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Zhou Y, Ye R, Guo X. Modifiable risk factors mediating the impact of educational inequality on heart failure: A Mendelian randomization study. Prev Med 2024; 186:108098. [PMID: 39127305 DOI: 10.1016/j.ypmed.2024.108098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/07/2024] [Accepted: 08/07/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Heart failure (HF) is a rapidly growing global disease burden with high mortality rates. We aimed to utilize mendelian randomization (MR) analyses to investigate the association between educational attainment (EA) and HF, and to evaluate the contribution of modifiable risk factors as mediators. METHODS We applied a two-sample MR approach based on the largest genome-wide association studies (GWAS) to investigate the causal relationship between EA and HF. Data collection was conducted in July 2023. We then conducted mediation analyses to explore whether body mass index (BMI), blood pressure, and type 2 diabetes mellitus (T2DM) mediate the effect of EA on HF, and utilized multivariable MR to estimate the proportion of mediation attributed to these factors. RESULTS Genetically predicted 3.4 years of additional education was associated with a decrease in the risk of HF (OR 0.76 for each 3.4 years of schooling; 95% CI 0.72, 0.81). BMI, T2DM, systolic blood pressure, and diastolic blood pressure mediated 40.82% (95% CI: 28.86%, 52.77%), 18.00% (95% CI: 12.10%, 23.90%), 11.60% (95% CI: 7.63%, 15.56%), and 7.80% (95% CI: 4.63%, 10.96%) of the EA-HF association, respectively. All risk factors combined were estimated to mediate 63.81% (95% CI: 45.91%, 81.71%) of the effect of EA on HF. CONCLUSION Higher EA has a protective effect against the risk of HF, and potential mechanisms may include regulation of BMI, blood pressure, and blood glucose. Further research is needed to understand whether interventions targeting these factors could influence the association between EA and HF risk.
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Affiliation(s)
- Yijiang Zhou
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang, China.
| | - Runze Ye
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang, China.
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang, China.
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Weber C, Hung J, Hickling S, Li I, Murray K, Briffa T. Unplanned 30-day readmissions, comorbidity and impact on one-year mortality following incident heart failure hospitalisation in Western Australia, 2001-2015. BMC Cardiovasc Disord 2023; 23:25. [PMID: 36647020 PMCID: PMC9843857 DOI: 10.1186/s12872-022-03020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Readmissions within 30 days after heart failure (HF) hospitalisation is considered an important healthcare quality metric, but their impact on medium-term mortality is unclear within an Australian setting. We determined the frequency, risk predictors and relative mortality risk of 30-day unplanned readmission in patients following an incident HF hospitalisation. METHODS From the Western Australian Hospitalisation Morbidity Data Collection we identified patients aged 25-94 years with an incident (first-ever) HF hospitalisation as a principal diagnosis between 2001 and 2015, and who survived to 30-days post discharge. Unplanned 30-day readmissions were categorised by principal diagnosis. Logistic and Cox regression analysis determined the independent predictors of unplanned readmissions in 30-day survivors and the multivariable-adjusted hazard ratio (HR) of readmission on mortality within the subsequent year. RESULTS The cohort comprised 18,241 patients, mean age 74.3 ± 13.6 (SD) years, 53.5% males, and one-third had a modified Charlson Comorbidity Index score of ≥ 3. Among 30-day survivors, 15.5% experienced one or more unplanned 30-day readmission, of which 53.9% were due to cardiovascular causes; predominantly HF (31.4%). The unadjusted 1-year mortality was 15.9%, and the adjusted mortality HR in patients with 1 and ≥ 2 cardiovascular or non-cardiovascular readmissions (versus none) was 1.96 (95% confidence interval (CI) 1.80-2.14) and 3.04 (95% CI, 2.51-3.68) respectively. Coexistent comorbidities, including ischaemic heart disease/myocardial infarction, peripheral arterial disease, pneumonia, chronic kidney disease, and anaemia, were independent predictors of both 30-day unplanned readmission and 1-year mortality. CONCLUSION Unplanned 30-day readmissions and medium-term mortality remain high among patients who survived to 30 days after incident HF hospitalisation. Any cardiovascular or non-cardiovascular readmission was associated with a two to three-fold higher adjusted HR for death over the following year, and various coexistent comorbidities were important associates of readmission and mortality risk. Our findings support the need to optimize multidisciplinary HF and multimorbidity management to potentially reduce repeat hospitalisation and improve survival.
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Affiliation(s)
- Courtney Weber
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| | - Joseph Hung
- grid.1012.20000 0004 1936 7910Medical School, University of Western Australia, Crawley, WA Australia
| | - Siobhan Hickling
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| | - Ian Li
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| | - Kevin Murray
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
| | - Tom Briffa
- grid.1012.20000 0004 1936 7910School of Population and Global Health, University of Western Australia, Crawley, WA Australia
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Wideqvist M, Rosengren A, Schaufelberger M, Pivodic A, Fu M. Ten year age- and sex-specific temporal trends in incidence and prevalence of heart failure in Västra Götaland, Sweden. ESC Heart Fail 2022; 9:3931-3941. [PMID: 35957620 PMCID: PMC9773728 DOI: 10.1002/ehf2.14103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/02/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023] Open
Abstract
AIM Heart failure (HF) is predominantly a disorder of the elderly. During the last decades, cardiovascular primary and secondary prevention and life expectancy have improved. Accordingly, trends in incidence and prevalence of HF are dynamic and may differ over time by age and gender. We aim to investigate the overall and age-specific and sex-specific trends, in incidence, prevalence, and the proportion with co-morbidities of HF over a 10 year period in Region Västra Götaland, Sweden. METHODS AND RESULTS The VEGA database is an administrative database of all patients managed in hospital and/or in primary care (private and public) living in Region Västra Götaland. All patients with a main or contributory diagnosis of HF (I50) aged 18 years or older between 2008 and 2017 were included. Incidence and prevalence of HF were calculated based on the entire adult population of Region Västra Götaland. The adult population in Region Västra Götaland increased by 8% from 2008 (n = 1 234 609) to 2017 (n = 1 338 906). Half the population was female and 69% < 60 years of age, both constant over time. In total, 62 228 incident cases of HF were identified. In 2008, we identified 6464 cases, mean age 78.7 (11.5) years, and 49.8% (n = 3222) men, while in 2017, 5727 cases were identified, mean age 78.3 (11.8) years, and 52.5% (n = 3006) men. The overall yearly incidence rate of HF decreased by 3%, RR 0.97 (95% CI 0.96-0.97) per year, P < 0.0001, mainly driven by the age categories >75 years. A constantly higher incidence of HF was seen for men compared with women in all age categories, RR 1.46 (95% CI 1.44-1.49), P < 0.0001. During the same period, we observed a steady increase in overall prevalence from 1.8% for women and 2.0% for men in 2008, to 2.4% in women and 2.8% in men in 2017, particularly in those >85 years of age who had a prevalence of 16.5% (men) and 14.6% (women) in 2008 and 23.5% (men) and 21.5% (women) in 2017. The overall 1 year mortality rate was 22.7%. When adjusted for age, women had a lower risk for death by 13% compared with men [hazard ratio 0.87 (95% CI 0.84-0.90, P < 0.0001)]. CONCLUSION We saw a decrease in overall incidence, but incidence of HF remains high, particularly in the oldest age groups. Prevalence of HF keeps increasing particularly in those aged >85 years. Our findings emphasize the need for implementation of effective preventive strategies for HF.
