PulseExploreJournal ClubDebatesTrendingResearchersJournals
Instagram
HomeExploreJournal ClubTrending
Synapse
⌘+K
Synapse
February 13, 2019BMJ503 citationsOpen Access

Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study

CTClare TaylorJOJosé M Ordóñez-MenaARAndrea Roalfe

Key Result

Survival rates at one year improved from 74.2% in 2000 to 80.8% in 2016, indicating a 6.6% increase over time in patients with new diagnoses of heart failure.

Study Design

Type

Cohort (n=55,959)

Multicenter

Yes

Structured PICO

P
Population
55,959 patients aged 45 and over with a new diagnosis of heart failure and 278,679 age and sex matched controls in the United Kingdom primary care setting (Clinical Practice Research Datalink).
C
Comparator
278,679 age and sex matched controls without heart failure.
O
Outcome
Survival rates at one, five, and 10 years and cause of death for people with and without heart failure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group.hard clinical

Survival after a heart failure diagnosis in the UK has shown only modest improvement since 2000, with persistent socioeconomic inequalities and significantly worse outcomes for those requiring hospital admission at the time of diagnosis.

Main Result

Effect estimate: HR 3.36 (95% CI 3.31-3.42)

p-value: p=<0.001

Limitations

  • The study did not explore effects of specific drugs or treatment devices on survival.
  • There was potential misclassification of previously diagnosed heart failure.
  • Survival was assessed based on the linked database records which might have incomplete data.
  • Death recording in general practice can vary and death certification may be inaccurate
  • Incomplete data due to clinical coding rather than for research purposes
  • Reduction in the number of practices contributing data because of a decline in the popularity of Vision software
  • Misclassification of pre-existing heart failure as a new diagnosis
  • Unable to identify the type of heart failure (reduced or preserved ejection fraction)
  • Did not explore the effect of drugs, devices, or transplantation on survival

Abstract

Abstract Objectives To report reliable estimates of short term and long term survival rates for people with a diagnosis of heart failure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group. Design Population based cohort study. Setting Primary care, United Kingdom. Participants Primary care data for 55 959 patients aged 45 and over with a new diagnosis of heart failure and 278 679 age and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data. Main outcome measures Survival rates at one, five, and 10 years and cause of death for people with and without heart failure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group. Results Overall, one, five, and 10 year survival rates increased by 6.6% (from 74.2% in 2000 to 80.8% in 2016), 7.2% (from 41.0% in 2000 to 48.2% in 2012), and 6.4% (from 19.8% in 2000 to 26.2% in 2007), respectively. There were 30 906 deaths in the heart failure group over the study period. Heart failure was listed on the death certificate in 13 093 (42.4%) of these patients, and in 2237 (7.2%) it was the primary cause of death. Improvement in survival was greater for patients not requiring admission to hospital around the time of diagnosis (median difference 2.4 years; 5.3 v 2.9 years, P<0.001). There was a deprivation gap in median survival of 0.5 years between people who were least deprived and those who were most deprived (4.6 v 4.1 years, P<0.001). Conclusions Survival after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer. New strategies to achieve timely diagnosis and treatment initiation in primary care for all socioeconomic groups should be a priority for future research and policy.

Ask AI
Helpful
Bookmark
Share
View Full Paper

Cite This Study

Taylor et al. (2019) conducted a cohort in heart failure (n=55,959). Survival rates at one year improved from 74.2% in 2000 to 80.8% in 2016, indicating a 6.6% increase over time in patients with new diagnoses of heart failure.

synapsesocial.com/papers/697a392d1b70efdef0670fd2https://doi.org/10.1136/bmj.l223
Ask AI
Helpful
Bookmark
Share
View Full Paper