HEART FAILURE PREVALENCE

Localised heart failure prevalence has been calculated by applying the age-specific estimates of heart failure crude prevalence from The Lancet article by Conrad et al. (2018)¹, "Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals" to ICS populations.²

For example, if there are 120,000 people aged 65-69 in an ICS, it is assumed that 2.55% of them will have heart failure which equals to 3,060 patients. This is repeated for all age groups and aggregated together at ICS level.

Heart failure prevalence is presented at four time points:

• 2002 (i.e historic prevalence) using 2002 benchmarks in Conrad et al. (2018)¹ and ONS Mid-2002 Population Estimates for ICSs³
• 2020 (i.e. latest prevalence) using 2014 benchmarks in Conrad et al. (2018)¹ and ONS Mid-2020 Population Estimates for ICSs⁴
• 2030 (i.e. projected prevalence) using 2014 benchmarks in Conrad et al. (2018)¹ and ONS 2018-based Subnational Population Projections⁵

National average prevalence figures are presented - these represent the average per organisation within England.

An 'average-sized ICS’ in England has been defined here as the mean population size of all ICSs in England. This has been calculated by dividing the total England population (using ONS Mid-2020 Population Estimates for CGGs aggregated to ICS level) by the number of ICSs in England.

HOSPITAL ADMISSIONS

A count of the number of hospital admissions where heart failure has been recorded as either a primary or secondary diagnosis in the admission episode, defined using the following ICD-10 codes:⁶

'I110 - Hypertensive heart disease with (congestive) heart failure

'I255 - Ischaemic cardiomyopathy

'I420 - Dilated cardiomyopathy

'I429 - Cardiomyopathy, unspecified

'I500 - Congestive heart failure

'I501 - Left ventricular failure

'I509 - Heart failure, unspecified

Data is split by diagnosis position, admission method (elective or non-elective), gender and broad age group. Trend data for five years (2016/2017 to 2020/2021) is also presented alongside the percentage change over the five-year period.

Readmissions are defined as non-elective admissions to hospital within 28 days of a patient's discharge where heart failure was a primary diagnosis in their initial (i.e. preceding) admission and is recorded in any diagnosis position in their readmission (i.e. the subsequent admission).

The average number of hospital admissions per ICS in England has been calculated by dividing the total number of hospital admissions where heart failure has been recorded as either a primary or secondary diagnosis in England in 2020/21, by the number of ICSs in England.

COSTS

The data in this section shows the indicative cost of hospital admissions where heart failure has been recorded as either a primary or secondary diagnosis in the admission episode. Cost have been calculated using the National Tariff Payment System 2020/21⁷ based on HRG code, admission method and length of stay. A Market Forces Factor (MFF) has been applied.^*

Data has been split by admission (elective or non-elective), gender and broad age group.

^*A Market Forces Factor is the percentage uplift to the tariff, depending on where in England the NHS Trust is based. It estimates the unavoidable cost differences between healthcare providers in different parts of the country.

The average cost of hospital admissions per ICS in England has been calculated by dividing the total cost of hospital admissions where heart failure has been recorded as either a primary or secondary diagnosis in England in 2020/21, by the number of ICSs in England.

MORTALITY

Mortality in heart failure patients is represented within the map by data drawn from CCG Outcome Indicator "1.21 All-cause mortality – 12 months following a first emergency admission to hospital for heart failure in people aged 16 and over".⁸

The map shows the number of recorded deaths from any cause in the 12 months following the first hospital attendance of an individual with a recorded primary diagnosis of heart failure, covering the period April 2016 to March 2019 (inclusive).

The ‘indicator value’ is calculated as a ratio indirectly standardised by age and sex (England has a ratio of 100). The figure sets out the standardised mortality rate of expected heart failure deaths in a local area, based on the demographic composition and associated benchmarks of specific gender-age groups. The figure is based against the number of deaths due to heart failure recorded at a national level during this period.

Because this indicator uses indirect standardisation it is not appropriate to make year-on-year comparisons or to compare ICSs with other ICSs. ICSs should only be compared to the national figure within the same reporting period.

ICS data has been calculated by aggregating CCG level data up to ICS based on hierarchical mapping produced by the Organisation Data Service (ODS). This hierarchy is also validated against the Wilmington Healthcare customer database to ensure accuracy. The Indicator Values at ICS level have been calculated by weighting the CCG Indicator Values based on denominators provided by NHS Digital.

HEART FAILURE PREVALENCE

Localised heart failure prevalence has been calculated by applying age-specific estimates of heart failure crude prevalence from The Lancet article by Conrad et al. (2018), “Temporal trends and patterns in heart failure incidence: a population- based study of 4 million individuals” to Health Board and national populations from the Mid-2021 Population Estimates Scotland published by NRS.^1,2

For example, if there are 120,000 people aged 65-69 in a Health Board, it is assumed that 2.55% of them will have heart failure which equals to 3,060 patients. This is repeated for all age groups and aggregated together at Health Board and national level.

