(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
This article has been cited by other articles:
 |
|
 |
|
  N. Derval, L. Barandon, P. Dufourcq, L. Leroux, J.-M. D. Lamaziere, D. Daret, T. Couffinhal, and C. Duplaa Epicardial deposition of endothelial progenitor and mesenchymal stem cells in a coated muscle patch after myocardial infarction in a murine model. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 248 - 254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. MacDonald, M. C. Petrie, N. M. Hawkins, J. R. Petrie, M. Fisher, R. McKelvie, D. Aguilar, H. Krum, and J. J.V. McMurray Diabetes, left ventricular systolic dysfunction, and chronic heart failure Eur. Heart J., May 2, 2008; 29(10): 1224 - 1240. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. F. Lewis, E. J. Velazquez, S. D. Solomon, A. S. Hellkamp, J. J.V. McMurray, J. Mathias, J.-L. Rouleau, A. P. Maggioni, K. Swedberg, L. Kober, et al. Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study Eur. Heart J., March 2, 2008; 29(6): 748 - 756. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Barnes, M. Gott, S. Payne, C. Parker, D. Seamark, S. Gariballa, and N. Small Predicting mortality among a general practice-based sample of older people with heart failure Chronic Illness, March 1, 2008; 4(1): 5 - 12. [Abstract] [PDF]
|
|
|
|
 |
|
 R. C. Myles, C. E. Jackson, I. Tsorlalis, M. C. Petrie, J. J. V. McMurray, and S. M. Cobbe Is Microvolt T-Wave Alternans the Answer to Risk Stratification in Heart Failure? Circulation, December 18, 2007; 116(25): 2984 - 2991. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Banerjee, J. Z. Ma, A. J. Collins, and C. A. Herzog Long-Term Survival of Incident Hemodialysis Patients Who Are Hospitalized for Congestive Heart Failure, Pulmonary Edema, or Fluid Overload Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1186 - 1190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Mosterd and A. W Hoes Clinical epidemiology of heart failure Heart, September 1, 2007; 93(9): 1137 - 1146. [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Peacock, N. F. Murphy, J. J. V. McMurray, L. Caballero, and S. Stewart An epidemiological study of pulmonary arterial hypertension Eur. Respir. J., July 1, 2007; 30(1): 104 - 109. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. F Murphy, C. R Simpson, P. S Jhund, S. Stewart, M. Kirkpatrick, J. Chalmers, K. MacIntyre, and J. J V McMurray A national survey of the prevalence, incidence, primary care burden and treatment of atrial fibrillation in Scotland Heart, May 1, 2007; 93(5): 606 - 612. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Goldberg, J. Ciampa, D. Lessard, T. E. Meyer, and F. A. Spencer Long-term Survival After Heart Failure: A Contemporary Population-Based Perspective Arch Intern Med, March 12, 2007; 167(5): 490 - 496. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Skali, M. A. Pfeffer, J. Lubsen, and S. D. Solomon Variable Impact of Combining Fatal and Nonfatal End Points in Heart Failure Trials Circulation, November 21, 2006; 114(21): 2298 - 2303. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Nieminen, D. Brutsaert, K. Dickstein, H. Drexler, F. Follath, V.-P. Harjola, M. Hochadel, M. Komajda, J. Lassus, J. L. Lopez-Sendon, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population Eur. Heart J., November 2, 2006; 27(22): 2725 - 2736. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. R. van Kimmenade, J. L. Januzzi Jr, P. T. Ellinor, U. C. Sharma, J. A. Bakker, A. F. Low, A. Martinez, H. J. Crijns, C. A. MacRae, P. P. Menheere, et al. Utility of Amino-Terminal Pro-Brain Natriuretic Peptide, Galectin-3, and Apelin for the Evaluation of Patients With Acute Heart Failure J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1217 - 1224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Monte, A. Macchia, F. Pellegrini, M. Romero, V. Lepore, A. D'Ettorre, M. Saugo, L. Tavazzi, and G. Tognoni Antithrombotic treatment is strongly underused despite reducing overall mortality among high-risk elderly patients hospitalized with atrial fibrillation Eur. Heart J., September 2, 2006; 27(18): 2217 - 2223. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Smit, P. F.H.M. Van Dessel, M. Rienstra, W. Nieuwland, A. C.P. Wiesfeld, E. S. Tan, R. L. Anthonio, D. J. Van Veldhuisen, and I. C. Van Gelder Atrial fibrillation predicts appropriate shocks in primary prevention implantable cardioverter-defibrillator patients. Europace, August 1, 2006; 8(8): 566 - 572. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Silke Beta-blockade in CHF: pathophysiological considerations Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C13 - C18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. R. Davis, L. B. Piller, J. A. Cutler, C. Furberg, K. Dunn, S. Franklin, D. Goff, F. Leenen, S. Mohiuddin, V. Papademetriou, et al. Role of Diuretics in the Prevention of Heart Failure: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Circulation, May 9, 2006; 113(18): 2201 - 2210. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Eschenhagen, W. H. Zimmermann, and A. G. Kleber Electrical Coupling of Cardiac Myocyte Cell Sheets to the Heart Circ. Res., March 17, 2006; 98(5): 573 - 575. [Full Text] [PDF]
|
|
|
|
|
|
W. H. Barker, J. P. Mullooly, and W. Getchell Changing Incidence and Survival for Heart Failure in a Well-Defined Older Population, 1970-1974 and 1990-1994 Circulation, February 14, 2006; 113(6): 799 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Lenzen, E. Boersma, W. J.M. Scholte op Reimer, A. H.M.M. Balk, M. Komajda, K. Swedberg, F. Follath, M. Jimenez-Navarro, M. L. Simoons, and J. G.F. Cleland Under-utilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: a report from the Euro Heart Survey on Heart Failure Eur. Heart J., December 2, 2005; 26(24): 2706 - 2713. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Gemmell, R F Heller, P McElduff, K Payne, G Butler, R Edwards, M Roland, and P Durrington Population impact of stricter adherence to recommendations for pharmacological and lifestyle interventions over one year in patients with coronary heart disease J. Epidemiol. Community Health, December 1, 2005; 59(12): 1041 - 1046. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Grigorian Shamagian, J. R. Gonzalez-Juanatey, A. V. Roman, J. M. G. Acuna, and A. V. Lamela The death rate among hospitalized heart failure patients with normal and depressed left ventricular ejection fraction in the year following discharge: evolution over a 10-year period Eur. Heart J., November 1, 2005; 26(21): 2251 - 2258. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. S. Lee, J. V. Tu, D. N. Juurlink, D. A. Alter, D. T. Ko, P. C. Austin, A. Chong, T. A. Stukel, D. Levy, and A. Laupacis Risk-Treatment Mismatch in the Pharmacotherapy of Heart Failure JAMA, September 14, 2005; 294(10): 1240 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C Berry, K Hogg, J Norrie, K Stevenson, M Brett, and J McMurray Heart failure with preserved left ventricular systolic function: a hospital cohort study Heart, July 1, 2005; 91(7): 907 - 913. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. T. Yan, R. T. Yan, and P. P. Liu Narrative Review: Pharmacotherapy for Chronic Heart Failure: Evidence from Recent Clinical Trials Ann Intern Med, January 18, 2005; 142(2): 132 - 145. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Unal, J. A. Critchley, D. Fidan, and S. Capewell Life-Years Gained From Modern Cardiological Treatments and Population Risk Factor Changes in England and Wales, 1981-2000 Am J Public Health, January 1, 2005; 95(1): 103 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-J. Blanc, M. Fatemi, V.ér. Bertault, F. Baraket, and Y. Etienne Evaluation of left bundle branch block as a reversible cause of non-ischaemic dilated cardiomyopathy with severe heart failure. A new concept of left ventricular dyssynchrony-induced cardiomyopathy Europace, January 1, 2005; 7(6): 604 - 610. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J.V. McMurray and M. A. Pfeffer The year in heart failure J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2398 - 2405. [Full Text] [PDF]
|
|
|
|
|
|
