Medline ® Abstracts for References 2-8
of 'Prognosis of heart failure'
Survival of patients with a new diagnosis of heart failure: a population based study.
Cowie MR, Wood DA, Coats AJ, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC
OBJECTIVE: To describe the survival of a population based cohort of patients with incident (new) heart failure and the clinical features associated with mortality.
DESIGN: A population based observational study.
SETTING: Population of 151 000 served by 82 general practitioners in west London.
PATIENTS: New cases of heart failure were identified by daily surveillance of acute hospital admissions to the local district general hospital, and by general practitioner referral of all suspected new cases of heart failure to a rapid access clinic.
INTERVENTIONS: All patients with suspected heart failure underwent clinical assessment, and chest radiography, ECG, and echocardiogram were performed. A panel of three cardiologists reviewed all the data and determined whether the definition of heart failure had been met. Patientswere subsequently managed by the general practitioner in consultation with the local cardiologist or admitting physician.
MAIN OUTCOME MEASURES: Death, overall and from cardiovascular causes.
RESULTS: There were 90 deaths (83 cardiovascular deaths) in the cohort of 220 patients with incident heart failure over a median follow up of 16 months. Survival was 81% at one month, 75% at three months, 70% at six months, 62% at 12 months, and 57% at 18 months. Lower systolic blood pressure, higher serum creatinine concentration, and greater extent of crackles on auscultation of the lungs were independently predictive of cardiovascular mortality (all p<0.001).
CONCLUSIONS: In patients with new heart failure, mortality is high in the first few weeks after diagnosis. Simple clinical features can identify a group of patients at especially high risk of death.
Cardiac Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London SW3, UK. firstname.lastname@example.org
Survival after the onset of congestive heart failure in Framingham Heart Study subjects.
Ho KK, Anderson KM, Kannel WB, Grossman W, Levy D
BACKGROUND: Relatively limited epidemiological data are available regarding the prognosis of congestive heart failure (CHF) and temporal changes in survival after its onset in a population-based setting.
METHODS AND RESULTS: Proportional hazards models were used to evaluate the effects of selected clinical variables on survival after the onset of CHF among 652 members of the Framingham Heart Study (51% men; mean age, 70.0 +/- 10.8 years) who developed CHF between 1948 and 1988. Subjects were older at the diagnosis of heart failure in the later decades of this study (mean age at heart failure diagnosis, 57.3 +/- 7.6 years in the 1950s, 65.9 +/- 7.9 years in the 1960s, 71.6 +/- 9.4 years in the 1970s, and 76.4 +/- 10.0 years in the 1980s; p<0.001). Median survival after the onset of heart failure was 1.7 years in men and 3.2 years in women. Overall, 1-year and 5-year survival rates were 57% and 25% in men and 64% and 38% in women, respectively. Survival was better in women than in men (age-adjusted hazards ratio for mortality, 0.64; 95% CI, 0.54-0.77). Mortality increased with advancing age in both sexes (hazards ratio for men, 1.27 per decade of age; 95% CI, 1.09-1.47; hazards ratio for women, 1.61 per decade of age; 95% CI, 1.37-1.90). Adjusting for age, there was no significant temporal change in the prognosis of CHF during the 40 years of observation (hazards ratio for men for mortality, 1.08 per calendar decade; 95% CI, 0.92-1.27; hazards ratio for women for mortality, 1.02 per calendar decade; 95% CI, 0.83-1.26).
CONCLUSIONS: CHF remains highly lethal, with better prognosis in women and in younger individuals. Advances in the treatment of hypertension, myocardial ischemia, and valvular heart disease during the four decades of observation did not translate into appreciable improvements in overall survival after the onset of CHF in this large, unselected population.
Cardiovascular Division, Charles A. Dana Research Institute, Boston, MA.
The incidence and prevalence of congestive heart failure in Rochester, Minnesota.
Rodeheffer RJ, Jacobsen SJ, Gersh BJ, Kottke TE, McCann HA, Bailey KR, Ballard DJ
Mayo Clin Proc. 1993;68(12):1143.
Although congestive heart failure is a fairly common clinical syndrome and the societal costs associated with its care are high, relatively little is known about the incidence or prevalence of the condition in the community. Using the resources of the Rochester Epidemiology Project, we identified all 46 persons 0 through 74 years of age who had a new diagnosis of congestive heart failure during 1981 and all 113 persons with a prevalent diagnosis on Jan. 1, 1982, in the city of Rochester, Minnesota. After confirming the diagnosis in the medical record by using criteria similar to those in the Framingham study, we found the annual incidence of congestive heart failure to be 110 per 100,000 after adjusting for age. Incidence rates were higher among male than among female study subjects (157 versus 71 per 100,000). In both male and female subjects, the incidence generally increased with advancing age, reaching 1,618 per 100,000 and 981 per 100,000, respectively. Prevalence rates on Jan. 1, 1982, demonstrated similar patterns. Overall, the prevalence of congestive heart failure was higher among male than among female subjects (327 versus 214 per 100,000) and increased exponentially with advancing age, reaching almost 3% in both sexes. Survival after a diagnosis of congestive heart failure was extremely poor, with only 80% alive at 3 months and 66% at 1 year. These data underscorethe effect of congestive heart failure in the community and provide estimates of the number of persons who might benefit from early intervention.
