Importance of diagnostic setting in determining mortality in patients with new-onset heart failure: temporal trends in Denmark 1997–2017

2021 ◽  
Author(s):  
Anojhaan Arulmurugananthavadivel ◽  
Anders Holt ◽  
Saaima Parveen ◽  
Morten Lamberts ◽  
Gunnar H Gislason ◽  
...  
Keyword(s):  
Heart Failure ◽  
Temporal Trends ◽  
Mortality Rates ◽  
Outpatient Setting ◽  
Lower Mortality ◽  
Risk Of Death ◽  
Hospitalization Rates ◽  
Standardized Mortality Rate ◽  
Subsequent Risk ◽  
New Onset

Abstract Aim To investigate temporal trends in in-patient versus out-patient diagnosis of new-onset heart failure (HF) and the subsequent risk of death and hospitalization. Methods and results Using nationwide registers, 192,581 patients with a first diagnosis of HF (1997–2017) were included. We computed incidences of HF, age-standardized mortality rates, and absolute risks (AR) of death and hospitalization (accounting for competing risk of death) to understand the importance of the diagnosis setting in relation to subsequent mortality and hospitalization. The overall incidence of HF was approximately the same (170/100,000 persons) every year during 1997–2017. However, in 1997, 77% of all first diagnoses of HF were made during a hospitalization, whereas the proportion was 39% in 2017. As in-patient diagnoses decreased, out-patient diagnoses increased from 23% to 61%. Out-patients had lower mortality and hospitalization rates than in-patients throughout the study period, although the 1-year age-standardized mortality rate decreased for each of in-patients (24 to 14/100-person) and out-patients (11 to 7/100-person). 1-year and 5-year AR of death decreased by 11.1% and 17.0%, respectively, for all HF patients, while the risk of hospitalization for HF did not decrease significantly (1.13% and 0.96%, respectively). Conclusions Between 1997 and 2017, HF changed from being primarily diagnosed during hospitalization to being mostly diagnosed in the outpatient setting. Out-patients had much lower mortality rates than in-patients throughout the study period. Despite a significant decrease in mortality risk for all HF patients, neither in-patients nor out-patients experienced a reduction in the risk of a HF hospitalization.

scholarly journals Mortality after hospital admission for heart failure: improvement over time, equally strong in women as in men

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
J. Buddeke ◽  
◽  
G. B. Valstar ◽  
I. van Dis ◽  
F. L. J. Visseren ◽  
...  
Keyword(s):  
Heart Failure ◽  
Absolute Risk ◽  
Mortality Rates ◽  
Dutch Hospital ◽  
Term Survival ◽  
Risk Of Death ◽  
Over Time ◽  
Age And Sex ◽  
New Onset

Abstract Background To assess the trend in age- and sex-stratified mortality after hospitalization for heart failure (HF) in the Netherlands. Methods Two nationwide cohorts of patients, hospitalized for new onset heart failure between 01.01.2000–31.12.2002 and between 01.01.2008–31.12.2010, were constructed by linkage of the Dutch Hospital Discharge Registry and the National Cause of Death registry. 30-day, 1-year and 5 -year overall and cause-specific mortality rates stratified by age and sex were assessed and compared over time. Results We identified 40,230 men and 41,582 women. In both cohorts, men were on average younger than women (74–75 and 78–79 years, respectively) and more often had comorbid conditions (37 and 30%, respectively). In the 2008–10 cohort, mortality rates for men were 13, 32 and 64% for respectively 30-day, 1-year and 5-year mortality and 14, 33 and 66% for women. Mortality rates increased considerably with age similarly in men and women (e.g. from 10.5% in women aged 25–54 to 46.1% in those aged 85 and older after 1 year). Between the two time periods, mortality rates dropped across all ages, equally strong in women as in men. The 1-year absolute risk of death declined by 4.0% (from 36.1 to 32.1%) in men and 3.2% (from 36.2 to 33.0%) in women. Conclusions Mortality after hospitalization for new onset HF remains high, however, both short-term and long-term survival is improving over time. This improvement was similar across all ages and equally strong in women as in men.

Abstract 205: New Onset Heart Failure and Adverse Ischemic Events Associated with Amiodarone and Dronedarone Use among Atrial Fibrillation Patients

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Gosia Sylwestrzak ◽  
Jinan Liu ◽  
Alan Rosenberg ◽  
Jeffrey White ◽  
John Barron ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Incidence Rate ◽  
Statistical Significance ◽  
Administrative Claims ◽  
Risk Of Death ◽  
Observational Cohort ◽  
New Onset

