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Background: The prognostic impact of heart failure relative to that of 'high-profile' disease states such as cancer, within the whole population, is unknown. Methods: All patients with a first admission to any Scottish hospital in 1991 for heart failure, myocardial infarction or the four most common types of cancer specific to men and women were identified. Five-year survival rates and associated loss of expected life-years were then compared. Results: In 1991, 16 224 men had an initial hospitalisation Ž . Ž . for heart failure n s 3241 , myocardial infarction n s 6932 or cancer of the lung, large bowel, prostate or bladder Ž . Ž . Ž . n s 6051 . Similarly, 14 842 women were admitted for heart failure n s 3606 , myocardial infarction n s 4916 , or cancer of Ž . the breast, lung, large bowel or ovary n s 6320 . With the exception of lung cancer, heart failure was associated with the Ž . poorest 5-year survival rate approximately 25% for both sexes . On an adjusted basis, heart failure was associated with worse Ž . long-term survival than bowel cancer in men adjusted odds ratio, 0.89; 95% CI, 0.82᎐0.97; P-0.01 and breast cancer in Ž . women odds ratio, 0.59; 95% CI, 0.55᎐0.64; P-0.001 . The overall population rate of expected life-years lost due to heart failure in men was 6.7 yearsr1000 and for women 5.1 yearsr1000. Conclusion: With the notable exception of lung cancer, heart failure is as 'malignant' as many common types of cancer and is associated with a comparable number of expected life-years lost. ᮊ

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All hospitalisations for pulmonary arterial hypertension (PAH) in the Scottish population were examined to determine the epidemiological features of PAH. These data were compared with expert data from the Scottish Pulmonary Vascular Unit (SPVU).Using the linked Scottish Morbidity Record scheme, data from all adults aged 16-65 yrs admitted with PAH (idiopathic PAH, pulmonary hypertension associated with congenital heart abnormalities and pulmonary hypertension associated with connective tissue disorders) during the period 1986-2001 were identified. These data were compared with the most recent data in the SPVU database (2005).Overall, 374 Scottish males and females aged 16-65 yrs were hospitalised with incident PAH during 1986-2001. The annual incidence of PAH was 7.1 cases per million population. On December 31, 2002, there were 165 surviving cases, giving a prevalence of PAH of 52 cases per million population. Data from the SPVU were available for 1997-2006. In 2005, the last year with a complete data set, the incidence of PAH was 7.6 cases per million population and the corresponding prevalence was 26 cases per million population.Hospitalisation data from the Scottish Morbidity Record scheme gave higher prevalences of pulmonary arterial hypertension than data from the expert centres (Scotland and France). The hospitalisation data may overestimate the true frequency of pulmonary arterial hypertension in the population, but it is also possible that the expert centres underestimate the true frequency.

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