Clinical focus 146 MJA 201 (3) · 4 August 2014 Karen Page RN, DN, BEd National Manager, Health Equity and Secondary Prevention 1 Thomas H Marwick MB BS, PhD, MPH Director 2 Rebecca Lee BPharm, MPH Project Officer, Health Equity and Secondary Prevention 1 Robert Grenfell MB BS, MPH, FAFPHM National Director, Cardiovascular Health 1 Walter P Abhayaratna FRACP, FACC, DrPH Cardiologist and Director of Clinical Trials 3 Anu Aggarwal MB BS, FRACP, PhD Cardiologist 4 Tom G Briffa PhD Researcher 5 Jan Cameron PhD, MHSc(Health Prom&HealthEd), BN Senior Research Fellow 6 Patricia M Davidson RN, PhD Director 7 Andrea Driscoll PhD Associate Professor 8 Jacquie Garton-Smith MB BS, FRACGP Clinical Lead 9 Debra J Gascard BN, MNP, NP Chronic Disease – Heart Failure Nurse Practitioner 10 Annabel Hickey MMSc(ClinEpi), BApp(OT) Statewide Heart Failure Services Coordinator 11 Dariusz Korczyk FRACP, FCSANZ Cardiologist 12 Julie-Anne Mitchell MPH, BA, RN Cardiovascular Health Director 13 Rhonda Sanders RN, MNSt Clinical Nurse Consultant and Representative of Australian College of Critical Care Nursing 14 Guidelines Summary  The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF.  Best-practice management of CHF involves evidence- based, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this.  Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically diverse populations.  Lack of data and inadequate identification of people with CHF prevents eicient patient monitoring, limiting information to improve or optimise care. This leads to ineffectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential.  As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing.  To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically diverse populations.  Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high- quality evidence into practice. A systematic approach to chronic heart failure care: a consensus statement C hronic heart failure (CHF) remains a major pub- lic health problem. CHF is not a static syndrome; individuals with CHF are at high risk of progres- sive cardiac dysfunction resulting in either sudden car- diac death or acute hospitalisation. Despite signi icant advances in CHF management, clinical outcomes are poor and associated with escalating health care costs. 1 Worldwide, there are an estimated 23 million people liv- ing with CHF and 5.7 million new cases each year. 2 With limited Australian data available, the Australian Institute of Health and Welfare has used overseas rates to suggest that 30 000 patients are diagnosed with incident heart failure annually and 300 000 people are living with CHF in Australia. 3 The prevalence of CHF continues to rise as the population ages and survival from cardiovascular disease continues to improve. Between 2006 and 2011, deaths from CHF in Australia rose by 20%. 4 CHF prognosis remains poorer than that for common forms of cancer (in terms of individual sur- vival and population life-years lost) for men and women. 5,6 5,6 Hospital separations for CHF increased by 24% between 2002–03 and 2011–12. 7 In the 2007–08 inancial year, CHF was a primary diagnosis in 45 212 hospitalisations and a contributory diagnosis in 94 599 hospitalisations. 8 The annual cost of CHF in Australia has been estimated at over $1 billion per year, with hospital care being the largest expenditure. 9 A signi icant proportion of this cost is asso- ciated with preventable CHF readmissions. Readmissions within 30 days of discharge can be as high as 20%–27%. 10,11 10,11 Overall, reported rates for readmission with CHF within 3–12 months of initial discharge are between 29% and 49%. 12,13 12,13 Given the high rate of readmissions, there is profound potential to improve CHF-related outcomes, at both indi- vidual and societal levels, through improved quality of care and system change. 14 14 Practice gaps Recent studies have highlighted signi icant variations in access to evidence-based care for patients with CHF. 15-17 15-17 Many individuals are not diagnosed in a timely manner and subsequent management is suboptimal. Initial diagnostic delay is often due to under-recognition of early heart failure symptoms. This is compounded by limited availability of public sector services, particularly in rural and remote areas. Additionally, patient data are not shared across health ser- vices, largely due to lack of integrated information systems and care coordination. These problems are ampli ied among marginalised popu- lations. CHF is 1.7 times more common, and occurs at a younger age, among Aboriginal and Torres Strait Islander peoples than among other Australians. 18 18 Aboriginal and Torres Strait Islander peoples are also more likely to die from CHF, and their rate of preventable CHF-related hos- pitalisations is three times higher than for non-Indigenous Australians. 18 18 Such health disparities frequently occur due to poor access to evidence-based care. Availability