Original articles

Heart failure and cardiomyopathy

Improving survival in the 6 months after diagnosis of heart failure in the past decade: population-based data from the UK

P A Mehta¹, S W Dubrey², H F McIntyre³, D M Walker³, S M C Hardman⁴, G C Sutton¹, T A McDonagh¹, Martin R Cowie¹

¹ Imperial College, London, UK
² The Hillingdon Hospital, London, UK
³ The Conquest Hospital, East Sussex, UK
⁴ The Whittington Hospital, London, UK

^{Correspondence to} Professor M R Cowie, Department of Cardiology, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK; m.cowie{at}imperial.ac.uk

Objective: To investigate the secular trend in survival after a new diagnosis of heart failure in the UK population.

Design and Setting: Comparison of all-cause mortality in the 6 months after diagnosis of heart failure in population-based studies in the south east of England in 2004–5 (Hillingdon–Hastings Study) and 1995–7 (Hillingdon–Bromley Studies).

Participants: 396 patients in the 2004–5 cohort and 552 patients in the 1995–7 cohort with incident (new) heart failure.

Main Outcome Measures: All-cause mortality.

Results: All-cause mortality rates were 6% (95% CI 3% to 8%) at 1 month, 11% (8% to 14%) at 3 months and 14% (11% to 18%) at 6 months in the 2004–5 cohort compared with 16% (13% to 20%), 22% (19% to 25%) and 26% (22% to 29%), respectively, in the 1995–7 cohort (difference between the two cohorts, p<0.001). The difference in survival was not explained by any difference in the demographics or severity of heart failure at presentation. There was a difference at baseline and thereafter in the use of neurohormonal antagonists (β-blockers and angiotensin-converting enzyme inhibitors).

Conclusions: Although early mortality remains high among patients with newly diagnosed heart failure in the UK general population, there is strong evidence of a marked improvement in survival from 1995–7 to 2004–5, perhaps partly explained by an increased usage of neurohormonal antagonists.

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