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
- 1Imperial College, London, UK
- 2The Hillingdon Hospital, London, UK
- 3The Conquest Hospital, East Sussex, UK
- 4The Whittington Hospital, London, UK
- Correspondence to Professor M R Cowie, Department of Cardiology, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK;
- Accepted 23 June 2009
- Published Online First 8 July 2009
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.
Funding This work was supported by British Heart Foundation Project grant PG/03/097 and by the Royal Brompton and Harefield Trustees.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Ethics approval The Hillingdon Hospital study site was granted ethical approval by the Hillingdon Local Research Ethics Committee on 11 November 2003 (ref no 1268). The Conquest Hospital study site was given ethical approval by the East Sussex Local Research Ethics Committee on 18 November 2003 (ref no ES 03/36).
Patient consent Obtained.
Research was conducted independently from the funders. Professor M R Cowie was the guarantor.