J. B. Young, M. E. Dunlap, M. A. Pfeffer, J. L. Probstfield, A. Cohen-Solal, R. Dietz, C. B. Granger, J. Hradec, J. Kuch, R. S. McKelvie, et al. Mortality and Morbidity Reduction With Candesartan in Patients With Chronic Heart Failure and Left Ventricular Systolic Dysfunction: Results of the CHARM Low-Left Ventricular Ejection Fraction Trials Circulation, October 26, 2004; 110(17): 2618 - 2626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gustafsson, C. Torp-Pedersen, M. Seibaek, H. Burchardt, L. Kober, and for the DIAMOND study group Effect of age on short and long-term mortality in patients admitted to hospital with congestive heart failure Eur. Heart J., October 1, 2004; 25(19): 1711 - 1717. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Barandon, T. Couffinhal, P. Dufourcq, P. Alzieu, D. Daret, C. Deville, and C. Duplaa Repair of Myocardial Infarction by Epicardial Deposition of Bone Marrow Cell-Coated Muscle Patch in a Murine Model Ann. Thorac. Surg., October 1, 2004; 78(4): 1409 - 1417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kimmelstiel, D. Levine, K. Perry, A. R. Patel, A. Sadaniantz, N. Gorham, M. Cunnie, L. Duggan, L. Cotter, P. Shea-Albright, et al. Randomized, Controlled Evaluation of Short- and Long-Term Benefits of Heart Failure Disease Management Within a Diverse Provider Network: The SPAN-CHF Trial Circulation, September 14, 2004; 110(11): 1450 - 1455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. McAlister, J. A. Ezekowitz, N. Wiebe, B. Rowe, C. Spooner, E. Crumley, L. Hartling, T. Klassen, and W. Abraham Systematic Review: Cardiac Resynchronization in Patients with Symptomatic Heart Failure Ann Intern Med, September 7, 2004; 141(5): 381 - 390. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Critchley, J. Liu, D. Zhao, W. Wei, and S. Capewell Explaining the Increase in Coronary Heart Disease Mortality in Beijing Between 1984 and 1999 Circulation, September 7, 2004; 110(10): 1236 - 1244. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gustafsson and J. M. O. Arnold Heart failure clinics and outpatient management: review of the evidence and call for quality assurance Eur. Heart J., September 2, 2004; 25(18): 1596 - 1604. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Bleumink, A. M. Knetsch, M. C.J.M. Sturkenboom, S. M.J.M. Straus, A. Hofman, J. W. Deckers, J. C.M. Witteman, and B. H.Ch. Stricker Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure: The Rotterdam Study Eur. Heart J., September 2, 2004; 25(18): 1614 - 1619. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. McAlister, S. Stewart, S. Ferrua, and J. J.J.V. McMurray Multidisciplinary strategies for the management of heart failure patients at high risk for admission: A systematic review of randomized trials J. Am. Coll. Cardiol., August 18, 2004; 44(4): 810 - 819. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 F A McAlister, N F Murphy, C R Simpson, S Stewart, K MacIntyre, M Kirkpatrick, J Chalmers, A Redpath, S Capewell, and J J V McMurray Influence of socioeconomic deprivation on the primary care burden and treatment of patients with a diagnosis of heart failure in general practice in Scotland: population based study BMJ, May 8, 2004; 328(7448): 1110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 F. Formiga, D. Chivite, N. Manito, V. Osma, S. Miravet, and R. Pujol One-year follow-up of heart failure patients after their first admission QJM, February 1, 2004; 97(2): 81 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 P. Le Corvoisier, H.-Y. Park, K. M. Carlson, D. A. Marchuk, and H. A. Rockman Multiple quantitative trait loci modify the heart failure phenotype in murine cardiomyopathy Hum. Mol. Genet., December 1, 2003; 12(23): 3097 - 3107. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|
|
|
 |
|
 C. Schalcher, H. Rickli, M. Brehm, D. Weilenmann, E. Oechslin, W. Kiowski, and H. P. Brunner-La Rocca Prolonged Oxygen Uptake Kinetics During Low-Intensity Exercise Are Related to Poor Prognosis in Patients With Mild-to-Moderate Congestive Heart Failure Chest, August 1, 2003; 124(2): 580 - 586. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
D. H. Kim and S. A. Hunt Heart Failure Management: Caregiver Versus Care Plan Circulation, July 15, 2003; 108(2): 129 - 131. [Full Text] [PDF]
|
|
|
|
|
|
J. A. Critchley and S. Capewell Mortality Risk Reduction Associated With Smoking Cessation in Patients With Coronary Heart Disease: A Systematic Review JAMA, July 2, 2003; 290(1): 86 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B Unal, J A Critchley, and S Capewell Missing, mediocre, or merely obsolete? An evaluation of UK data sources for coronary heart disease J. Epidemiol. Community Health, July 1, 2003; 57(7): 530 - 535. [Abstract] [Full Text] [PDF]
|
|
|
|
|