(Circulation. 2000;102:1126.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
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
BackgroundContemporary 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 ResultsIn 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.
ConclusionsHeart 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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