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Affiliation(s)
- Maria Wideqvist
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of CardiologySahlgrenska University HospitalGothenburgSweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Medicine, Geriatrics and Emergency MedicineSahlgrenska University HospitalGothenburgSweden
| | - Maria Schaufelberger
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Medicine, Geriatrics and Emergency MedicineSahlgrenska University HospitalGothenburgSweden
| | - Aldina Pivodic
- Statistiska konsultgruppenGothenburgSweden,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Medicine, Geriatrics and Emergency MedicineSahlgrenska University HospitalGothenburgSweden
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Trends for Readmission and Mortality After Heart Failure Hospitalisation in Malaysia, 2007 to 2016. Glob Heart 2022; 17:20. [PMID: 35342695 PMCID: PMC8916062 DOI: 10.5334/gh.1108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background and objectives: Data on population-level outcomes after heart failure (HF) hospitalisation in Asia is sparse. This study aimed to estimate readmission and mortality after hospitalisation among HF patients and examine temporal variation by sex and ethnicity. Methods: Data for 105,399 patients who had incident HF hospitalisations from 2007 to 2016 were identified from a national discharge database and linked to death registration records. The outcomes assessed here were 30-day readmission, in-hospital, 30-day and one-year all-cause mortality. Results: Eighteen percent of patients (n = 16786) were readmitted within 30 days. Mortality rates were 5.3% (95% confidence interval (CI) 5.1–5.4%), 11.2% (11.0–11.4%) and 33.1% (32.9–33.4%) for in-hospital, 30-day and 1-year mortality after the index admission. Age, sex and ethnicity-adjusted 30-day readmissions increased by 2% per calendar year while in-hospital and 30-day mortality declined by 7% and 4% per year respectively. One-year mortality rates remained constant during the study period. Men were at higher risk of 30-day readmission (adjusted rate ratio (RR) 1.16, 1.13–1.20) and one-year mortality (RR 1.17, 1.15–1.19) than women. Ethnic differences in outcomes were evident. Readmission rates were equally high in Chinese and Indians relative to Malays whereas Others, which mainly comprised Indigenous groups, fared worst for in-hospital and 30-day mortality with RR 1.84 (1.64–2.07) and 1.3 (1.21–1.41) relative to Malays. Conclusions: Short-term survival was improving across sex and ethnic groups but prognosis at one year after incident HF hospitalisation remained poor. The steady increase in 30-day readmission rates deserves further investigation.
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Nghiem S, Afoakwah C, Scuffham P, Byrnes J. A baseline profile of the Queensland Cardiac Record Linkage Cohort (QCard) study. BMC Cardiovasc Disord 2022; 22:35. [PMID: 35120447 PMCID: PMC8817516 DOI: 10.1186/s12872-022-02478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/26/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is one of the leading causes of death in Australia. Longitudinal record linkage studies have the potency to influence clinical decision making to improve cardiac health. This paper describes the baseline characteristics of the Queensland Cardiac Record Linkage Cohort study (QCard). METHODS International Classification of Disease, 10th Revision Australian Modification (ICD-10-AM) diagnosis codes were used to identify CVD and comorbidities. Cost and adverse health outcomes (e.g., comorbidities, hospital-acquired complications) were compared between first-time and recurrent admissions. Descriptive statistics and standard tests were used to analyse the baseline data. RESULTS There were 132,343 patients with hospitalisations in 2010, of which 47% were recurrent admissions, and 53% were males. There were systematic differences between characteristics of recurrent and first-time hospitalisations. Patients with recurrent episodes were nine years older (70 vs. 61; p < 0.001) and experienced a twice higher risk of multiple comorbidities (3.17 vs. 1.59; p < 0.001). CVD index hospitalisations were concentrated in large metropolitan hospitals. CONCLUSIONS Our study demonstrates that linked administrative health data provide an effective tool to investigate factors determining the progress of heart disease. Our main finding suggests that recurrent admissions were associated with higher hospital costs and a higher risk of having adverse outcomes.
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Affiliation(s)
- Son Nghiem
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia.
| | - Clifford Afoakwah
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia
| | - Paul Scuffham
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Level 8.86, G40-Griffith Health Centre, Gold Coast, QLD, 4222, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, 117 Kessels Road, Nathan, Brisbane, QLD, 4111, Australia
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Weber C, Hung J, Hickling S, Li I, Murray K, Briffa T. Changing age-specific trends in incidence, comorbidities and mortality of hospitalised heart failure in Western Australia between 2001 and 2016. Int J Cardiol 2021; 343:56-62. [PMID: 34520794 DOI: 10.1016/j.ijcard.2021.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incident heart failure (HF) hospitalisation rates in most high-income countries are stable or declining. However, HF incidence may be increasing in younger people linked to changing risk factor profiles in the general population. We examined age and sex-specific patterns of incidence, comorbidities and mortality of hospitalised HF in Western Australia (WA) between 2001 and 2016. METHODS AND RESULTS All WA residents aged 25-94 years, with an incident (first-ever) principal HF discharge diagnosis between 2001 and 2016 were included (n = 22,476). Poisson regression derived annual age and sex-standardised rates of incident HF and 1-year mortality overall, and by age groups (25-54, 55-74, 75-94), across the study period. Overall, the age and sex-standardised rates of incident HF increased marginally by 0.6% per year (95% confidence interval (CI), 0.3, 0.8) whereas incidence increased by 3.1% per year (95% CI, 2.2, 4.0) in the 25-54 year age-group (trend p < 0.0001). There was a high prevalence (≥15%) of obesity, diabetes mellitus, cardiomyopathy, hypertension, ischemic heart disease, atrial fibrillation, and chronic kidney disease in younger HF patients. Overall standardised 1-year mortality declined by -1.0% per year (95%CI, -0.4, -1.6), driven largely by the mortality decline in the 55-74 year age group. CONCLUSION Incident HF hospitalisation rates have been rising in WA since 2006, notably in individuals under 55 years. The underlying reasons require further investigation, particularly the population-attributable risk related to increasing obesity and diabetes mellitus in the general population. Rising HF incidence along with declining mortality rates portends to an increasing HF burden in the community.
