Mortality Readmission Rates Were Similar In All Groups
The findings in this study show that in this very large national registry-based HF patient cohort, mortality and readmission rates were similar in all groups irrespective of EF classification with and without risk adjustment.
There was no significant interaction between time and EF groups for any of these outcomes. These similarities across EF groups held true even when adjusting for patient demographics, medical history, examination findings, laboratory findings, and medications, as well as when looking at event-free patients who survived the first 6 months or 1 year post-admission.
The authors of this study conclude that “in patients age 65 years hospitalized with HF, 5-year risk of all-cause mortality is high regardless of EF, and the median survival is substantially lower than the general population of similar age.”
Heart Failure Prevalence Incidence And Mortality In The Elderly With Diabetes
Alain G. Bertoni, W. Gregory Hundley, Mark W. Massing, Denise E. Bonds, Gregory L. Burke, David C. Goff Heart Failure Prevalence, Incidence, and Mortality in the Elderly With Diabetes . Diabetes Care 1 March 2004 27 : 699703.
OBJECTIVEThe goal of this study was to determine heart failure prevalence and incidence rates, subsequent mortality, and risk factors for heart failure among older populations in Medicare with diabetes.
RESEARCH DESIGN AND METHODSWe used a national 5% sample of Medicare claims from 1994 to 1999 to perform a population-based, nonconcurrent cohort study in 151,738 beneficiaries with diabetes who were age 65 years, not in managed care, and were alive on 1 January 1995. Prevalent heart failure was defined as a diagnosis of heart failure in 1994 incident heart failure was defined as a new diagnosis in 19951999 among those without prevalent heart failure. Mortality was assessed through 31 December 1999.
These data demonstrate alarmingly high prevalence, incidence, and mortality for heart failure in individuals with diabetes. Prevention of heart failure should be a research and clinical priority.
Box 1established And Hypothesized Risk Factors For Hf
Major clinical risk factors
Increased LV internal dimension, mass, asymptomatic LV dysfunction
Biomarker risk predictors
Immune activation , natriuretic peptides , high sensitivity cardiac troponin
Abbreviations: BNP, brain natriuretic peptide CRP, C-reactive protein 5-FU, 5-fluorouracil HF, heart failure IGF, insulin-like growth factor IL, interleukin LV, left ventricular NSAIDs, nonsteroidal anti-inflammatory drugs NT-BNP, N-terminal BNP SNP, single-nucleotide polymorphism TNF, tumor necrosis factor. Adapted from Schocken, D. D. et al. Prevention of heart failure: a scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research Quality of Care and Outcomes Research Interdisciplinary Working Group and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation117, 25442565 .
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Mortality Rate In Hfref Compared Hfpef
In general, the mortality rate of patients with HFpEF varied substantially across the studies . Many cohort studies reported lower mortality in HFpEF patients compared with HFrEF patients . Smith et al. found that patients with HFrEF had a higher death rate during six months of follow-up compared with HFpEF patients . Along the same lines, the Veterans Administration Heart Failure Trial showed that the annual mortality was higher in HFrEF compared with HFpEF patients . Similarly, the study by Tribouilloy et al. , showed that patients with reduced EF had higher in-hospital mortality rate than those with preserved . Similarly, a meta-analysis of 17 studies of HF patients with a total of 24501 patients, by Somaratne et al. also showed that there is difference in mortality between these two groups of patients. In this study, after 47 months of follow-up period , the mortality rate among patients with HFrEF was 40.6% compared with 32.1% among HFpEF patients. In regard to age, Kerzner et al. found that mortality rate in elderly HFrEF patients was higher compared with HFpEF , whereas in patients older than 75 years, the difference in mortality rates between groups was not significant .
Congestive Heart Failure Prognosis And Progression Stages
The ACC/AHA Guidelines specify four stages of HF, indirectly determining how long can a person live with congestive heart failure, depending on the given phase of the disease.
Patients at risk of developing HF
Hypertension, diabetes, coronary heart disease, in general: their cardiovascular risk
Patients with anatomical changes and no symptoms
Heart attack, valves, atria or ventricles changes
Patients with anatomical changes and the presence of symptoms
Tiredness, shortness of breath, treatment due to the presence of symptoms
Advanced disease, require special medical attention
Hospitalized patients, patients awaiting heart transplant, patients with mechanical device supporting heart function
Progressing through the above stages is exaggerated by:
- Lack of treatment
- Heart events, such as the heart attack
- General health .
We can slow down the progression of the disease by:
- Maintaining the correct blood pressure and
- Keeping our heart healthy by meeting certain target heart rates close to our maximum heart rate during exercise and everyday activities.
Find out your patient’s HEART score for cardiovascular risk.
Also, you may be interested in our qp/qs calculator which helps in determining the magnitude of a cardiac shunt.
Recommended Reading: Who Is At Risk For Heart Disease
Facts About Heart Failure In The United States
- About 6.2 million adults in the United States have heart failure.1
- In 2018, heart failure was mentioned on 379,800 death certificates .1
- Heart failure costs the nation an estimated $30.7 billion in 2012.2 This total includes the cost of health care services, medicines to treat heart failure, and missed days of work.
Study Population And Outcomes
All consecutive ambulatory patients admitted to a structured multidisciplinary HF clinic at a university hospital between August 2001 and September 2018, regardless of aetiology, were considered for the study. During the 19-year study period, the clinical pathways and referral geographic area, covering~850,000 inhabitants in the northern Barcelona Metro Area, remained stable. Patients were referred to the HF clinic mostly by the Cardiology or Internal Medicine Departments, and to a lesser extent by the Emergency Department or other hospital departments. The criteria for referral to the HF clinic were HF according to the European Society of Cardiology guidelines, regardless of aetiology, at least one HF hospitalization, and/or reduced LVEF,. All patients were seen regularly for follow-up visits at the HF clinic according to their clinical needs and treated according to a unified protocol. Follow-up visits included a minimum of one visit with a nurse every 3 months and one visit with a physician every 6 months, as well as optional visits with specialists in geriatrics, psychiatry, and rehabilitation,, with the addition of a nephrologist and endocrinologist in recent years.
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Predicting An Individual’s Risk
The models in Tables and can be used to predict any individual’s risk of each outcome. For any patient, one forms a risk score that is a linear combination of their variable values multiplied by coefficients. For ease of presentation, that risk score has been multiplied by 10. Examples of how to use the risk score for risk prediction in individual patients are presented in the appendix.
Figure shows both the distribution of the risk score for CV death or HF hospitalization and the relationship between risk score and estimated probability of a primary event within 2 years of follow-up. Figure shows the corresponding distribution and probability curve for the all-cause mortality risk score.
Figure further illustrates the predictive power of each of the two risk scores, by showing KaplanMeier plots for CV death or HF hospitalization and for all-cause mortality for patients classified into 10 equal sized groupings of the risk score.
Figure demonstrates the two models’ goodness-of-fit by comparing the observed and expected probabilities of CV death or HF hospitalization, and mortality within 2 years, for patients classified into 10 consecutive equal sized groups. For both outcomes, we see a very strong gradient in risk with patients in the top 10th of the risk score, having over 10 times and over 15 times the risk of patients in the bottom 10th of risk.
The Percentage Of Heart Failure
- The percentage of heart failure-related deaths that occurred in a hospital decreased 30%, from 42.6% in 2000 to 30.0% in 2014 .
- The percentage of heart failure-related deaths that occurred at a descendants home increased 51%, from 18.3% in 2000 to 27.6% in 2014.
- The percentage of heart failure-related deaths that occurred in nursing homes or long-term care facilities decreased 11%, from 30.1% in 2000 to 26.7% in 2014.
- The percentage of heart failure-related deaths that occurred in other places increased 74%, from 9.0% in 2000 to 15.7% in 2014.
1Increases in the percentage of deaths that occurred at home and other places were statistically significant .2Percentages of heart failure-related deaths that occurred in a hospital, nursing home, and long-term care facilities declined significantly .NOTES: Heart failure-related deaths were identified as those with heart failure reported anywhere on the death certificate . Access data table for Figure 4pdf icon.SOURCE: CDC/NCHS, National Vital Statistics System mortality data, 20002014.
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What You Can Do
Some risk factors of heart failure, like age, cant be modified. Still, people with CHF can take steps to improve the long-term prognosis. The first thing to do is to be familiar with any family history of heart disease. You’ll also want to learn about all the possible symptoms. Don’t ignore any symptom that you think is cause for concern. Tell your healthcare provider about them right away.
Regular exercise, along with managing any other health issues you may have, can also help to keep CHF under control.
Patient Hospital And Country
- Aleksandra Torbica,
Roles Conceptualization, Investigation, Supervision, Writing original draft
Affiliations Centre for Research on Health and Social Care Management , SDA Bocconi, Milan, Italy, Department of Social and Political Sciences, Bocconi University, Milan, Italy
- Chris P. Gale,
Roles Supervision, Visualization, Writing original draft
Affiliations Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom, Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom, Department of Cardiology, Leeds General Infirmary, Leeds, United Kingdom
Roles Supervision, Visualization, Writing original draft
Affiliation Maria Cecilia HospitalGVM Care & Research, Cotignola, Italy
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Prognosis At Different Ages
In general, younger people diagnosed with CHF tend to have a better outlook than older people.
