Changing heart failure definition may lead to spike in diagnoses: RACGP

The National Heart Foundation of Australia (NHF) and Cardiac Society of Australia and New Zealand (CSANZ) are proposing to expand the definition of heart failure from an ejection fraction of below 40% to below 50% in their 2018 Guidelines for the prevention, detection and management of chronic heart failure in Australia.
 
The RACGP, however, has raised concerns that the proposed expansion lacks the necessary evidence to support the proposed change, which it believes may lead to a significant spike in diagnoses.
 
‘It appears the rate [of diagnosis] could greatly increase,’ the RACGP stated in a submission to the NHF and CSANZ.
 
‘The RACGP understands there is ongoing difficulty in establishing the diagnosis of heart failure with preserved ejection fraction, but this change will significantly widen the definition of heart failure with reduced ejection fraction. Importantly, there is no evidence provided in the guidelines to show that the new definition of heart failure will be able to predict clinically important outcomes, compared with the old definition.
 
‘Significantly, the incremental harm for patients under this new definition of heart failure is not discussed, neither is the net benefit and harms to patients.’
 
The submission comes as the NHF and CSANZ are updating their 2011 guidelines on heart failure.
 
An estimated 111,000 adult Australians are living with heart failure as of 2014–15 – around 0.6% of the adult population, according to the ABS Adult Health Survey. Two thirds of adults with heart failure are aged 65 or more.
 
The proposed new guidelines state that heart failure with preserved ejection fraction has less well defined pathophysiology.
 
‘Its wide acceptance as a true syndromic entity remained under question until relatively recently. It is accepted that this condition is a major source of heart failure morbidity, seen in typically comorbid and older patients,’ the proposed guidelines state.
 
‘This ongoing pathophysiologic uncertainty has undoubtedly contributed to the lack of treatment success for this common condition.’

Email qualitycare@racgp.org.au for more information.

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