Background: Dronedarone is a non-iodinated form of amiodarone that may not cause some of serious adverse effects associated with amiodarone. However, it is less effective than amiodarone in maintaining normal sinus rhythm, and it does not improve success of electrical cardioversion. Additionally, dronedarone use has been associated with new onset or worsening of heart failure (HF), including a doubling of the risk of death in patients with symptomatic heart failure. We aimed to compare the incidence of newly diagnosed HF and HF hospitalizations among dronedarone and amiodarone users. Secondary outcomes of interest included rates of acute ischemic stroke (IS) and transient ischemic attack (TIA). Methods: This retrospective study utilized administrative claims data between 1/1/2007-9/30/2011 from the HealthCore Integrated Research Environment (HIRE ® ). Patients were required to have at least one claim for atrial fibrillation. Propensity score matching was employed to adjust for differences between the cohorts. Incidence rate of HF, HF hospitalizations, IS and TIA events were compared between matched cohorts using Poisson time-to-event model. Results: The cohort consisted of 6,013 amiodarone and 1,534 dronedarone patients. Dronedarone patients were younger, healthier per Deyo-Charlson Index (DCI) and CHADS2 score, and less likely to have underlying heart disease (all p-values<0.05). In the propensity score matching process 838 patients with comparable baseline characteristics were selected in each group. Median follow up was 552 days in the amiodarone cohort and 412 days in the dronedarone cohort. Among patients without HF history, new onset HF incidence rate was 34.6 per 100 person-year in amiodarone cohort and 19.1 per 100 person-year in dronedarone cohort (IRR=1.61, 95% CI: 1.30-2.01, p<0.01). The incidence rate for HF hospitalization was also higher in amiodarone patients-- 10.7 per 100 person-year against 7.8 per 100 person-year for dronedarone (IRR=1.39, 95% CI: 1.02-1.85, p=0.03). For IS, the incidence rate was 1.68 per 100 person-year in amiodarone vs. 0.84 in dronedarone but results did not reach statistical significance (IRR=1.91, 95% CI: 0.84-4.30, p=0.12); for TIA, it was 3.67 vs. 2.35 for amiodarone and dronedarone respectively (IRR=2.01, 95% CI: 1.14-3.57, p=0.02). Conclusions: In a propensity score matched observational cohort study, amiodarone use was associated with higher incidence rate of new onset HF, HF hospitalizations, and TIA as identified from claims. This finding differs from other clinical studies. Future observational cohort studies should incorporate medical record review for validation since information from claims might be insufficient to fully account for underlying patient risk status, or accurately determine if HF was new onset. Key words: amiodarone; dronedarone; atrial fibrillation; heart failure.

Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?

2017 ◽  
Vol 77 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Marie Holmqvist ◽  
Lotta Ljung ◽  
Johan Askling
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Excess Mortality ◽  
Disease Onset ◽  
Mortality Rates ◽  
Calendar Time ◽  
Risk Of Death ◽  
Quality Register ◽  
Increased Risk ◽  
New Onset

ObjectiveTo investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death.MethodsUsing an extensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onset RA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register.Results17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently.ConclusionsDespite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.

scholarly journals Early risk of mortality, cardiovascular events, and bleeding in patients with newly diagnosed atrial fibrillation

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L110-L113
Author(s):  
Ilaria Cavallari ◽  
Giuseppe Patti
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Causes Of Death ◽  
Temporal Trends ◽  
Bleeding Complications ◽  
Modifiable Risk Factors ◽  
Close Monitoring ◽  
Newly Diagnosed ◽  
Risk Of Death ◽  
Risk Of Mortality

Abstract Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is independently associated with a 1.5- to 2.0-fold higher risk of all-cause death and increased morbidity, in particular for heart failure and stroke. Previous studies have shown that the annual rate of death in AF patients is ∼5%; however, emerging data indicate that the risk of death, but also of thromboembolic and bleeding complications, is highest early after the diagnosis, especially during the first month. In light of these observations, patients with newly diagnosed AF deserve close monitoring and may benefit from a comprehensive care targeting modifiable risk factors for death, such as heart failure, diabetes, renal impairment, and vascular disease. Aim of this report is to focus on timing and causes of death as well as on temporal trends of cardiovascular and bleeding complications in patients with newly diagnosed AF.

Temporal trends in hospitalization and in-hospital mortality rates due to heart failure by age and sex in Spain (2003-2018)

2021 ◽  
Author(s):  
Manuel Anguita Sánchez ◽  
Juan Luis Bonilla Palomas ◽  
María García Márquez ◽  
José Luis Bernal Sobrino ◽  
Francisco Javier Elola Somoza ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Temporal Trends ◽  
Mortality Rates ◽  
Age And Sex

Mortality rates are going down in clinical use of inotropics. Temporal trends for prognosis in acute decompensated heart failure (1992/1999–2005/ 2006)

2014 ◽  
Vol 175 (3) ◽  
pp. 584-586 ◽  
Author(s):  
Juliano N. Cardoso ◽  
André Grossi ◽  
Carlos H. Del Carlo ◽  
Cristina Martins dos Reis ◽  
Milena Curiati ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Temporal Trends ◽  
Decompensated Heart Failure ◽  
Mortality Rates ◽  
Clinical Use