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905.
Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort.
Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D
J Am Coll Cardiol. 1999;33(7):1948.
OBJECTIVES: The purpose of this study was to assess the relative proportions of normal versus impaired left ventricular (LV) systolic function among persons with congestive heart failure (CHF) in the community and to compare their long-term mortality during follow-up.
BACKGROUND: Several hospital-based investigations have reported that a high proportion of subjects with CHF have normal LV systolic function. The prevalence and prognosis of CHF with normal LV systolic function in the community are not known.
METHODS: We evaluated the echocardiograms of 73 Framingham Heart Study subjects with CHF (33 women, 40 men, mean age 73 years) and 146 age- and gender-matched control subjects (nested case-control study). Impaired LV systolic function was defined as an LV ejection fraction (LVEF)<0.50.
RESULTS: Thirty-seven CHF cases (51%) had a normal LVEF; 36 (49%) had a reduced LVEF. Women predominated in the former group (65%), whereas men constituted 75% of the latter group. During a median follow-up of 6.2 years, CHF cases with normal LVEF experienced an annual mortality of 8.7% versus 3.0% for matched control subjects (adjusted hazards ratio = 4.06, 95% confidence interval 1.61 to 10.26). Congestive heart failure cases with reduced LVEF had an annual mortality of 18.9% versus 4.1% for matched control subjects (adjusted hazards ratio = 4.31, 95% confidence interval 1.98 to 9.36).
CONCLUSIONS: Normal LV systolic function is often found in persons with CHF in the community and is more common in women than in men. Although CHF cases with normal LVEF have a lower mortality risk than cases with reduced LVEF, they have a fourfold mortality risk compared with control subjects who are free of CHF.
National Heart, Lung, and Blood Institute's Framingham Heart Study, Massachusetts 01702, USA.
Prevalence and mortality rate of congestive heart failure in the United States.
Schocken DD, Arrieta MI, Leaverton PE, Ross EA
J Am Coll Cardiol. 1992;20(2):301.
OBJECTIVES: The study was designed to determine the prevalence and mortality rate of congestive heart failure in noninstitutionalized men and women in the U.S.
BACKGROUND: Congestive heart failure is a serious condition with significant morbidity and mortality. Earlier epidemiologic descriptions of congestive heart failure were constructed from small surveys, limited data, hospital records or death certificates. No nationally representative data from noninstitutionalized persons have been examined.
METHODS: Data collected from the National Health and Nutrition Examination Survey (NHANES-I, 1971 to 1975) were used to determine the prevalence of heart failure on the basis of both self-reporting and a clinical definition. Mortality data were derived from the NHANES-I Epidemiologic Follow-up Study (1982 to 1986).
RESULTS: The prevalence of self-reported congestive heart failure approximates 1.1% of the noninstitutionalized U.S. adult population; the prevalence of congestive heart failure based on clinical criteria is 2%. These estimates suggest that between 1 and 2 million adults are affected. Mortality at 10 and 15 years for those persons with congestive heart failure increases in graded fashion with advancing age, with men more likely to die than women. In the group greater than or equal to 55 years old, the 15-year total mortality rate was 39.1% for women and 71.8% for men.
CONCLUSIONS: Congestive heart failure is a common problem in the U.S., with significant prevalence and mortality, both of which increase with advancing age. As the population of the U.S. becomes older, the health care impact of congestive heart failure will probably grow.
Department of Internal Medicine, College of Medicine, University of South Florida, Tampa 33612.
Evidence of improving prognosis in heart failure: trends in case fatality in 66 547 patients hospitalized between 1986 and 1995.
MacIntyre K, Capewell S, Stewart S, Chalmers JW, Boyd J, Finlayson A, Redpath A, Pell JP, McMurray JJ
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.
Department of Public Health, University of Glasgow, Glasgow, UK.
The prognosis of heart failure in the general population: The Rotterdam Study.
Mosterd A, Cost B, Hoes AW, de Bruijne MC, Deckers JW, Hofman A, Grobbee DE
Eur Heart J. 2001;22(15):1318.
AIMS: To determine the prognosis, cause of death, and its determinants in participants of the population-based Rotterdam Study who were found to have heart failure.
METHODS AND RESULTS: In 5255 Rotterdam Study participants (aged 68.9+/-8.6 years, 3113 women) the presence of heart failure was determined. Data were analysed with Cox's proportional-hazards models. One hundred and eighty-one participants (age 77.3+/-7.9 years, 109 women) had heart failure. Of these 85 (47%) died during the 4.8-8.5 (mean 6.1) years of follow-up. One, 2 and 5 years' survival was 89%, 79%, and 59%, representing an age-adjusted mortality twice that of persons without heart failure (hazard ratio 2.1, 95% CI 1.8-2.7). The hazard ratio for sudden death was even more pronounced: 4.8, (95% CI 2.6-8.7). Diabetes mellitus, impairment of renal function and atrial fibrillation were associated with a poor outcome. A higher blood pressure and body mass index conferred a more favourable prognosis in those with heart failure.
CONCLUSION: Heart failure generally afflicts older subjects in the community, carries a poor prognosis, especially in the presence of concomitant diseases, and confers a fivefold increase in the risk of sudden death.
Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands.