6129Temporal trends and patterns in cause-specific mortality and hospitalisations after incident heart failure: a longitudinal analysis of 86,000 individuals

Abstract Background The past two decades have brought considerable improvements in heart failure care. Clinical trials have demonstrated effectiveness of several different treatments in reducing mortality and hospitalisations, and observational studies have shown that these treatments are increasingly being used in many countries. Little is known about whether these changes have been reflected in patient outcomes in routine clinical settings. Methods We used anonymised electronic health records that link information from primary care, secondary care, and the national death registry to investigate 86,000 individuals with newly diagnosed heart failure between 2002 and 2013 in the UK. We computed all-cause and cause-specific mortality rates and number of hospitalisations in the first year following diagnosis. We used Poisson regression models to calculate category-specific rate ratios and 95% confidence intervals, adjusting for patients' age, sex, region, socioeconomic status and 17 major comorbidities. Findings One year after initial heart failure diagnosis, all-cause mortality rates were high (32%) and did not change significantly over the period of study (adjusted rate ratio (RR) 2013 vs 2002: 0.94 [0.88, 1]). Overall rates masked diverging trends in cause-specific outcomes: a decline in cardiovascular mortality (RR: 0.74 [0.68, 0.81]) was offset by an increase in non-cardiovascular mortality (RR: 1.28 [1.17, 1.39]), largely due to infections and chronic respiratory conditions. Sub-group analyses further showed that overall mortality declined among patients under 80 years of age (RR 2013 vs 2002: 0.79 [0.71, 0.88]), although not in older age groups (RR 2013 vs 2002: 0.97 [0.9, 1.06]). After cardiovascular causes (43%), the major causes of death identified in 2013 were neoplasms (15%), respiratory conditions (12%), and infections (11%). Hospital admissions within a year of heart failure diagnosis were common (1.15 hospitalisations per patient-year at risk), changed little over time (RR: 0.96 [0.92, 0.99]), and were largely (60%) due to non-cardiovascular causes. Interpretation Despite increased use of life-saving interventions, overall mortality and hospitalisations following a new diagnosis of heart failure have changed little over the past decade. Improved prognosis among young and middle-aged patients marks an important achievement and attests of complex barriers to progress in elderly patients. The shift from cardiovascular to non-cardiovascular causes of death suggest that management of associated comorbidities might offer additional opportunities to improve patients' prognosis. Acknowledgement/Funding British Heart Foundation, National Institute for Health Research, UK Research and Innovation.

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Abstract P159: No Gender Difference in All-Cause Mortality Rates in a Cohort of Heart Failure With Preserved Ejection Fraction in the US Veteran Population

Circulation ◽

10.1161/circ.137.suppl_1.p159 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Katherine E Kurgansky ◽

David Gagnon ◽

Kelly Cho ◽

J M Gaziano ◽

Jacob Joseph ◽

...

Keyword(s):

Heart Failure ◽

Mortality Rate ◽

Ejection Fraction ◽

Rate Ratio ◽

Total Mortality ◽

Mortality Rates ◽

Failure Diagnosis ◽

Preserved Ejection Fraction ◽

Heart Failure Diagnosis

Introduction: Heart failure with preserved ejection fraction (HFpEF) affects about 5% of people 65 or older, with a higher prevalence in women. Previous studies suggest that women with HFpEF may live longer than men. Further understanding of mortality outcomes by gender could be useful in implementing gender-specific treatment strategies to improve outcomes in HFpEF patients. Hypothesis: We assessed the hypothesis that women have a lower rate of total mortality than males in a US Veteran HFpEF cohort. Methods: We used a validated algorithm to curate a HFpEF cohort using ICD9 codes, laboratory values, medications, and ejection fraction values from the national Veterans Affairs database. This algorithm had 88% sensitivity and 96% specificity. We examined crude and adjusted mortality rates by gender, beginning at the time of heart failure diagnosis with follow-up through 2016. The adjusted mortality rate was directly standardized to the population of veterans with heart failure (n= 626,179) according to distribution of age, race, cardiovascular disease (CVD), and chronic kidney disease (CKD). Crude and standardized rate ratios were calculated from the mortality rates. Results: Our HFpEF cohort (n= 74,937) included 72,267 men and 2,670 women. Mean age was 72.5 (11.2) in men and 69.1 (14.3) in women at the time of heart failure diagnosis. Males were 85.2% white, 33.7% had CVD, and 27.1% had CKD, whereas females were 82.5% white, 28.7% had CVD, and 20.5% had CKD. During a mean follow up of 4.8 (3.7) years, 52,703 deaths occurred in men and 1,614 deaths occurred in women.The crude mortality rate was significantly lower for females (109.7/1000 person-years) compared to males (153.5/1000 person-years). Corresponding crude incidence rate ratio (95% CI) for total mortality comparing females to males was 0.71 (0.69-0.74; p<.0001). However, after standardizing, there was no significant difference in total mortality rates between men (170.0/1000 person-years) and women (173.4/1000 person-years). The standardized mortality rate ratio was 1.02 (95% CI: 0.84-1.23; p=0.8397). Conclusions: In conclusion, our data do not show any difference in total mortality rate between men and women following the diagnosis of HFpEF.

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Abstract P396: Thirty Years of Cardiovascular Mortality in Quebec, is the Decline Slowing in the Younger Population?

Circulation ◽

10.1161/circ.125.suppl_10.ap396 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Claudia Blais ◽

Denis Hamel

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Mortality Rate ◽

Cardiovascular Mortality ◽

Age Groups ◽

Mortality Rates ◽

Age Group ◽

Annual Percentage Change ◽

Specific Mortality ◽

Adjusted Rate

Background: It has been demonstrated in many countries that cardiovascular mortality has decreased over recent decades and the decline was accelerating for people aged 35 years and older and slowing in the younger population. Coronary heart disease (CHD) and stroke were the major causes responsible of this decline. We hypothesized that this fall and deceleration of the decline has occurred also in Quebec, Canada and looked if other diseases, such as heart failure (HF) and high blood pressure (HBP) presented a similar decline. Methods: Age-adjusted and specific mortality rates were obtained with the Quebec registry of death for each year of 1978–2007 period for all cardiovascular diseases and divided into CHD, stroke, HF and HBP for people aged ≥35 years and for each 10 year-age groups respectively. Joinpoint regressions on these mortality rates were used to estimate the annual percentage change (APC) and to detect points in time at which significant changes in the trends occurred. Several methods of forecasting were compared to predict age-adjusted mortality rates for the next decade (2008–2017). Results: There were 542,712 cardiovascular deaths. All CHD age-adjusted mortality rates for both sexes combined declined with a marked acceleration in 1997 (APC 1978–1997 and 1997–2007 of −3.05 and −5.99 respectively) while stroke presented with a lower decline between years 1988 and 1997 and reaccelerated thereafter (APC 1978–1988: −4.72, 1988–1997: −2.22 and 1997–2007: −5.39). HF presented an increase between years 1978 and 1981 (APC: 6.28) followed by a decline (APC 1981–2007: −3.58). Death due to HBP in the same group showed a deceleration of the decline in 1992 (APC 1978–1992: −7.46 and APC 1992–2007: −1.97). In the group aged 35–44 years, when both sexes were combined, only HF presented an increase in the mortality rate (APC 1978–1992: −7.76 and 1992–2007: 4.97). CHD and stroke presented constant declines for this age group (APC 1978-2007: −5.17 and −4.73, respectively) while HBP had no mortality at all. CHD mortality for all ages is projected to decrease to an adjusted rate of 100 per 100,000 person-year in 2017 (−38% from 2007). Conclusions: Death due to HBP was the only cause responsible of a slowing of the decline in people aged 35 years and older. However, when looking at the younger population, HF is presenting not only a slowing of the decline but, more importantly, an increase in the mortality rate. The forecasting of cardiovascular deaths seems to get a constant decline for the principal cause, CHD.

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