(Circulation. 2000;102:1126.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Evidence of Improving Prognosis in Heart Failure
Trends in Case Fatality in 66 547 Patients Hospitalized Between 1986 and 1995
From the Department of Public Health (K.M., S.C., S.S.), University of Glasgow, Glasgow, UK; Information and Statistics Division (J.W.T.C., J.B., A.F., A.R.), Edinburgh, UK; Greater Glasgow Health Board (J.P.P.), Glasgow, UK; and the Department of Cardiology (J.J.V.M.), Western Infirmary, Glasgow, UK.
Correspondence to Professor John J.V. McMurray, CRI in Heart Failure, Wolfson Building, University of Glasgow, Glasgow G12 8QQ, UK. E-mail j.mcmurray{at}bio.gla.ac.uk
Background—Contemporary survival in unselected patients with heart failure and the population impact of newer therapies have not been widely studied. Therefore, we have documented case-fatality rates (CFRs) over a recent 10-year period.
Methods and Results—In Scotland, all hospitalizations and deaths are captured on a single database. We have studied case fatality in all patients admitted with a principal diagnosis of heart failure from 1986 to 1995. A total of 66 547 patients (47% male) were studied. Median age was 72 years in men and 78 years in women. Crude CFRs at 30 days and at 1, 5, and 10 years were 19.9%, 44.5%, 76.5%, and 87.6%, respectively. Median survival was 1.47 years in men and 1.39 years in women (2.47 and 2.36 years, respectively, in those surviving 30 days). Age had a powerful effect on survival, and sex, comorbidity, and deprivation had modest effects. One-year CF was 24.2% in those aged <55 years and 58.1% in those aged >84 years. After adjustment, 30-day CFRs fell between 1986 and 1995, by 26% (95% CI 15 to 35, P<0.0001) in men and 17% (95% CI 6 to 26, P<0.0001) in women. Longer term CFRs fell by 18% (95% CI 13 to 24, P<0.0001) in men and 15% (95% CI 10 to 20, P<0.0001) in women. Median survival increased from 1.23 to 1.64 years.
Conclusions—Heart failure CF is much higher in the general population than in clinical trials, especially in the elderly. Although survival has increased significantly over the last decade, there is still much room for improvement.
Key Words: heart failure • prognosis • population • epidemiology • survival
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J. Muntwyler, A. Cohen-Solal, N. Freemantle, J. Eastaugh, J. G. Cleland, and F. Follath Relation of sex, age and concomitant diseases to drug prescription for heart failure in primary care in Europe Eur J Heart Fail, August 1, 2004; 6(5): 663 - 668. [Abstract] [Full Text] [PDF]
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V. L. Roger, S. A. Weston, M. M. Redfield, J. P. Hellermann-Homan, J. Killian, B. P. Yawn, and S. J. Jacobsen Trends in Heart Failure Incidence and Survival in a Community-Based Population JAMA, July 21, 2004; 292(3): 344 - 350. [Abstract] [Full Text] [PDF]
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I. Gustafsson, B. Brendorp, M. Seibaek, H. Burchardt, P. Hildebrandt, L. Kober, C. Torp-Pedersen, and DIAMOND Study Group Influence of diabetes and diabetes-gender interaction on the risk of death in patients hospitalized with congestive heart failure J. Am. Coll. Cardiol., March 3, 2004; 43(5): 771 - 777. [Abstract] [Full Text] [PDF]
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F. A. McAlister, J. Ezekowitz, M. Tonelli, and P. W. Armstrong Renal Insufficiency and Heart Failure: Prognostic and Therapeutic Implications From a Prospective Cohort Study Circulation, March 2, 2004; 109(8): 1004 - 1009. [Abstract] [Full Text] [PDF]
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S Stewart, N Murphy, A Walker, A McGuire, and J J V McMurray Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK Heart, March 1, 2004; 90(3): 286 - 292. [Abstract] [Full Text] [PDF]
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M. Metra, S. Nodari, and L. Dei Cas Current guidelines in the pharmacological management of chronic heart failure Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1_suppl): S11 - S16. [Abstract] [PDF]
