Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study

Clare J. Taylor*, José M. Ordóñez-Mena, Andrea Roalfe, Sarah Lay-Flurrie, Nicholas R. Jones, Tom Marshall, F D Richard Hobbs Hobbs

*Corresponding author for this work

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Abstract

OBJECTIVES: To report reliable estimates of short term and long term survival rates for people with a diagnosis of heart failure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group.

DESIGN: Population based cohort study.

SETTING: Primary care, United Kingdom.

PARTICIPANTS: Primary care data for 55 959 patients aged 45 and overwith a new diagnosis of heart failure and 278 679 age and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data.

MAIN OUTCOME MEASURES: Survival rates at one, five, and 10 years and cause of death for people with and without heart failure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group.

RESULTS: Overall, one, five, and 10 year survival rates increased by 6.6% (from 74.2% in 2000 to 80.8% in 2016), 7.2% (from 41.0% in 2000 to 48.2% in 2012), and 6.4% (from 19.8% in 2000 to 26.2% in 2007), respectively. There were 30 906 deaths in the heart failure group over the study period. Heart failure was listed on the death certificate in 13 093 (42.4%) of these patients, and in 2237 (7.2%) it was the primary cause of death. Improvement in survival was greater for patients not requiring admission to hospital around the time of diagnosis (median difference 2.4 years; 5.3 v 2.9 years, P<0.001). There was a deprivation gap in median survival of 0.5 years between people who were least deprived and those who were most deprived (4.6 v 4.1 years, P<0.001) [corrected].

CONCLUSIONS: Survival after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer. New strategies to achieve timely diagnosis and treatment initiation in primary care for all socioeconomic groups should be a priority for future research and policy.

Original languageEnglish
Article number1223
Number of pages10
JournalBMJ
Volume364
DOIs
Publication statusPublished - 13 Feb 2019

Bibliographical note

Funding:
The study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust and the Wellcome Institutional Strategic Fund. The funders did not have any role in the design of the study, analysis and interpretation of the data, or writing of the results for publication. CJT is a NIHR academic clinical lecturer. AKR, SL-F, and JMOM are supported by the NIHR Biomedical Research Centre Oxford (BRC) Oxford University Hospitals NHS Foundation Trust. JMOM is also supported by the NIHR Community Healthcare Medtech and In Vitro Diagnostics Cooperative. NRJ is a Wellcome Trust doctoral research fellow (grant number 203921/Z/16/Z). TM is funded by the CLAHRC West Midlands. FDRH acknowledges support from the NIHR School for Primary Care Research, NIHR CLAHRC Oxford, the NIHR Oxford BRC and Harris Manchester College, Oxford. 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.

Keywords

  • Aged
  • Aged, 80 and over
  • Cause of Death/trends
  • Cohort Studies
  • Databases, Factual
  • Female
  • Heart Failure/mortality
  • Hospitalization/trends
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care/trends
  • Retrospective Studies
  • Risk Factors
  • Survival Rate/trends
  • United Kingdom

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