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Affiliation(s)
- Courtney Weber
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.
| | - Joseph Hung
- Medical School, Faculty of Medicine and Health Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Siobhan Hickling
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Ian Li
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
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Verulava T, Jorbenadze R, Lordkipanidze A, Gongadze A, Tsverava M, Donjashvili M. Readmission after hospitalization for heart failure in elderly patients in Chapidze Emergency Cardiology Center, Georgia. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-07-2020-0294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeHeart Failure (HF) is one of the leading mortality causes in elderly people. The purpose of this study is to assess readmission rates and reasons in elderly patients with HF.Design/methodology/approachThe authors explored medical records of elderly patients with HF (75 years and more) at Chapidze Emergency Cardiology Center (Georgia) from 2015 to 2019. The authors analyzed the structure of the cardiovascular diseases and readmission rates of hospitalized patients with HF (I50, I50.0 I50.1). A multivariate logistic regression model was used to identify factors, associated with readmission for any reason during 6–9 months after the initial hospitalization for HF.FindingsThe major complication of cardiovascular diseases in elderly patients is HF (68.6%). Hospitalization rates due to HF in elderly patients have increased in recent years, which is associated with the population aging process. This trend will be most likely continue. Despite significant improvements in HF treatment, readmission rates are still high. HF is the most commonly revealed cause of readmission (48% of all readmissions). About 6–9 months after the primary hospitalization due to HF, readmission for any reason was 60%. Patients had concomitant diseases, including hypertension (43%), myocardial infarction (14%), diabetes (36%) and stroke (8%), affecting the readmission rate.Originality/valueHF remains an important problem in public health. During HF-associated hospitalizations, both cardiac and non-cardiac conditions should be addressed, which has the potential for health problems and disease progression. Some readmissions may be prevented by the proper selection of medicines and monitoring.
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Chan DZL, Kerr AJ, Doughty RN. Temporal trends in the burden of heart failure. Intern Med J 2021; 51:1212-1218. [PMID: 33650267 DOI: 10.1111/imj.15253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
Heart failure is a common healthcare problem associated with high morbidity and mortality. The burden of heart failure is changing; increases secondary to an ageing population may be offset by improved primary cardiovascular prevention and advances in heart failure therapies. In this review, we evaluate recent international trends in heart failure incidence, morbidity and mortality. Although the age-standardised incidence of heart failure has been decreasing since 2000, the incidence in those age groups <55 years is increasing with patients being diagnosed at younger ages. Despite improvements in therapies for heart failure, prognosis still remains poor with up to one-third of patients not surviving beyond 1 year following diagnosis and no improvements in mortality over the past 10 years. The case-mix of heart failure patients is changing with a greater proportion having non-ischaemic aetiology and preserved ejection fraction, and a higher prevalence of non-cardiovascular comorbidity and mortality.
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Affiliation(s)
- Daniel Z L Chan
- Department of Cardiology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Cardiology, Counties Manukau District Health Board, Auckland, New Zealand.,School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rob N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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Labrosciano C, Horton D, Air T, Tavella R, Beltrame JF, Zeitz CJ, Krumholz HM, Adams RJT, Scott IA, Gallagher M, Hossain S, Hariharaputhiran S, Ranasinghe I. Frequency, trends and institutional variation in 30-day all-cause mortality and unplanned readmissions following hospitalisation for heart failure in Australia and New Zealand. Eur J Heart Fail 2020; 23:31-40. [PMID: 33094886 DOI: 10.1002/ejhf.2030] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/21/2020] [Accepted: 08/27/2020] [Indexed: 12/20/2022] Open
Abstract
AIMS National 30-day mortality and readmission rates after heart failure (HF) hospitalisations are a focus of US policy intervention and yet have rarely been assessed in other comparable countries. We examined the frequency, trends and institutional variation in 30-day mortality and unplanned readmission rates after HF hospitalisations in Australia and New Zealand. METHODS AND RESULTS We included patients >18 years hospitalised with HF at all public and most private hospitals from 2010-15. The primary outcomes were the frequencies of 30-day mortality and unplanned readmissions, and the institutional risk-standardised mortality rate (RSMR) and readmission rate (RSRR) evaluated using separate cohorts. The mortality cohort included 153 592 patients (mean age 78.9 ± 11.8 years, 51.5% male) with 16 442 (10.7%) deaths within 30 days. The readmission cohort included 148 704 patients (mean age 78.6 ± 11.9 years, 51.7% male) with 33 158 (22.3%) unplanned readmission within 30 days. In 392 hospitals with at least 25 HF hospitalisations, the median RSMR was 10.7% (range 6.1-17.3%) with 59 hospitals significantly different from the national average. Similarly, in 391 hospitals with at least 25 HF hospitalisations, the median RSRR was 22.3% (range 17.7-27.1%) with 24 hospitals significantly different from the average. From 2010-15, the adjusted 30-day mortality [odds ratio (OR) 0.991/month, 95% confidence interval (CI) 0.990-0.992, P < 0.01] and unplanned readmission (OR 0.998/month, 95% CI 0.998-0.999, P < 0.01) rates declined. CONCLUSION Within 30 days of a HF hospitalisation, one in 10 patients died and almost a quarter of those surviving experienced an unplanned readmission. The risk of these outcomes varied widely among hospitals suggesting disparities in HF care quality. Nevertheless, a substantial decline in 30-day mortality and a modest decline in readmissions occurred over the study period.
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Affiliation(s)
- Clementine Labrosciano
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Dennis Horton
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Tracy Air
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Rosanna Tavella
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - John F Beltrame
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Christopher J Zeitz
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, Australia
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA.,Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Robert J T Adams
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Australia.,Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | | | - Sadia Hossain
- Discipline of Medicine, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Isuru Ranasinghe
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia.,School of Clinical Medicine, The University of Queensland, Brisbane, Australia
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Liao LZ, Zhuang XD, Zhang SZ, Liao XX, Li WD. Education and heart failure: New insights from the atherosclerosis risk in communities study and mendelian randomization study. Int J Cardiol 2020; 324:115-121. [PMID: 33017630 DOI: 10.1016/j.ijcard.2020.09.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/09/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We aim to characterize the nature and magnitude of the prospective association between education and incident heart failure (HF) in the Atherosclerosis Risk in Communities (ARIC) Study and investigate any causal relevance to the association between them. METHODS The final sample size was 12,315 in this study. Baseline characteristics between education levels were compared using 1-way ANOVA test, the Kruskal-Wallis test, or the χ2 test. We used the Kaplan-Meier estimate to compute the cumulative incident of HF by education levels and the difference in estimate was compared using the log-rank test. Cox hazard regression models were used to explore the association between education levels and incident HF. Two-sample Mendelian randomization (MR) based on publicly available summary-level data from genome-wide association studies (GWASs) was used to estimate the causal influence of the education and incident HF. RESULTS During a median follow-up of 25.1years, 2453 cases (19.9%) of incident HF occurred. After multiple adjustments in the final model, participants in the intermediate and advanced education levels were still associated with 18% and 21% decreased rate of incident HF separately. In MR analysis, we detected a protective causal association between education and HF (P=0.005). CONCLUSIONS Participants with higher education levels were associated with a decreased rate of incident HF. There was a causal association between education and HF.
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Affiliation(s)
- Li-Zhen Liao
- Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China; Guangdong Engineering Research Center for Light and Health, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China
| | - Xiao-Dong Zhuang
- Cardiology Department, The First affiliated hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yue Xiu, GuangZhou 510080, GuangDong, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), PR China
| | - Shao-Zhao Zhang
- Cardiology Department, The First affiliated hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yue Xiu, GuangZhou 510080, GuangDong, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), PR China
| | - Xin-Xue Liao
- Cardiology Department, The First affiliated hospital of Sun Yat-sen University, 58 Zhongshan 2nd Road, Yue Xiu, GuangZhou 510080, GuangDong, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), PR China.
| | - Wei-Dong Li
- Guangdong Pharmaceutical University, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China; Guangdong Engineering Research Center for Light and Health, Guangzhou Higher Education Mega Center, Guangzhou, GuangDong, PR China.
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11
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Khera R, Kondamudi N, Zhong L, Vaduganathan M, Parker J, Das SR, Grodin JL, Halm EA, Berry JD, Pandey A. Temporal Trends in Heart Failure Incidence Among Medicare Beneficiaries Across Risk Factor Strata, 2011 to 2016. JAMA Netw Open 2020; 3:e2022190. [PMID: 33095250 PMCID: PMC7584929 DOI: 10.1001/jamanetworkopen.2020.22190] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Heart failure (HF) incidence is declining among Medicare beneficiaries. However, the epidemiological mechanisms underlying this decline are not well understood. OBJECTIVE To evaluate trends in HF incidence across risk factor strata. DESIGN, SETTING, AND PARTICIPANTS Retrospective, national cohort study of 5% of all fee-for-service Medicare beneficiaries with no prior HF followed up from 2011 to 2016. The study examined annual trends in HF incidence among groups with and without primary HF risk factors (hypertension, diabetes, and obesity) and predisposing cardiovascular conditions (acute myocardial infarction [MI] and atrial fibrillation [AF]). EXPOSURES The presence of comorbid HF risk factors including hypertension, diabetes, obesity, acute MI, and AF identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. MAIN OUTCOMES AND MEASURES Incident HF, defined using at least 1 inpatient HF claim or at least 2 outpatient HF claims among those without a previous diagnosis of HF. RESULTS Of 1 799 027 unique Medicare beneficiaries at risk for HF (median age, 73 years [interquartile range, 68-79 years]; 56% female [805 060-796 253 participants during the study period]), 249 832 had a new diagnosis of HF. The prevalence of all 5 risk factors increased over time (0.8% mean increase in hypertension per year, 1.9% increase in diabetes, 2.9% increase in obesity, 0.2% increase in acute MI, and 0.4% increase in AF). Heart failure incidence declined from 35.7 cases per 1000 beneficiaries in 2011 to 26.5 cases per 1000 beneficiaries in 2016, consistent across subgroups based on sex and race/ethnicity. A greater decline in HF incidence was observed among patients with prevalent hypertension (relative excess decline, 12%), diabetes (relative excess decline, 3%), and obesity (relative excess decline, 16%) compared with those without corresponding risk factors. In contrast, there was a relative increase in HF incidence among individuals with acute MI (26% vs no acute MI) and AF (22% vs no AF). CONCLUSIONS AND RELEVANCE Findings of this study suggest that the temporal decline in HF incidence among Medicare beneficiaries reflects a decrease in HF incidence among those with primary HF risk factors. The increase in HF incidence among those with acute MI and those with AF highlights potential targets for future HF prevention strategies.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Nitin Kondamudi
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Lin Zhong
- Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas
| | - Muthiah Vaduganathan
- Brigham and Women’s Hospital Heart and Vascular Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Joshua Parker
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sandeep R. Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Justin L. Grodin
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ethan A. Halm
- Division of General Internal Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Jarett D. Berry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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12
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Qin X, Hung J, Teng THK, Briffa T, Sanfilippo FM. Long-Term Adherence to Renin-Angiotensin System Inhibitors and β-Blockers After Heart Failure Hospitalization in Senior Patients. J Cardiovasc Pharmacol Ther 2020; 25:531-540. [PMID: 32500739 DOI: 10.1177/1074248420931617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS We investigated long-term adherence to renin-angiotensin system inhibitors (RASIs) and β-blockers, and associated predictors, in senior patients after hospitalization for heart failure (HF). METHODS A population-based data set identified 4488 patients who survived 60 days following their index hospitalization for HF in Western Australia from 2003 to 2008 with a 3-year follow-up. Their person-linked Pharmaceutical Benefits Scheme records identified medications dispensed during follow-up. Drug discontinuation was defined as the first break ≥90 days following the previous supply. Medication adherence was calculated using the proportion of days covered (PDC), with PDC ≥ 80% defined as being adherent. Multivariable logistic regression models were used to identify predictors of PDC < 80%. RESULTS In the cohort (57% male, mean age: 76.6 years), 77.4% were dispensed a RASI and 52.7% a β-blocker within 60 days postdischarge. Over the 3-year follow-up, 28% and 42% of patients discontinued RASI and β-blockers, respectively. Only 64.6% and 47.5% of RASI and β-blocker users, respectively, were adherent to their treatment over 3 years, with adherence decreasing over time (trend P < .0001 for RASI and trend P = .02 for β-blockers). Older age, increasing Charlson comorbidity score, chronic kidney disease, and chronic obstructive pulmonary disease were independent predictors of PDC < 80% for both drug groups. CONCLUSION Among seniors hospitalized for HF, discontinuation gaps were common for RASI and β-blockers postdischarge, and long-term adherence to these medications was suboptimal. Where appropriate, strategies to improve long-term medication adherence are indicated in HF patients, particularly in elderly patients with comorbidities.
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Affiliation(s)
- Xiwen Qin
- School of Population and Global Health, 2720The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, 2720The University of Western Australia, Perth, Western Australia, Australia
| | - Tiew-Hwa Katherine Teng
- School of Population and Global Health, 2720The University of Western Australia, Perth, Western Australia, Australia
- 68753National Heart Centre Singapore, Singapore
| | - Tom Briffa
- School of Population and Global Health, 2720The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, 2720The University of Western Australia, Perth, Western Australia, Australia
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13
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Groenewegen A, Rutten FH, Mosterd A, Hoes AW. Epidemiology of heart failure. Eur J Heart Fail 2020; 22:1342-1356. [PMID: 32483830 PMCID: PMC7540043 DOI: 10.1002/ejhf.1858] [Citation(s) in RCA: 943] [Impact Index Per Article: 235.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022] Open
Abstract
The heart failure syndrome has first been described as an emerging epidemic about 25 years ago. Today, because of a growing and ageing population, the total number of heart failure patients still continues to rise. However, the case mix of heart failure seems to be evolving. Incidence has stabilized and may even be decreasing in some populations, but alarming opposite trends have been observed in the relatively young, possibly related to an increase in obesity. In addition, a clear transition towards heart failure with a preserved ejection fraction has occurred. Although this transition is partially artificial, due to improved recognition of heart failure as a disorder affecting the entire left ventricular ejection fraction spectrum, links can be made with the growing burden of obesity‐related diseases and with the ageing of the population. Similarly, evidence suggests that the number of patients with heart failure may be on the rise in low‐income countries struggling under the double burden of communicable diseases and conditions associated with a Western‐type lifestyle. These findings, together with the observation that the mortality rate of heart failure is declining less rapidly than previously, indicate we have not reached the end of the epidemic yet. In this review, the evolving epidemiology of heart failure is put into perspective, to discern major trends and project future directions.
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Affiliation(s)
- Amy Groenewegen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arend Mosterd
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Arno W Hoes
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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14
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Byrnes J, Nghiem S, Afoakwah C, Scuffham PA. Queensland Cardiovascular Data Linkage (QCard): A population-based cohort study. F1000Res 2020. [DOI: 10.12688/f1000research.23261.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Queensland is Australia's hotspot for cardiovascular disease (CVD). Critically, beyond modifiable lifestyle risk factors; socio-demographic differences and environmental factors account for significant variations in healthcare use and outcomes among cardiac patients across the country. To better understand the impacts of these factors on the health of cardiac patients, there is a need for a comprehensive and robust longitudinal cohort study that can unpack the underlying dynamics. This paper describes the protocol for the Queensland Cardiovascular Linkage (QCard) Study. The QCard is a longitudinal linkage cohort study of cardiac patients who were first hospitalised with any cardiac condition in 2010, with follow up hospitalisations until December 2015. The primary aim of the QCard is to identify and characterise the nature and impact of socio-demographic inequality among those presenting for the first time with the most common form of CVD in Australia (heart disease) in Queensland from 2010 with minimum 5-years follow-up of subsequent healthcare utilisation and outcomes. A secondary aim is to undertake an exploration of the impact of environmental and specific health service factors on healthcare use and survival time in the same QCard cohort. Administrative public and private hospital inpatient, outpatient and emergency department data for all of Queensland will be linked with individual primary care data and pharmaceutical data. These data will also be linked to regional socio-demographic data and environmental data, as well as data that describes the features of each hospital in the region. The findings from the study will provide critical information for cardiac patients, clinicians and health policymakers. Such information ranges from identifying most vulnerable cardiac patients who may require targeted needs to providing estimates for cost-effective ways of evaluating healthcare interventions that seek to improve the health of cardiac patients.
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15
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Ergatoudes C, Hansson PO, Svärdsudd K, Rosengren A, Östgärd Thunström E, Caidahl K, Pivodic A, Fu M. Comparison of incidence rates and risk factors of heart failure between two male cohorts born 30 years apart. Heart 2020; 106:1672-1678. [PMID: 32114518 DOI: 10.1136/heartjnl-2019-316059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/30/2020] [Accepted: 02/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare two cohorts of middle-aged men from the general population born 30 years apart for incidence and predictors of heart failure (HF). METHODS Two population samples of men, born in 1913 (n=855) and in 1943 (n=797), were examined at 50 years of age and followed up for 21 years (1963-1994 and 1993-2014). Cox regression analysis was used to examine the impact of different factors on the risk of developing HF. RESULTS Eighty men born in 1913 (9.4%) and 42 men born in 1943 (5.3%) developed HF during follow-up; adjusted HRs comparing the two cohorts (born 1943 vs 1913) were: 0.46 (95% CI 0.28 to 0.74, p=0.002). In both cohorts, higher body mass index, higher diastolic blood pressure, treatment for hypertension, onset of either atrial fibrillation (AF), ischaemic heart disease and diabetes mellitus were associated with higher risk of HF. Higher heart rate was associated with an increased risk only in men born in 1913, whereas higher systolic blood pressure (SBP), smoking, higher glucose, higher cholesterol and physical inactivity were associated with an increased risk in men born in 1943. AF contributed higher risk of incident HF, whereas SBP and physical inactivity contributed lower risk in men born in 1943 compared with men born in 1913. CONCLUSIONS Men born in 1943 had half the risk of HF after their 50s than those born 30 years earlier. AF, obesity, ischaemic heart disease, diabetes and hypertension remain important precursors of HF.
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Affiliation(s)
- Constantinos Ergatoudes
- Sahlgrenska Universitetssjukhuset Ostra Sjukhuset, Goteborg, Sweden .,Department of Molecular and Clinical Medicine/Emergency and Cardiovascular Medicine Cardiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Per-Olof Hansson
- Sahlgrenska Universitetssjukhuset Ostra Sjukhuset, Goteborg, Sweden.,Department of Molecular and Clinical Medicine/Emergency and Cardiovascular Medicine Cardiology, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Annika Rosengren
- Sahlgrenska Universitetssjukhuset Ostra Sjukhuset, Goteborg, Sweden.,Department of Molecular and Clinical Medicine/Emergency and Cardiovascular Medicine Cardiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Erik Östgärd Thunström
- Sahlgrenska Universitetssjukhuset Ostra Sjukhuset, Goteborg, Sweden.,Department of Molecular and Clinical Medicine/Emergency and Cardiovascular Medicine Cardiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Kenneth Caidahl
- Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden.,Sahlgrenska Academy, Goteborg, Sweden
| | - Michael Fu
- Sahlgrenska Universitetssjukhuset Ostra Sjukhuset, Goteborg, Sweden.,Department of Molecular and Clinical Medicine/Emergency and Cardiovascular Medicine Cardiology, Sahlgrenska Academy, Gothenburg, Sweden
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16
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Jhund PS. The recurring problem of heart failure hospitalisations. Eur J Heart Fail 2020; 22:249-250. [DOI: 10.1002/ejhf.1721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pardeep S. Jhund
- British Heart Foundation Glasgow Cardiovascular Research CentreInstitute of Cardiovascular and Medical Sciences, University of Glasgow Glasgow UK
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17
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15-Year Trends in Patients Hospitalised With Heart Failure and Enrolled in an Australian Heart Failure Management Program. Heart Lung Circ 2019; 28:1646-1654. [DOI: 10.1016/j.hlc.2018.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 08/12/2018] [Accepted: 10/08/2018] [Indexed: 11/19/2022]
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18
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Sulo G, Igland J, Øverland S, Egeland GM, Roth GA, Vollset SE, Tell GS. Heart failure in Norway, 2000-2014: analysing incident, total and readmission rates using data from the Cardiovascular Disease in Norway (CVDNOR) Project. Eur J Heart Fail 2019; 22:241-248. [PMID: 31646725 DOI: 10.1002/ejhf.1609] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/10/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS To examine trends in heart failure (HF) hospitalization rates and risk of readmissions following an incident HF hospitalization. METHODS AND RESULTS During 2000-2014, we identified in the Cardiovascular Disease in Norway Project 142 109 hospitalizations with HF as primary diagnosis. Trends of incident and total (incident and recurrent) HF hospitalization rates were analysed using negative binomial regression models. Changes over time in 30-day and 3-year risk of HF recurrences or cardiovascular disease (CVD)-related readmissions were analysed using Fine and Grey competing risk regression, with death as competing events. Age-standardized rates declined on average 1.9% per year in men and 1.8% per year in women for incident HF hospitalizations (both Ptrend < 0.001) but did not change significantly in either men or women for total HF hospitalizations. In men surviving the incident HF hospitalization, 30-day and 3-year risk of a HF recurrent event increased 1.7% and 1.2% per year, respectively. Similarly, 30-day and 3-year risk of a CVD-related hospitalization increased 1.5% and 1.0% per year, respectively (all Ptrend < 0.001). No statistically significant changes in the risk of HF recurrences or CVD-related readmissions were observed among women. In-hospital mortality for a first and recurrent HF episode declined over time in both men and women. CONCLUSIONS Incident HF hospitalization rates declined in Norway during 2000-2014. An increase in the risk of recurrences in the context of reduced in-hospital mortality following an incident and recurrent HF hospitalization led to flat trends of total HF hospitalization rates.
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Affiliation(s)
- Gerhard Sulo
- Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Jannicke Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Simon Øverland
- Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Grace M Egeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Divisions of Health Data and Digitalization and Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA, USA
| | - Stein E Vollset
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA, USA
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
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19
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Newton PJ, Si S, Reid CM, Davidson PM, Hayward CS, Macdonald PS. Survival After an Acute Heart Failure Admission. Twelve-Month Outcomes From the NSW HF Snapshot Study. Heart Lung Circ 2019; 29:1032-1038. [PMID: 31708454 DOI: 10.1016/j.hlc.2019.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/02/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The New South Wales (NSW) Heart Failure Snapshot sought to provide a contemporaneous profile of patients admitted with acute heart failure. We have previously reported the baseline results, and this paper reports the 30-day and 12-month outcomes. METHODS A prospective audit of consecutive patients admitted to 24 teaching hospitals across NSW and the Australian Capital Territory in July-August 2013 with acute heart failure. Follow-up data were obtained by integration of hospital administrative records and follow-up phone calls with the patients. RESULTS Eight hundred eleven (811) patients were recruited across the 24 sites. The NSW HF Snapshot was an elderly cohort (77 ± 14 yrs) with high comorbidity (mean Charlson Comorbidity Index 3.5 ± 2.6), and 71% were frail at baseline. Twenty-four per cent (24%) of patients were readmitted within 30-days post discharge. One hundred seventy-eight (178) patients died within 12 months post discharge. The independent predictors of death were frailty (Hazard Ratio 1.98 [95% Confidence interval 1.18-3.30]; p < 0.01) Charlson Comorbidity Index (HR 1.06 [95% CI 1.00-1.13]; p = 0.05); New York Heart Association (NYHA) class 4 (HR 2.62 [95% CI 1.32-5.22]; p < 0.01); eGFR<30 ml/min/1.73 m2 (HR 2.16 [95% CI 1.45-3.21]; p < 0.01); hypokalaemia at discharge (HR 2.55 [95% CI 1.44-4.51]; p < 0.01) and readmission within 30 days of baseline admission (HR 2.13 [95% CI 1.49-3.13]; p < 0.01). CONCLUSION In one of the largest prospective audits of acute heart failure outcomes in Australia, we found that short-term readmissions and mortality at 12 months remain high but were largely driven by patient-level factors.
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Affiliation(s)
- Phillip J Newton
- School of Nursing & Midwifery, Western Sydney University, Sydney, NSW, Australia.
| | - Si Si
- NHMRC Centre for Research Excellence in Cardiovascular Outcomes Improvement (CRECOI), School of Public Health, Curtin University, Perth, WA, Australia
| | - Christopher M Reid
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health & Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Patricia M Davidson
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA; Faculty of Health, University of Technology, Sydney, NSW, Australia
| | - Christopher S Hayward
- St. Vincent's Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Peter S Macdonald
- St. Vincent's Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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20
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Adena MA, Hamann G, Sindone AP. Cost-Effectiveness of Ivabradine in the Treatment of Chronic Heart Failure. Heart Lung Circ 2019; 28:414-422. [DOI: 10.1016/j.hlc.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/28/2017] [Accepted: 01/07/2018] [Indexed: 12/31/2022]
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21
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Smeets M, Vaes B, Mamouris P, Van Den Akker M, Van Pottelbergh G, Goderis G, Janssens S, Aertgeerts B, Henrard S. Burden of heart failure in Flemish general practices: a registry-based study in the Intego database. BMJ Open 2019; 9:e022972. [PMID: 30617099 PMCID: PMC6326340 DOI: 10.1136/bmjopen-2018-022972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES To assess the prevalence and incidence of heart failure (HF) stages A to C/D and their evolution over a 16-year period. Additionally, trends in comorbidities and cardiovascular (CV) treatment in patients with HF were studied in the same period. DESIGN Registry-based study. SETTING Primary care, Flanders, Belgium. PARTICIPANTS Data were obtained from Intego, a morbidity registration network in which 111 general practitioners of 48 practices collaborate. In the study period between 2000 and 2015, data from 165 796 unique patients aged 45 years and older were available. OUTCOME MEASURES Prevalence and incidence were calculated for HF stage A, B and C/D by gender. Additionally, the trend in age-standardised prevalence and incidence rates between 2000 and 2015 was analysed with joint-point regression. The same model was used to study trends in comorbidity profiles in incident HF cases and trends in cardiovascular medication in prevalent HF cases. RESULTS We found a downward trend in the incidence and prevalence of HF stage C/D in Flemish general practice between 2000 and 2015, whereas the prevalence and incidence of stage A and B increased. The burden of comorbidities in incident HF cases increased during the study period, as shown by an increasing disease count (p<0.001). The prescription of cardiovascular medication such as renin-angiotensin-aldosterone system blockade, β-blockers and statins showed a sharp increase in the first part of the study period (2000-2008). CONCLUSION Age-standardised incidence and prevalence of HF stage C/D showed a slightly downward trend over the past 16 years, probably due to the sharp increase in cardiovascular treatment. However, the increasing age-standardised incidence and prevalence of stage A and B, as precursors of symptomatic HF, together with a rising comorbid burden, highlights the challenges we are still facing.
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Affiliation(s)
- Miek Smeets
- Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bert Vaes
- Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Louvain Drug Research Institute, Clinical Pharmacy Research Group and Institute of Health and Society (IRSS), Université catholique de Louvain (UCL), Brussels, Belgium
| | - Pavlos Mamouris
- Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marjan Van Den Akker
- Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Gijs Van Pottelbergh
- Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Geert Goderis
- Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stefan Janssens
- Departement of Cardiovascular Diseases, Universitair Ziekenhuis Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Bert Aertgeerts
- Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Séverine Henrard
- Departement of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
- Louvain Drug Research Institute, Clinical Pharmacy Research Group and Institute of Health and Society (IRSS), Université catholique de Louvain (UCL), Brussels, Belgium
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Herber OR, Kastaun S, Wilm S, Barroso J. From Qualitative Meta-Summary to Qualitative Meta-Synthesis: Introducing a New Situation-Specific Theory of Barriers and Facilitators for Self-Care in Patients With Heart Failure. QUALITATIVE HEALTH RESEARCH 2019; 29:96-106. [PMID: 30261808 DOI: 10.1177/1049732318800290] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Situation-specific theories provide nurses with a vehicle to interpret situations, guide their decisions or make assumptions about factors influencing a health problem. In this article, we used meta-synthesis techniques to integrate statements of findings pertaining to barriers and facilitators to heart failure self-care that were derived previously through meta-summary techniques leading to a new situation-specific theory. According to our proposed theory, self-care behavior is the result of a patient's naturalistic decision-making process. This process is influenced by two key concepts: "self-efficacy" and the "patient's disease concept of heart failure." Numerous facilitative and inhibitive factors have been identified influencing these two key concepts as well as the decision-making process, thereby either enabling or hampering the execution of effective heart failure self-care. Further research is needed to validate the model through empirical testing. Once fully matured, the model may be useful in developing behavioral interventions aiming at enhancing adherence to self-care recommendations.
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Affiliation(s)
- Oliver Rudolf Herber
- 1 Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- 2 University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | | | - Stefan Wilm
- 1 Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julie Barroso
- 3 Medical University of South Carolina, Charleston, SC, USA
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23
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Niedziela JT, Parma Z, Pawlowski T, Rozentryt P, Gasior M, Wojakowski W. Secular trends in first-time hospitalization for heart failure with following one-year readmission and mortality rates in the 3.8 million adult population of Silesia, Poland between 2010 and 2016. The SILCARD database. Int J Cardiol 2018; 271:146-151. [DOI: 10.1016/j.ijcard.2018.05.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
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24
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Qin X, Hung J, Knuiman M, Teng THK, Briffa T, Sanfilippo FM. Evidence-based pharmacotherapies used in the postdischarge phase are associated with improved one-year survival in senior patients hospitalized with heart failure. Cardiovasc Ther 2018; 36:e12464. [PMID: 30126048 DOI: 10.1111/1755-5922.12464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 01/01/2023] Open
Abstract
AIM Hospitalized heart failure (HF) patients have a poor prognosis postdischarge. We determined whether renin-angiotensin system inhibitors (RASI) and β-blockers dispensed to patients within 60 days post-HF hospital discharge are associated with improved 1-year survival. METHODS A retrospective population-based study was conducted in 4897 seniors, aged 65-84 years, alive at 60 days postindex HF hospitalization in Western Australia over 2003-2008. Dispensing of RASI and β-blocker dispensing was identified from the Pharmaceutical Benefits Scheme claims database linked to hospital admission and death records. RESULTS At 1-year posthospital discharge, the all-cause mortality and all-cause death or HF rehospitalization rate was 13.5% (n = 663) and 24.4% (n = 1193), respectively. Postdischarge RASI and β-blocker were dispensed in 77.4% and 53.0% of patients, respectively. Their use was associated with a lower inverse probability treatment weighted (IPTW) HR for 1-year mortality of 0.70, 95% CI 0.61-0.81 and 0.79, 95% CI 0.68-0.92, respectively (both P < 0.0001), with a survival advantage most evident in the subgroup (70.1%) of patients with ischemic HF. In the overall cohort, these therapies were also associated with reduced IPTW HRs for all-cause death or HF rehospitalization (both P < 0.005) but not for HF rehospitalization exclusively. Use of a β-blocker was associated with a reduced IPTW HR for HF rehospitalization in the ischemic HF subgroup only. CONCLUSIONS In a cohort of senior patients hospitalized with HF, dispensing of a RASI or β-blocker within 60 days postdischarge is associated with a 1-year survival benefit. Early postdischarge support programs after recent HF hospitalization should include measures to optimize adherence to evidence-based medications.