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M. T. Kearney and M. Marber Trends in incidence and prognosis of heart failure: You always pass failure on the way to success Eur. Heart J., February 2, 2004; 25(4): 283 - 284. [Full Text] [PDF]
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M. Schaufelberger, K. Swedberg, M. Koster, M. Rosen, and A. Rosengren Decreasing one-year mortality and hospitalization rates for heart failure in Sweden: Data from the Swedish Hospital Discharge Registry 1988 to 2000 Eur. Heart J., February 2, 2004; 25(4): 300 - 307. [Abstract] [Full Text] [PDF]
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F. Gustafsson, C. Torp-Pedersen, H. Burchardt, P. Buch, M. Seibaek, E. Kjoller, I. Gustafsson, L. Kober, and for the DIAMOND Study group Female sex is associated with a better long-term survival in patients hospitalized with congestive heart failure Eur. Heart J., January 2, 2004; 25(2): 129 - 135. [Abstract] [Full Text] [PDF]
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G Lyratzopoulos and R F Heller Prognosis for South Asian and white patients with heart failure in the United Kingdom: Deprivation gradient in mortality should not be dismissed as artefactual BMJ, December 13, 2003; 327(7428): 1406 - 1406. [Full Text]
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I. Squire, J. Newton, and H. Blackledge Prognosis for South Asian and white patients with heart failure in the United Kingdom: Authors' reply BMJ, December 13, 2003; 327(7428): 1406 - 1406. [Full Text]
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E. C. Vourvouri, A. F.L. Schinkel, J. R.T.C. Roelandt, F. Boomsma, G. Sianos, M. Bountioukos, F. B. Sozzi, V. Rizzello, J. J. Bax, H. I. Karvounis, et al. Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device Eur J Heart Fail, December 1, 2003; 5(6): 767 - 774. [Abstract] [Full Text] [PDF]
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L. L. Ng, I. Loke, J. E. Davies, K. Khunti, M. Stone, K. R. Abrams, D. T. Chin, and I. B. Squire Identification of previously undiagnosed left ventricular systolic dysfunction: community screening using natriuretic peptides and electrocardiography Eur J Heart Fail, December 1, 2003; 5(6): 775 - 782. [Abstract] [Full Text] [PDF]
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K. Muller, G. Gamba, F. Jaquet, and B. Hess Torasemide vs. furosemide in primary care patients with chronic heart failure NYHA II to IV--efficacy and quality of life Eur J Heart Fail, December 1, 2003; 5(6): 793 - 801. [Abstract] [Full Text] [PDF]
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D. S. Lee, P. C. Austin, J. L. Rouleau, P. P. Liu, D. Naimark, and J. V. Tu Predicting Mortality Among Patients Hospitalized for Heart Failure: Derivation and Validation of a Clinical Model JAMA, November 19, 2003; 290(19): 2581 - 2587. [Abstract] [Full Text] [PDF]
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H. M Blackledge, J. Newton, and I. B Squire Prognosis for South Asian and white patients newly admitted to hospital with heart failure in the United Kingdom: historical cohort study BMJ, September 6, 2003; 327(7414): 526 - 531. [Abstract] [Full Text] [PDF]
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T P Ng and M Niti Trends and ethnic differences in hospital admissions and mortality for congestive heart failure in the elderly in Singapore, 1991 to 1998 Heart, August 1, 2003; 89(8): 865 - 870. [Abstract] [Full Text] [PDF]
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R. J. O'Brien, I. B. Squire, B. Demme, J. E. Davies, and L. L. Ng Pre-discharge, but not admission, levels of NT-proBNP predict adverse prognosis following acute LVF Eur J Heart Fail, August 1, 2003; 5(4): 499 - 506. [Abstract] [Full Text] [PDF]
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