Abstract
Aim: To provide reliable survival estimates for people with chronic heart failure and explain variation in survival by key factors including age at diagnosis, left ventricular ejection fraction, decade of diagnosis, and study setting. Methods and results: We searched in relevant databases from inception to August 2018 for non-interventional studies reporting survival rates for patients with chronic or stable heart failure in any ambulatory setting. Across the 60 included studies, there was survival data for 1.5 million people with heart failure. In our random effects meta-analyses the pooled survival rates at 1 month, 1, 2, 5 and 10 years were 95.7% (95% confidence interval 94.3–96.9), 86.5% (85.4–87.6), 72.6% (67.0–76.6), 56.7% (54.0–59.4) and 34.9% (24.0–46.8), respectively. The 5-year survival rates improved between 1970–1979 and 2000–2009 across healthcare settings, from 29.1% (25.5–32.7) to 59.7% (54.7–64.6). Increasing age at diagnosis was significantly associated with a reduced survival time. Mortality was lowest in studies conducted in secondary care, where there were higher reported prescribing rates of key heart failure medications. There was significant heterogeneity among the included studies in terms of heart failure diagnostic criteria, participant co-morbidities, and treatment rates. Conclusion: These results can inform health policy and individual patient advanced care planning. Mortality associated with chronic heart failure remains high despite steady improvements in survival. There remains significant scope to improve prognosis through greater implementation of evidence-based treatments. Further research exploring the barriers and facilitators to treatment is recommended.
| Original language | English |
|---|---|
| Pages (from-to) | 1306-1325 |
| Number of pages | 20 |
| Journal | European Journal of Heart Failure |
| Volume | 21 |
| Issue number | 11 |
| DOIs | |
| Publication status | Published - 1 Nov 2019 |
Bibliographical note
Funding Information:Nicholas R. Jones is supported by a Wellcome Trust Doctoral Research Fellowship [grant number 203921/Z/16/Z]. This project was completed during his time as a NIHR Academic Clinical Fellow. Andrea Roalfe is funded by the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust. F.D. Richard Hobbs acknowledges his part‐funding from the NIHR School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research Care (CLAHRC) Oxford, the NIHR Oxford Biomedical Research Centre (BRC), and the NIHR Oxford Medtech and In‐Vitro Diagnostics Co‐operative (MIC). The project was supported by the NIHR Oxford BRC and CLAHRC. Clare J. Taylor is a NIHR Academic Clinical Lecturer. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Funding Information:
Nicholas R. Jones is supported by a Wellcome Trust Doctoral Research Fellowship [grant number 203921/Z/16/Z]. This project was completed during his time as a NIHR Academic Clinical Fellow. Andrea Roalfe is funded by the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust. F.D. Richard Hobbs acknowledges his part-funding from the NIHR School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research Care (CLAHRC) Oxford, the NIHR Oxford Biomedical Research Centre (BRC), and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative (MIC). The project was supported by the NIHR Oxford BRC and CLAHRC. Clare J. Taylor is a NIHR Academic Clinical Lecturer. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Conflict of interest: C.J.T reports speaker fees from Vifor and Novartis and non-financial support from Roche outside the submitted work. F.D.R.H. reports personal fees and other from Novartis, Boehringer Ingelheim, and grants from Pfizer outside the submitted work. The other authors have nothing to disclose. Thanks to Nia Roberts and Jenny Hirst for their feedback on the search strategy. This work was conducted as part of N.R.J.'s MSc in Evidence Based Health Care at the University of Oxford. This work uses data provided by patients and collected by the NHS as part of their care and support and would not have been possible without access to these data. The National Institute for Health Research recognises and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. Nicholas R. Jones is supported by a Wellcome Trust Doctoral Research Fellowship [grant number 203921/Z/16/Z]. This project was completed during his time as a NIHR Academic Clinical Fellow. Andrea Roalfe is funded by the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust. F.D. Richard Hobbs acknowledges his part-funding from the NIHR School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research Care (CLAHRC) Oxford, the NIHR Oxford Biomedical Research Centre (BRC), and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative (MIC). The project was supported by the NIHR Oxford BRC and CLAHRC. Clare J. Taylor is a NIHR Academic Clinical Lecturer. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Conflict of interest: C.J.T reports speaker fees from Vifor and Novartis and non-financial support from Roche outside the submitted work. F.D.R.H. reports personal fees and other from Novartis, Boehringer Ingelheim, and grants from Pfizer outside the submitted work. The other authors have nothing to disclose.
Publisher Copyright:
© 2019 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Keywords
- Heart failure
- Meta-analysis
- Prognosis
- Survival analysis
- Systematic review
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
