Heart failure incidence remains stable; survival increases
CHICAGO – The incidence of heart failure did not decline over the last two decades of the 20th Century, but survival after the onset of heart failure increased overall, with less improvement among women and the elderly, according to a study in the July 21 issue of The Journal of the American Medical Association (JAMA).
Heart failure is the inability of the heart to keep up with the demands on it – specifically, failure to pump blood with normal efficiency. According to background information in the article, approximately 4.9 million Americans have been diagnosed with heart failure, and it is the most frequent cause of hospitalization in people aged 65 and older. Despite the staggering costs to society, the epidemic of heart failure has yet to be fully investigated, and data on incidence, survival, and sex-specific trends over time in community-based populations are limited.
Veronique L. Roger, M.D., M.P.H., of the Mayo Clinic and Foundation, Rochester, Minn., and colleagues conducted a population-based cohort study to test the hypothesis that the incidence of heart failure has declined and survival after heart failure diagnosis has improved over time, but that secular trends have diverged by sex. The study used the resources of the Rochester Epidemiology Project conducted in Olmsted County, Minn. The patients included 4,537 Olmsted County residents (57 percent women; average age, 74) with a diagnosis of heart failure between 1979 and 2000.
"In this large geographically defined community, the incidence of heart failure has remained stable during the past two decades in men and women," the authors write. "The incidence of heart failure is higher among men, and survival after its onset is worse among men."
The incidence of heart failure among men was 378 per 100,000 people, and the incidence of heart failure among women was 289 per 100,000 people. This did not change over time among men or women.
After an average follow-up of 4.2 years, 3,347 deaths occurred, including 1,930 among women and 1,417 among men.
"Survival after heart failure diagnosis was worse among men than women [relative risk, 33 percent higher among men] but overall improved over time," the authors report. The five-year age-adjusted survival was 43 percent in 1979-1984, compared with 52 percent in 1996-2000.
The study findings suggest the apparent gains have not been achieved equally. "Men and younger persons experienced larger survival gains, contrasting with less or no improvement for women and elderly persons," the authors report.
"These findings highlight the increasing population burden of heart failure mediated by stagnating incidence and unequal improvement in survival within the context of an aging and growing population," they conclude. (JAMA. 2004; 292:344-350. Available post-embargo at JAMA.com)
Source: Eurekalert & othersLast reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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