Abstract 3104: Heart Failure: Is there an Epidemic? A 17-Year Longitudinal Study on the Incidence, Prevalence and Survival Outcomes
Background Despite concerns of a heart failure ‘epidemic’, long term population trends on the incidence, prevalence and survival outcomes of heart failure (HF) are not well characterized.
Methods The Western Australian Hospital Morbidity Database was used to identify index patients with first-time admissions for HF from 1990 to 2006, with no prior admission for HF since 1 January 1980. Age and gender adjusted temporal trends in HF incidence were examined and Cox-proportional hazards model used to analyse 5-year survival following index admissions, adjusted for significant covariates. Prevalence was calculated at end of each calendar year. Base period used was 1990–1993.
Results There were 70,967 index heart failure (HF) patients identified during 1990–2006, with almost equal distribution between genders. There was a significant downward trend for age and gender-adjusted incidence of HF with average decline of 1.73% (95% CI 1.5%, 1.9%, p=0.001) per year over the 17-year period. Incidence rate reached a peak in 1993 and thereafter there was a steady decline. Compared to the base period, age and gender-adjusted survival at 5-year after index HF admission improved with an absolute survival gain of 6.9% (95% CI 4.3%, 9.4% p=0.001) for 1994–97 period, 9.3% (95% CI 6.7%, 11.9%, p=0.001) for 1998–2001 period and 7.0% (95% CI 4.1%, 9.8%, p=0.001) for 2002– 05 period respectively. Prevalence of HF increased significantly over the different time periods, with a 2.26 fold higher prevalence in 2002–2006 compared to base period. The increase in prevalence was greatest in the 70–79 year age group, with an increase from 200.3 per 10,000 in the base period to 606.0 per 10,000 in 2002–2006.
Conclusions In the last 17 years, incidence of hospitalized HF patients has declined steadily in both genders. However, there has been a marked increase in prevalence of HF due in part to an ageing population and improved HF survival. Management of these chronic elderly HF patients remains a major public health problem.