A report averaging several smaller studies found that people under age 65 generally had a 5-year survival rate of 78.8 percent following CHF diagnosis. The same report found that people over age 75 had an average 5-year survival rate of 49.5 percent following diagnosis.
Older people diagnosed with CHF may already have other chronic health conditions. This can make it difficult to manage CHF and create a more challenging outlook for them.
for congestive heart failure. The treatment thats best for you will depend on:
- your overall health
- any other health conditions you have
- how you respond to any medications
- what stage of CHF you have
Common options include:
There are lifestyle changes a person with CHF can make that have been shown to help slow the conditions progression. Talk with your doctor before making changes to your diet or starting an exercise routine.
Registries And Linkage Procedure
Details of the registries and linkage procedures used to construct nationwide cohorts of patients hospitalized for the first time for heart failure have been previously described . Briefly, the data of the Dutch Hospital Discharge Register , the Dutch Population Register , and the National Cause of Death Register were linked using a unique record identification number based on a combination of birth, sex and postal code . The PR was used to obtain data on demographic characteristics, HDR was used to identify patients with a hospital admission for heart failure, and cause of death statistics were used to obtain data on causes of death following admission for heart failure . The PR became electronically available from 1995 onwards. Linkage of the registries is therefore possible from 1995 and onwards. For this study data was available from 1995 to 2015. All linkages and analyses were performed in agreement with the privacy legislation in the Netherlands and conforms with the principles outlined in the Declaration of Helsinki .
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Heart Failure Mortality Lower With Healthier Food Environment
Lower county food insecurity percentage, higher county food environment index linked to lower heart failure mortality rate
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Heart Disease Statistics And Maps
Find facts, statistics, maps, and other data related to heart disease.
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Risk Factors Associated With Hf And Preserved Lvef
The relative contributions of risk factors and risk profile also differ for patients with HF and preserved LVEF compared with patients with HF and reduced LVEF.19,21,31,6568,75,100,101 In a study from Framingham,65 independent predictors of the onset of HF and preserved LVEF included elevated systolic blood pressure , atrial fibrillation , and female sex . Prior MI and left bundle-branch block morphology were associated with reduced odds of HF and preserved LVEF.65 Cardiovascular disease risk factors, including diabetes, smoking, and hypertension commonly preceded the onset of both HF and reduced LVEF as well as HF and preserved LVEF, but these pre-onset risk factors did not distinguish between the two.65 Hence characteristics at the time of acute onset were more able to differentiate HF and preserved LVEF versus HF and reduced LVEF than long-standing risk factors.
Cohort Characteristics And Heart Failure Prevalence
The selection criteria resulted in a population with diabetes that was 84% white, 12% black, and 4% other race. This differed from the racial distribution of the U.S. population aged 65 years in the 1990 census in that the cohort had proportionately more black participants. The age distribution was slightly older than the corresponding U.S. population, with fewer elderly between age 65 and 74 years , more aged 7584 years , and fewer aged 85 years .
There were 33,805 individuals with a diagnosis of heart failure in 1994. In comparison with those without heart failure, individuals with prevalent heart failure were somewhat older, more likely to be of lower socioeconomic status, and to have cardiovascular and diabetes-related comorbidities diagnosed . The prevalence of heart failure increased substan-tially with age but was similar by sex and race . In a multivariable-adjusted logistic regression analysis , ischemic heart disease and nephropathy were most strongly correlated with prevalent heart failure. Other vascular diagnoses and metabolic complications of diabetes were modestly associated with heart failure. The findings were similar when reclassifying 2,130 individuals with heart failure identified only via the alternate heart failure definition. Our prevalence estimate increased slightly to 23.7%. Including these individuals in the logistic regression model did not appreciably change any estimates .
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How Long Will I Live With Heart Failure
The congestive heart failure lifespan depends on many variables, such as the cause of heart failure, its severity, and other comorbidities.The survival rates for those affected in the general population are:
- 5-years: 51.5% and
- 10-years: 29.5%.
There are 6 million people alive in the US that suffer from this disease, and almost 1 million in the UK. The data shown above tells us that only a half of these people will survive the next 5 years.
A heart transplant, being the ultimate treatment for such a disease, prolongs the estimated survival. 20 years after a transplant, around21% of patients are still alive.
There’s a special tool for assessing the mortality rate of heart failure patients admitted to the ICU.