per patient was estimated to be about €550.