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

doi:10.1136/bmj.l223

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 language	English
Article number	1223
Number of pages	10
Journal	BMJ
Volume	364
DOIs	https://doi.org/10.1136/bmj.l223
Publication status	Published - 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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/bmj.l223Licence: Creative Commons: Attribution (CC BY)

Taylor_et_al_Trends_in_survival_after_a_diagnosis_BMJ_2019
Taylor, CJ, Ordóñez-Mena, JM, Roalfe, A, Lay-Flurrie, S, Jones, NR, Marshall, T & Hobbs, R 2019, 'Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study', BMJ, vol. 364, no. 8187, 1223, pp. 1-10. https://doi.org/10.1136/bmj.l223
Final published version, 706 KBLicence: Creative Commons: Attribution (CC BY)

https://www.bmj.com/content/364/bmj.l223Licence: Creative Commons: Attribution (CC BY)

Cite this

@article{82c8efd4984f4fffa4a8a7fceaafcd96,

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

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.",

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",

author = "Taylor, {Clare J.} and Ord{\'o}{\~n}ez-Mena, {Jos{\'e} M.} and Andrea Roalfe and Sarah Lay-Flurrie and Jones, {Nicholas R.} and Tom Marshall and Hobbs, {F D Richard Hobbs}",

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. ",

year = "2019",

month = feb,

day = "13",

doi = "10.1136/bmj.l223",

language = "English",

volume = "364",

journal = "BMJ",

issn = "0959-535X",

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TY - JOUR

T1 - Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017

T2 - population based cohort study

AU - Taylor, Clare J.

AU - Ordóñez-Mena, José M.

AU - Roalfe, Andrea

AU - Lay-Flurrie, Sarah

AU - Jones, Nicholas R.

AU - Marshall, Tom

AU - Hobbs, F D Richard Hobbs

N1 - 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.

PY - 2019/2/13

Y1 - 2019/2/13

N2 - 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.

AB - 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.

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KW - Aged, 80 and over

KW - Cause of Death/trends

KW - Cohort Studies

KW - Databases, Factual

KW - Female

KW - Heart Failure/mortality

KW - Hospitalization/trends

KW - Humans

KW - Male

KW - Middle Aged

KW - Primary Health Care/trends

KW - Retrospective Studies

KW - Risk Factors

KW - Survival Rate/trends

KW - United Kingdom

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DO - 10.1136/bmj.l223

M3 - Article

C2 - 30760447

SN - 0959-535X

VL - 364

JO - BMJ

JF - BMJ

M1 - 1223

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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