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Original research article
Epidemiology and long-term outcome in outpatients with chronic heart failure in Northwestern Europe
  1. Hanna Fröhlich1,
  2. Niklas Rosenfeld1,
  3. Tobias Täger1,
  4. Kevin Goode2,
  5. Syed Kazmi3,
  6. Torstein Hole4,
  7. Hugo A Katus5,
  8. Dan Atar6,
  9. John G F Cleland7,
  10. Stefan Agewall8,
  11. Andrew L Clark9,
  12. Lutz Frankenstein1,
  13. Morten Grundtvig10
  1. 1 Department of Cardiology, Angiology and Pulmonology, University of Heidelberg, Heidelberg, Germany
  2. 2 Health Technology, University of Hull, Kingston-upon-Hull, UK
  3. 3 Academic Cardiology, University of Hull, Kingston-upon-Hull, UK
  4. 4 Medical Faculty, Norwegian University of Science and Technology, Trondheim, Norway
  5. 5 Cardiology and Pneumology, University of Heidelberg, Heidelberg, Germany
  6. 6 Department of Cardiology, Oslo University Hospital, Oslo, Norway
  7. 7 Royal Brompton & Harefield Hospitals, Imperial College, London, UK
  8. 8 Department of Cardiology, Oslo University Hospital, Oslo, Norway
  9. 9 Castle Hill Hospital, University of Hull, Hull, UK
  10. 10 Fagavdelingen, St Olavs Hospital, Trondheim, Norway
  1. Correspondence to Dr Hanna Fröhlich, Department of Cardiology, Angiology, and Pulmonology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Hanna.Froehlich{at}med.uni-heidelberg.de

Abstract

Objective To describe the epidemiology, long-term outcomes and temporal trends in mortality in ambulatory patients with chronic heart failure (HF) with reduced (HFrEF), mid-range (HFmrEF) or preserved ejection fraction (HFpEF) from three European countries.

Methods We identified 10 312 patients from the Norwegian HF Registry and the HF registries of the universities of Heidelberg, Germany, and Hull, UK. Patients were classified according to baseline left ventricular ejection fraction (LVEF) and time of enrolment (period 1: 1995–2005 vs period 2: 2006–2015). Predictors of mortality were analysed by use of univariable and multivariable Cox regression analyses.

Results Among 10 312 patients with stable HF, 7080 (68.7%), 2086 (20.2%) and 1146 (11.1%) were classified as having HFrEF, HFmrEF or HFpEF, respectively. A total of 4617 (44.8%) patients were included in period 1, and 5695 (55.2%) patients were included in period 2. Baseline characteristics significantly differed with respect to type of HF and time of enrolment. During a median follow-up of 66 (33–105) months, 5297 patients (51.4%) died. In multivariable analyses, survival was independent of LVEF category (p>0.05), while mortality was lower in period 2 as compared with period 1 (HR 0.81, 95% CI 0.72 to 0.91, p<0.001). Significant predictors of all-cause mortality regardless of HF category were increasing age, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide and use of loop diuretics.

Conclusion Ambulatory patients with HF stratified by LVEF represent different phenotypes. However, after adjusting for a wide range of covariates, long-term survival is independent of LVEF category. Outcome significantly improved during the last two decades irrespective from type of HF.

  • heart failure
  • ejection fraction
  • epidemiology
  • prognosis
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Footnotes

  • Contributors HF: study design, data acquisition, statistical analysis, data interpretation, draft of the manuscript, responsible for the overall content as a guarantor. NR: study design, data acquisition, statistical analysis, review of the manuscript. TT: data acquisition, statistical analysis, review of the manuscript. KG: data acquisition, statistical analysis, review of the manuscript. SK: data acquisition, statistical analysis, review of the manuscript. TH: data acquisition, statistical analysis, review of the manuscript. HAK: review of the manuscript. DA: review of the manuscript. JGFC: review of the manuscript. SA: review of the manuscript. ALC: study design, data acquisition, review of the manuscript. LF: study design, data acquisition, review of the manuscript, responsible for the overall content as a guarantor. MG: study design, data acquisition, review of the manuscript, supervisorship, responsible for the overall content as a guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The study conformed to the principles outlined in the Declaration of Helsinki and was approved by the local ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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