Abstract 223: National and Regional Trends in Hospitalizations for Hemorrhagic Stroke after Acute Myocardial Infarction in the United States: 1999-2010

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Ruizhi Shi ◽  
Yun Wang ◽  
Judith H Lichtman ◽  
Kumar Dharmarajan ◽  
Frederick A Masoudi ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hemorrhagic Stroke ◽  
Temporal Trends ◽  
The United States ◽  
Mortality Rates ◽  
Hospitalization Rates ◽  
One Year ◽  
Stroke Belt

Background: Elderly survivors of acute myocardial infarction (AMI) are at elevated risk for hemorrhagic stroke, which has a mortality rate of approximately 50%. Increasing use of warfarin for arterial fibrillation and anti-platelet agents for AMI combined with an increasing aging population may have influenced the risk of post-AMI strokes. We sought to characterize temporal trends in the risk for and mortality from hemorrhagic stroke over 12 years among older AMI survivors of different age, sex, race, revascularization status, and region within the US. Methods: We used 100% of Medicare inpatient claims data to identify all fee-for-service (FFS) patients aged> 64 years who were hospitalized for AMI in 1999-2010. We excluded patients who died during the hospitalization or were transferred. Revascularization procedures were identified during the index admission. We used a Cox proportional-hazards regression model to estimate the risk-adjusted annual changes in one-year hemorrhagic stroke hospitalization after AMI, overall and by subgroups. Changes were adjusted by age, gender, race, medical history and comorbidities. We calculated the 30-day mortality among patients readmitted for hemorrhagic stroke. Stroke belt regions were defined as the states with high stroke hospitalization rates in the southeast United States. Results: Among 2,433,036 AMI hospitalizations and 4,852 hemorrhagic stroke readmissions, the risk-adjusted one-year post-AMI hemorrhagic stroke rate remained stable from 1999 to 2010 (range, 0.2% to 0.3%). No significant trends were found for post-AMI stroke rates across all age-sex-race groups and all treatment groups (Figure). Thirty-day mortality rates for stroke after AMI did not show significant changes (1999, 46.7%, 95% CI 39.9%-53.7%; 2010, 50.7%, 95% CI 45.3%-56.1%; range: 46.5% to 54.6%). No difference was found in post-AMI hemorrhagic stroke rates between the stroke belt and non-stroke belt regions. Conclusions: From 1999 to 2010, the overall hospitalization rates of hemorrhagic stroke after AMI were relatively stable without significant changes across all subgroups. Thirty-day mortality rates remained largely unchanged over time. Stroke risk in the stroke belt was not found significantly higher comparing with non-stroke belt states.

scholarly journals Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e044126
Author(s):  
Louise Y Sun ◽  
Lisa M Mielniczuk ◽  
Peter P Liu ◽  
Rob S Beanlands ◽  
Sharon Chih ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Temporal Trends ◽  
Population Based ◽  
Outpatient Setting ◽  
Secondary Outcome ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
New Diagnosis

ObjectivesTo examine the temporal trends in mortality and heart failure (HF) hospitalisation in ambulatory patients following a new diagnosis of HF.DesignRetrospective cohort studySettingOutpatientParticipantsOntario residents who were diagnosed with HF in an outpatient setting between 1994 and 2013.Primary and secondary outcome measuresThe primary outcome was all-cause mortality within 1 year of diagnosis and the secondary outcome was HF hospitalisation within 1 year. Risks of mortality and hospitalisation were calculated using the Kaplan-Meier method and the relative hazard of death was assessed using multivariable Cox proportional hazard models.ResultsA total of 352 329 patients were studied (50% female). During the study period, there was a greater decline in age standardised 1-year mortality rates (AMR) in men (33%) than in women (19%). Specifically, female AMR at 1 year was 10.4% (95% CI 9.1% to 12.0%) in 1994 and 8.5% (95% CI 7.5% to 9.5%) in 2013, and male AMR at 1 year was 12.3% (95% CI 11.1% to 13.7%) in 1994 and 8.3% (95% CI 7.5% to 9.1%) in 2013. Conversely, age standardised HF hospitalisation rates declined in men (11.4% (95% CI 10.1% to 12.9%) in 1994 and 9.1% (95% CI 8.2% to 10.1%) in 2013) but remained unchanged in women (9.7% (95% CI 8.3% to 11.3%) in 1994 and 9.8% (95% CI 8.6% to 11.0%) in 2013).ConclusionAmong patients with HF over a 20-year period, there was a greater improvement in the prognosis of men compared with women. Further research should focus on the determinants of this disparity and ways to reduce this gap in outcomes.

Cardiology participation improves outcomes in patients with new-onset heart failure in the outpatient setting

2003 ◽  
Vol 12 (3) ◽  
pp. 48
Author(s):  
M. Ansari ◽  
M. Alexander ◽  
A. Tutar ◽  
D. Bello ◽  
B.M. Massie
Keyword(s):  
Heart Failure ◽  
Outpatient Setting ◽  
New Onset
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