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Re: Heart failure in the UK

Dear Editor,

We read with interest the report of Nicol and colleagues on heart failure admissions in England, Wales and Northern Ireland1, having published extensively on this problem in Scotland.2,3

In Scotland 51% of patients hospitalized in 2003 with heart failure as the principal diagnosis were men, compared to 50% in the rest of the UK. The average age of men was 72 years and for women it was 77 years, compared to 75 and 80 years, respectively in the other UK countries (table). The median length of stay in Scotland was 5 days (IQR 2-10) for men and 5 days (2-11) for women, compared to 7 (4-14) and 8 (4-15) days respectively, in the rest of the UK. The in-patient unadjusted case fatality rate for men in Scotland was 8.4% and 9.5% in women, compared to 16 and 14% respectively in England, Wales and Northern Ireland (we think the case-fatality rates reported in the abstract by Nicol et al are unadjusted rather than adjusted, as stated). We reported considerable between-hospital variation in outcomes in Scotland.4 A similar analysis for the other UK countries would be of interest. Of more concern, however, is the apparently large discrepancy in outcomes between all the UK countries and elsewhere. For example, 30 day mortality in the USA and Australia is in the range of 8 to 9% and in Canada 12%.5-8 Reported in hospital mortality is as low as 4 to 5% in some countries, compared to the much higher rates reported in the UK countries. 7,8 It is important for all UK physicians with an interest in the management of heart failure (and for our patients) to understand and explain these apparent differences.

REFERENCES

1. Nicol ED, Fittall B, Roughton M, Cleland JG, Dargie H, Cowie MR. NHS heart failure survey: a survey of acute heart failure admissions in England, Wales and Northern Ireland. Heart 2008; 94:172-7.

2. McMurray J, McDonagh T, Morrison CE, Dargie HJ. Trends in hospitalization for heart failure in Scotland 1980-1990. Eur Heart J 1993; 14: 1158-62.

3. Stewart S, MacIntyre K, MacLeod MM, Bailey AE, Capewell S, McMurray JJ. Trends in hospitalization for heart failure in Scotland, 1990-1996. An epidemic that has reached its peak? Eur Heart J 2001; 22: 209-17.

4. Stewart S, Demers C, Murdoch DR, McIntyre K, MacLeod ME, Kendrick S, Capewell S, McMurray JJ. Substantial between-hospital variation in outcome following first emergency admission for heart failure. Eur Heart J 2002; 23: 650-7.

5. Lee DS, Johansen H, Gong Y, Hall RE, Tu JV, Cox JL; Canadian Cardiovascular Outcomes Research Team. Regional outcomes of heart failure in Canada. Can J Cardiol 2004; 20: 599-607.

6. Najafi F, Dobson AJ, Jamrozik K. Recent changes in heart failure hospitalisations in Australia. Eur J Heart Fail 2007; 9: 228-33.

7. Baker DW, Einstadter D, Thomas C, Cebul RD. Mortality trends for 23,505 Medicare patients hospitalized with heart failure in Northeast Ohio, 1991 to 1997. Am Heart J 2003; 146: 258-64.