Heart failure prevalence is presented at three time points:

• 2002 (i.e. historical prevalence) using 2002 benchmarks in Conrad et al. (2018) and mid-2002 population estimates as published in NRS Mid-2021 Population Estimates Scotland: Time Series Data³
• 2021 (i.e. current prevalence) using 2014 benchmarks in Conrad et al. (2018) and NRS Mid-2021 Population Estimates Scotland²
• 2030 (i.e. projected prevalence) using 2014 benchmarks in Conrad et al. (2018) and mid-2030 population projections as published in NRS 2018-based Principal Population Projections for 2018-2043⁴

National average prevalence figures are presented - these represent the average per organisation within Scotland.

HOSPITAL ADMISSIONS

Hospital activity data has been taken from Public Health Scotland’s ‘Scottish heart disease statistics’ to the year ending 31st March 2022. It includes heart failure inpatient and daycase discharges, defined using the following ICD-10 code:

• 150 - Heart Failure

Data is split by diagnosis position, admission method (emergency or elective), gender, broad age group, and covers the period from 2017-22. Elective admissions include:

• Routine Admission
• Routine elective (i.e. from waiting list as planned, excludes planned transfers)
• Patient admitted on day of decision to admit, or following day, not for medical reasons, but because suitable resources are available
• Routine Admission, type not known

Planned transfer episodes for heart failure (SMRO1) are generated under the following circumstances:

• Inpatients and day cases change specialty in the same hospital (with or without a change of consultant)
• Inpatients move into and/or out of another valid significant facility
• Inpatients return to hospital having been temporality absent from the ward by arrangement (on pass) such as after being allowed to go home temporarily or after being transferred to another hospital

Emergency admissions include:

• Urgent Admission, no additional detail added
• Patient delay (for domestic, legal or other practical reasons)
• Hospital delay (for administrative or clinical reasons e.g. arranging appropriate facilities, for test to be carried out, specialist equipment, etc.)
• Emergency Admission, no additional detail added
• Patient Injury - Self Inflicted (Injury or Poisoning)
• Patient Injury - Road Traffic Accident (RTA)
• Patient Injury - Home Incident (including Assault or Accidental Poisoning in the home)
• Patient Injury - Incident at Work (including Assault or Accidental Poisoning at work)
• Patient Injury - Other Injury (inc. Accidental Poisoning other than in the home) - not elsewhere classified
• Patient Non-Injury (e.g. stroke, MI, Ruptured Appendix)
• Other Emergency Admission (including emergency transfers)
• Emergency Admission, type not known

The age-sex standardised discharge rate takes account of the changes in age structure of the population being analysed.

The age-sex standardised rates were calculated using the direct method, standardised to the 2013 European Standard Population (ESP2013).

MORTALITY

Heart Failure Mortality data is taken from Public Health Scotland’s ‘Scottish heart disease statistics’ to the year ending 31st March 2022. The number of deaths is based on the date of registration and main cause of death, defined using the following ICD-10 code:

• I50 – Heart Failure

Data is split by gender, broad age groups and covers the period from 2017-2021.

The age-sex standardised mortality rate takes account of the changes in age structure of the population being analysed.

The age-sex standardised rates were calculated using the direct method, standardised to the 2013 European Standard Population (ESP2013).

INCIDENCE

Heart failure incidence data is taken from Public Health Scotland’s ‘Scottish heart disease statistics to the year ending 31st March 2022. The incidence number includes new hospital cases and deaths. It is screened back to exclude those with no similar previous admissions within 10 years, defined using the following ICD-10 code:

• I50 – Heart Failure

Data is split by gender and broad age groups and covers the period from 2017-2022.

The age-sex standardised incidence rate takes account of the changes in age structure of the population being analysed.

The age-sex standardised rates were calculated using the direct method, standardised to the 2013 European Standard Population (ESP2013).

It is important to note that this map presents a mixture of ‘actual’ and ‘estimated’ heart failure data, as well as data drawn from different time periods. Further information on the data included within each individual map section is set out in the supporting methodologies above.

'Actual' data

The following data presented in the map are based on actual recorded data:

• Population data (published by the Office for National Statistics and the National Records of Scotland)
• Hospital admission data (published by NHS Digital and Public Health Scotland)
• Mortality data (published by NHS Digital and Public Health Scotland)
• Incidence data (Published by Public Health Scotland)

'Estimated' data

Local heart failure prevalence data included in the map are estimates which are based on the heart failure crude prevalence figures established from Conrad et al. (2018)¹ ,which are given at age group level. These estimates have been applied to local Integrated Care System (ICS) and Health Board populations based on their age structures.

Indicative heart failure-related costs included within the map have been calculated using the National Tariff Payment System 2020/21 and are based on the Healthcare Resource Group (HRG) code, admission method and length of stay of each recorded hospital admission.

Map data time periods

Datasets included within the map are based on the following time points:

• Crude prevalence estimates from Conrad et al. (2018)¹ are based on 2014 populations
• Hospital admission data are taken from HES 2020/21 and PHS 2021/22
• Mortality data from NHS Digital covers the entire period April 2016 to March 20202020, whilst mortality data from Public Health Scotland covers the period from April 2017 to March 2021
• Incidence data are taken from PHS 2021/22