The epidemiology of heart failure

Cowie, Martin R.; Mosterd, A.; Wood, David; Deckers, Jaap W.; Poole‐Wilson, P.A.; Sutton, George C.; Grobbee, Diederick E.

doi:10.1093/oxfordjournals.eurheartj.a015223

Cited by 838 publications

(481 citation statements)

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“…1 Among the general HF population, over half have diastolic HF (DHF). [2][3][4] Observation studies have concluded that the morbidity associated with DHF (including the rate of hospitalization) is similar to that associated with systolic HF.…”

Section: Introductionmentioning

confidence: 99%

Demonstrating the pharmacogenetic effects of angiotensin-converting enzyme inhibitors on long-term prognosis of diastolic heart failure

Jl²,

Tsai

et al. 2009

Pharmacogenomics J

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The objective of this study was to evaluate the effects of angiotensin-converting enzyme (ACE) inhibitors and pharmacogenetic interaction on the survival of the patients with diastolic heart failure (DHF). A total of 285 subjects with DHF confirmed by echocardiography were recruited in the period between 1995 and 2003. Baseline characteristics (age, sex, prior history, medication, and echocardiographic findings) and genetic polymorphisms (ACE gene insertion/ deletion (I/D) polymorphism; T174M, M235T, G-6A, A-20C, G-152A, and G-217A polymorphisms of the angiotensinogen (AGT) gene; and A1166C polymorphisms of the angiotensin II type I receptor (AT1R)) were collected and matched (by propensity score) in those who received and those who did not receive ACE inhibitors. The patients were followed up to 10 years. Kaplan-Meier curves and Cox regression models were used to demonstrate the survival trend. The 85 patients who received ACE inhibitors and the other 85 patients who did not were found to have comparable baseline characteristics and polymorphism distribution. Prescription of ACE inhibitors was associated with a significant decrease in overall mortality (hazard ratio (HR), 0.45; 95% confidence interval (CI), 0.24-0.83; P ¼ 0.01), and a lower rate of cardiovascular events at 4000 days (HR, 0.53; 95% CI, 0.32-0.90; P ¼ 0.02). In addition, ACE I/D gene D allele was associated with higher overall mortality as compared with the I allele (HR, 2.04; P ¼ 0.003). This effect was diminished in those who received ACE inhibitors. The use of ACE inhibitor was associated with a significant decrease in long-term mortality and cardiovascular events in the patients with DHF. Genetic variants in the renin-angiotensin system genes were also associated, but their effects could be modified by the use of ACE inhibitors.

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Section: Introductionmentioning

confidence: 99%

Demonstrating the pharmacogenetic effects of angiotensin-converting enzyme inhibitors on long-term prognosis of diastolic heart failure

Jl²,

Tsai

et al. 2009

Pharmacogenomics J

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“…C ongestive heart failure has reached pan-epidemic proportions in industrialized countries and is responsible for vast patient morbidity and mortality (1)(2)(3)(4). Mortality associated with moderate to severe congestive heart failure may exceed that associated with many neoplasms, and the 1-year survival rate is as dismal as 50% (5).…”

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confidence: 99%

β-Blockers in Congestive Heart Failure: A Bayesian Meta-Analysis

2001

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Purpose: Congestive heart failure is an important cause of patient morbidity and mortality. Although several randomized clinical trials have compared ␤-blockers with placebo for treatment of congestive heart failure, a meta-analysis quantifying the effect on mortality and morbidity has not been performed recently. Data Extraction: A specified protocol was followed to extract data on patient characteristics, ␤-blocker used, overall mortality, hospitalizations for congestive heart failure, and study quality.Data Synthesis: A hierarchical random-effects model was used to synthesize the results. A total of 22 trials involving 10 135 patients were identified. There were 624 deaths among 4862 patients randomly assigned to placebo and 444 deaths among 5273 patients assigned to ␤-blocker therapy. In these groups, 754 and 540 patients, respectively, required hospitalization for congestive heart failure. The probability that ␤-blocker therapy reduced total mortality and hospitalizations for congestive heart failure was almost 100%. The best estimates of these advantages are 3.8 lives saved and 4 fewer hospitalizations per 100 patients treated in the first year after therapy. The probability that these benefits are clinically significant (>2 lives saved or >2 fewer hospitalizations per 100 patients treated) is 99%. Both selective and nonselective agents produced these salutary effects. The results are robust to any reasonable publication bias.Conclusions: ␤-Blocker therapy is associated with clinically meaningful reductions in mortality and morbidity in patients with stable congestive heart failure and should be routinely offered to all patients similar to those included in trials. Ann Intern Med. 2001;134:550-560. www.annals.org For author affiliations, current addresses, and contributions, see end of text.C ongestive heart failure has reached pan-epidemic proportions in industrialized countries and is responsible for vast patient morbidity and mortality (1-4). Mortality associated with moderate to severe congestive heart failure may exceed that associated with many neoplasms, and the 1-year survival rate is as dismal as 50% (5). Quality of life is also adversely affected, and congestive heart failure is the most common cause of hospital admission in elderly persons in North America (6). Clearly, additional therapies are urgently needed.Randomized clinical trials are the gold standard for comparative research and have been used to investigate both new and old therapies for congestive heart failure. For example, trials have clearly demonstrated the beneficial effect of angiotensin-converting enzyme inhibitors on patient mortality (7), the neutral effect of digitalis (8), and the deleterious effects of other inotropic agents in congestive heart failure (9 -11).Although conventional medical education previously viewed congestive heart failure as a contraindication for the use of ␤-blockers because of their potential short-term negative inotropic effects, benefits of ␤-blocker treatment in this condition have been sporadica...

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“…lence of heart failure ranges from 3 to 20 cases per 1000 of the population [1]. This worrying variation is due more to the use of different definitions of heart failure, which were based on symptoms, signs and treatment, than true differences between the populations studied.…”

Section: Why Define Heart Failure?mentioning

confidence: 99%