The clinical epidemiology of heart failure in Western Australia

Research output: ThesisDoctoral Thesis

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Abstract

[Truncated abstract] Aims This thesis investigates the epidemiology, survival and determinants of survival in patients hospitalised with heart failure (HF) in Western Australia (WA), with a view to better inform health policy. The major aims are, firstly, to validate the accuracy of HF coding in the WA Hospital Morbidity Data (HMD) as a whole-of-state linked health data, secondly, to examine temporal trends in incidence, pattern of hospitalisation and survival; thirdly, to examine factors influencing survival in HF patients, including gender differences and ischaemic versus non-ischaemic aetiology of HF. In addition, we assessed if discharge prescription of evidence-based HF medications improved survival in a sub-cohort of index HF patients. Methodology The WA HMD was used to identify a retrospective population-based cohort, with an index hospitalisation for HF as a principal diagnosis between 1990 and 2005. A weighted Charlson comorbidity index (CCI), as a measure of comorbidity burden, was calculated for each patient. Additional comorbidities and interventional procedures, such as percutaneous coronary angioplasty (PTCA) and coronary artery by-pass grafting (CABG), were similarly identified. Furthermore, in a random sample of index HF patients (n=1,006), medical records were reviewed and the diagnosis of HF was assessed against the Boston diagnostic criteria for „definite HF. In addition, biochemical and echocardiography results, and medications prescribed at discharge, were abstracted. Descriptive statistics were used to characterise the study cohort. The principal diagnosis of HF in the WA HMD was compared to the medical chart diagnosis and secondly, to the Boston criteria for concordance in the random sample. Risk-adjusted multivariable models were used to examine 30-day, 1-year and 5-year mortality. Poisson regression models were used to examine rates.
Original languageEnglish
QualificationDoctor of Philosophy
Publication statusUnpublished - 2010

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