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To the Editor;
Cowie et al(1) reported high case fatality rates in a population-based
cohort of patients with incident heart failure between 1995 and 1996.
Survival was 81% at one month, 75% at 3 months, 70% at 6 months, 62% at 12
months and 57% at 18 months. There are few population data that describe
the contemporary survival of patients with heart failure.
The Linked Morbidity Record Database con...
The Linked Morbidity Record Database contains accurate data on all
hospital admissions in Scotland since 1981 and is linked to the Registrar
General's death certificate data. Using this database, we analysed case
fatality in all 66,547 patients admitted to Scottish hospitals for the
first time with a principal diagnosis of heart failure in the period 1986
to 1995.(2) The study by Cowie et al looked at new cases of heart failure
referred to a rapid access clinic as well as those admitted to hospital.
Our results were remarkably consistent with those of Cowie et al. The
median age of our patients was 75 years (compared to 76 in their study)
and men accounted for 47% of our cohort (compared to 54% of theirs). In
1995 unadjusted survival was 81% at 30 days, 73% at three months, 67% at
six months, 58% at one year and 52% at 18 months. Median survival was
only 20 months. Whilst case fatality fell during the period of our study,
it remains high and is substantially greater than that reported in
clinical trials that enrol carefully selected patients.
The data from both these studies highlight the poor prognosis that
patients with heart failure continue to have in the UK. There is still
much room for further improvement in the management of heart failure.
K MacIntyre(1), S Capewell(2), S Stewart(1), JWT Chalmers(3), JJV McMurray(4)
(1) Department of Public Health, University of Glasgow
(2) Department of Public Health, University of Liverpool (3) Information and Statistics Division, Edinburgh
(4) Clinical Research Initiative in Heart Failure, University
1. Cowie MR, Wood DA, Coats AJS, Thompson SG, Suresh V, Poole-Wilson PA, Sutton GC. Survival of patients with a new diagnosis of heart failure: a population based study. Heart 2000;83:505-10.
2. MacIntyre K, Capewell S, Livingston M, Chalmers J, Boyd J, Finlayson A, Redpath A, Pell J, Evans C, McMurray JJV. Mortality trends in 86,000 patients admitted with heart failure 1981-1995. Eur Heart J 2000;20(suppl):471.