Observational studyEuropean journal of heart failure2013
Reducing heart failure admission rates in England 2004-2011 are not related to changes in primary care quality: national observational study.
Observational study in European journal of heart failure, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.
- Which features of primary care affect unscheduled secondary care use? A systematic review.BMJ open · 2014Pooled it
- Plasma galectin 3 and heart failure risk in the Physicians' Health Study.European journal of heart failure · 2014Trial
- Evolving trends and persistent challenges in chronic left ventricular heart failure management: insights from a 9-year analysis of in-hospital outcomes in Germany.Clinical research in cardiology : official journal of the German Cardiac Society · 2026Article
- Quality and outcomes framework achievement and unplanned admissions for cardiovascular disease.BMC health services research · 2025Article
- National trend in heart failure hospitalization and outcome under public health insurance system in Thailand 2008-2013.BMC cardiovascular disorders · 2022Article
- Non-linear association of cystatin C and all-cause mortality of heart failure: A secondary analysis based on a published database.Frontiers in cardiovascular medicine · 2022Article
- The non-linear association between ascending aorta diameter and risk of 12-month mortality in Chinese patients with heart failure: A retrospective cohort study.Frontiers in cardiovascular medicine · 2022Article
- Article
- Hospitalization for acute heart failure: the in-hospital care pathway predicts one-year readmission.Scientific reports · 2020Article
- Prevalence of Hypertension in Cardiovascular Disease in Iran: Systematic Review and Meta-Analysis.International journal of preventive medicine · 2020Review
- Extended opening hours and patient experience of general practice in England: multilevel regression analysis of a national patient survey.BMJ quality & safety · 2017Article
- Emergency hospital admissions for asthma and access to primary care: cross-sectional analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2016Article
- Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis.PLoS medicine · 2016Article
- Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study.BMJ open · 2016Observational
- Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data.BMJ quality & safety · 2016Article
- Risk factors for heart failure in a cohort of patients with newly diagnosed myocardial infarction: a matched, case-control study in Iran.Epidemiology and health · 2016Article
- Much more medicine for the oldest old: trends in UK electronic clinical records.Age and ageing · 2015Observational
- Emergency hospital admissions via accident and emergency departments in England: time trend, conceptual framework and policy implications.Journal of the Royal Society of Medicine · 2014Review
- A qualitative study of a primary-care based intervention to improve the management of patients with heart failure: the dynamic relationship between facilitation and context.BMC family practice · 2014Article
- Estimating smoking prevalence in general practice using data from the Quality and Outcomes Framework (QOF).BMJ open · 2014Observational
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsHeart failure (HF) is an important clinical problem. Expert consensus has defined HF as a primary care-sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. We analysed time trends in HF admission rates in England and risk and protective factors for admission. METHODS AND
resultsWe used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004-2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality ('Quality and Outcomes Framework' indicator.) There were 327,756 HF admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100,000 in 2004 to 5.60/100,000 in 2010 (P < 0.001). Deprivation and HF prevalence were risk factors for admission. GP supply and access protected against admission. However, these effects were small and did not explain the large and highly significant annual trend in falling admission rates.
conclusionsThe observed fall in admissions over time cannot be explained by the primary care covariates we included. This analysis suggests that the potential for further significant reduction in emergency HF admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions.
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