Has the survival of the heart failure population changed? lessons from trials

Cleland, Jennifer; Clark, Andrew L.

doi:10.1016/s0002-9149(98)01011-x

Cited by 44 publications

(32 citation statements)

References 47 publications

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“…In the study conducted by Cowie et al [27], with rather bstrictQ diagnostic criteria for HF, the 1-year probability of survival was 0.62. The shape of the survival curve of patients with definite HF is similar to that usually reported in the literature in patients with new diagnosis of HF [10,27,28]. Even survival curves in patients with signs and symptoms of HF but without a stated or confirmed diagnosis show a rapid decline in survival (even less steep than in definite HF) in the first 3 months after the beginning of clinical manifestations.…”

Section: Discussionsupporting

confidence: 82%

Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom

Giuli

Khaw

Cowie

et al. 2005

European Journal of Heart Failure

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Background: There are few large population-based studies of the incidence and outcome of heart failure where the diagnosis of heart failure (HF) has been made by a General Practitioner (GP) in the community. Methods: From the General Practice Research Database in the UK, we selected a population of 686,884 people 45 years or older. Incident cases of HF in 1991 were classified definite HF, possible HF, or a first prescription of diuretics without a diagnosis of HF. The population was followed for 3-year mortality. Results: A total of 6478 patients had definite HF (mean age 77.2 years, 55.5% women), 14,050 had possible HF and 6076 persons were prescribed diuretics without a definite or possible diagnosis of HF. The overall incidence of definite HF was 9.3/1000 persons/year and of possible HF 20.2/1000 persons/year. Diuretics were prescribed for the first time for other reasons for 8.7 persons/1000/year. The incidence of HF was higher in men. The incidence of definite HF increased with age. Survival curves showed higher mortality rates in the first 3 months after the diagnosis of HF. One-year cumulative probability of death for patients with definite HF was 15.9 times higher in men and 14.7 times higher in women in comparison with the UK population. Conclusion: The diagnosis of HF by a GP successfully identifies patients at high risk of death, comparable to patients with HF identified by cardiologists on the basis of defined diagnostic criteria. HF is common in the general population, increases sharply with age, and has a poor prognosis.

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Section: Discussionsupporting

confidence: 82%

Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom

Giuli

Khaw

Cowie

et al. 2005

European Journal of Heart Failure

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“…In particular, evaluation of venous pressure specific for HF, and a third heart sound, are rarely used in their clinical practice. The prevalence of HF defined from the medical records of health centers greatly exceeds that presented in studies using strict criteria (3). Therefore, the false positive HF cases should critically medically evaluated in primary health care, as also previously indicated.…”

Section: Discussionmentioning

confidence: 99%

Practices of Clinical Examination of Heart Failure Patients in Primary Health Care

Laukkanen¹,

Ikäheimo²,

Luukinen³

2006

Cent Eur J Public Health

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SummAryThe aim of this cross-sectional cohort study was to examine practices of clinical examination of heart failure patients in three primary health care regions in northern Finland. Altogether, 825 randomly selected heart failure patients aged 45 years or older, who had special reimbursement for drugs for the treatment of heart failure, were included. Main outcome measures were the frequency of medical visits and the mode of clinical examinations during control visits and symptomatic visits due to heart failure made by general practitioners.The prevalence of heart failure was 2% among those aged 45-75 years and 18% among the older ones. No differences existed in the incidence of all medical visits made as a result of heart failure, between the regions. ECG recordings, auscultation of the heart and lungs, measurements of blood pressure and recordings of ankle swelling were carried out in 72%, 79%, 85%, 90% and 59% of cases of control visits, and in 78%, 63%, 79%, 77% and 49% of cases in symptomatic visits, respectively. Chest X-ray examinations and recording of liver size were seldom carried out: 16% and 12% in control visits, and 19% and 11% in symptomatic visits, respectively. Important prognostic markers of heart failure were recorded even more rarely: jugular venous pressure, in 1% of control visits and 3% of symptomatic visits and the third heart sound not at all. NYHA grading had been carried out in 8% and echocardiography in 13% of cases.The prevalence of heart failure was higher than in many clinical studies, suggesting high number of false positive heart failure diagnoses made in primary health care. Some clinical examinations of significant prognostic value in heart failure are underused by general practitioners. Therefore, further education among general practitioners is needed to improve the practices of clinical examination in heart failure patients.

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“…Patients enrolled in this study met the following inclusion criteria: (1) diagnosis of chronic HF from either preserved (left ventricular ejection fraction [LVEF] ≥ 40%) or nonpreserved systolic function (LVEF < 40%); 25 (2) underwent evaluation of HF by a cardiologist and optimization of medical therapy, defined as receiving stable doses of HF medications for 1 month with no plans to add HF medications or titrate further; and (3) able to read and speak English. Patients were excluded if they had (1) obvious cognitive impairment, including not being able to give informed consent or participate in an interview; (2) a coexisting terminal illness, such as cancer or chronic renal failure requiring dialysis; (3) a myocardial infarction within the past 3 months; or (4) a history of cerebral vascular accident within the past 3 months or with major sequelae.…”

Section: Sample and Settingmentioning

confidence: 99%

Objectively Measured, but Not Self-Reported, Medication Adherence Independently Predicts Event-Free Survival in Patients With Heart Failure

Moser

Chung

et al. 2008

Journal of Cardiac Failure

135

152

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Has the survival of the heart failure population changed? lessons from trials

Cited by 44 publications

References 47 publications

Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom

Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom

Practices of Clinical Examination of Heart Failure Patients in Primary Health Care

Objectively Measured, but Not Self-Reported, Medication Adherence Independently Predicts Event-Free Survival in Patients With Heart Failure

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