CARDIOVASCULAR MEDICINE

National survey of the prevalence, incidence, primary care burden, and treatment of heart failure in Scotland

N F Murphy¹, C R Simpson², F A McAlister³, S Stewart⁴, K MacIntyre⁵, M Kirkpatrick⁶, J Chalmers⁶, A Redpath⁶, S Capewell⁷, J J V McMurray¹

¹ Department of Cardiology, Western Infirmary, Glasgow, UK
² Department of General Practice and Primary Care, University of Aberdeen, Aberdeen, UK
³ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
⁴ Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
⁵ Department of Public Health, University of Glasgow, Glasgow, UK
⁶ Information and Statistics Division, Trinity Park House, Edinburgh, UK
⁷ Department of Public Health, University of Liverpool, Liverpool, UK

Correspondence to:
Correspondence to:
Professor John J V McMurray
Department of Cardiology, Western Infirmary, Glasgow, G11 6NT, UK; j.mcmurray{at}bio.gla.ac.uk

Objective: To examine the epidemiology, primary care burden, and treatment of heart failure in Scotland, UK.

Design: Cross sectional data from primary care practices participating in the Scottish continuous morbidity recording scheme between 1 April 1999 and 31 March 2000.

Setting: 53 primary care practices (307 741 patients).

Subjects: 2186 adult patients with heart failure.

Results: The prevalence of heart failure in Scotland was 7.1 in 1000, increasing with age to 90.1 in 1000 among patients 85 years. The incidence of heart failure was 2.0 in 1000, increasing with age to 22.4 in 1000 among patients 85 years. For older patients, consultation rates for heart failure equalled or exceeded those for angina and hypertension. Respiratory tract infection was the most common co-morbidity leading to consultation. Among men, 23% were prescribed a ß blocker, 11% spironolactone, and 46% an angiotensin converting enzyme inhibitor. The corresponding figures for women were 20% (p = 0.29 versus men), 7% (p = 0.02), and 34% (p < 0.001). Among patients < 75 years 26% were prescribed a ß blocker, 11% spironolactone, and 50% an angiotensin converting enzyme inhibitor. The corresponding figures for patients 75 years were 19% (p = 0.04 versus patients < 75), 7% (p = 0.04), and 33% (p < 0.001).

Conclusions: Heart failure is a common condition, especially with advancing age. In the elderly, the community burden of heart failure is at least as great as that of angina or hypertension. The high rate of concomitant respiratory tract infection emphasises the need for strategies to immunise patients with heart failure against influenza and pneumococcal infection. Drugs proven to improve survival in heart failure are used less frequently for elderly patients and women.

Abbreviations: ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker; CMR, continuous morbidity recording; EPICA, epidemiologia da insuficincia cardiaca a aprendizagen; NHANES, national health and nutrition examination survey; OR, odds ratio

Keywords: heart failure; epidemiology; prescribing; primary care

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