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Affiliation(s)
- Xiwen Qin
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Tiew-Hwa K Teng
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,National Heart Centre Singapore, Singapore, Singapore
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Tsao CW, Lyass A, Enserro D, Larson MG, Ho JE, Kizer JR, Gottdiener JS, Psaty BM, Vasan RS. Temporal Trends in the Incidence of and Mortality Associated With Heart Failure With Preserved and Reduced Ejection Fraction. JACC. HEART FAILURE 2018; 6:678-685. [PMID: 30007560 PMCID: PMC6076350 DOI: 10.1016/j.jchf.2018.03.006] [Citation(s) in RCA: 292] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES This study aimed to determine temporal trends in the incidence of and mortality associated with heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart rate with preserved ejection fraction [HFpEF]) in the community. BACKGROUND Major shifts in cardiovascular disease risk factor prevalence and advances in therapies may have influenced HF incidence and mortality. METHODS In the FHS (Framingham Heart Study) and CHS (Cardiovascular Health Study), for participants who were ≥60 years of age and free of HF (n = 15,217; 60% women; 2,524 incident HF cases; 115,703 person-years of follow-up), we estimated adjusted incidence rate ratios of HF, HFrEF, and HFpEF from 1990 to 1999 and 2000 to 2009. We compared the cumulative incidence of and mortality associated with HFrEF versus HFpEF within and between decades. RESULTS Across the 2 decades, HF incidence rate ratio was similar (p = 0.13). The incidence rate ratio of HFrEF declined (p = 0.0029), whereas HFpEF increased (p < 0.001). Although HFrEF incidence declined more in men than in women, men had a higher incidence of HFrEF than women in each decade (p < 0.001). The incidence of HFpEF significantly increased over time in both men and women (p < 0.001 and p = 0.02, respectively). During follow-up after HF, 1,701 individuals died (67.4%; HFrEF, n = 557 [33%]; HFpEF, n = 474 [29%]). There were no significant differences in mortality rates (overall, cardiovascular disease, and noncardiovascular disease) across decades within HF subtypes or between HFrEF and HFpEF within decade. CONCLUSIONS In several U.S. community-based samples from 1990 to 2009, we observed divergent trends of decreasing HFrEF and increasing HFpEF incidence, with stable overall HF incidence and high risk for mortality. Our findings highlight the need to elucidate factors contributing to these observations.
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Affiliation(s)
- Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts.
| | - Asya Lyass
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Danielle Enserro
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts; Roswell Park Cancer Institute, Buffalo, New York
| | - Martin G Larson
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Jennifer E Ho
- Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge R Kizer
- Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - John S Gottdiener
- Division of Cardiology, Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington; Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts; Sections of Cardiology and Preventative Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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Lenihan CR, Liu S, Deswal A, Montez-Rath ME, Winkelmayer WC. De Novo Heart Failure After Kidney Transplantation: Trends in Incidence and Outcomes. Am J Kidney Dis 2018; 72:223-233. [DOI: 10.1053/j.ajkd.2018.01.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/14/2018] [Indexed: 02/08/2023]
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27
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Al‐Omary MS, Khan AA, Davies AJ, Fletcher PJ, Mcivor D, Bastian B, Oldmeadow C, Sverdlov AL, Attia JR, Boyle AJ. Outcomes following heart failure hospitalization in a regional Australian setting between 2005 and 2014. ESC Heart Fail 2018; 5:271-278. [PMID: 29265710 PMCID: PMC5880667 DOI: 10.1002/ehf2.12239] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/27/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022] Open
Abstract
AIMS The aim of the current study is to examine 10 year trends in mortality and readmission following heart failure (HF) hospitalization in metropolitan and regional Australian settings. METHODS AND RESULTS We identified all index HF hospitalizations in the Hunter New England region from 2005 to 2014, using a 10 year 'look back' period. The primary endpoint was a composite of all-cause mortality or all-cause readmission at 1 year. Secondary endpoints included all-cause mortality, all-cause readmission, and HF readmission at 30 days and 1 year. We used logistic regression to explore the predictors of the composite outcome of either all-cause death or readmission at 1 year. There were 12 114 patients admitted with a first episode of HF between 2005 and 2014, followed up until death or the end of 2015. The mean age was 78 ± 12 years and 49% (n = 5906) were male. A total of 4831 (40%) resided in regional areas and the remainder in metropolitan areas. One hundred sixty-eight patients (1.4%) were Aboriginal. Approximately 69% of patients had either died or been readmitted for any cause within 12 months of their index event. The 30 day and 1 year all-cause mortality rates were 13% and 32%, respectively, with no change in the trend over the study period. Age, socio-economic disadvantage, ischaemic heart disease, renal failure, and chronic lower respiratory disease were predictors of the primary endpoint. CONCLUSIONS Heart failure hospitalizations are followed by high rates of death or readmission. There was no change in this composite endpoint over the 10 year study period.
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Affiliation(s)
- Mohammed S. Al‐Omary
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Arshad A. Khan
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Allan J. Davies
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Peter J. Fletcher
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
| | - Dawn Mcivor
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Bruce Bastian
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
| | - Christopher Oldmeadow
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Aaron L. Sverdlov
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - John R. Attia
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
| | - Andrew J. Boyle
- John Hunter HospitalHunter New England HealthNewcastleNSWAustralia
- The University of NewcastleNewcastleNSWAustralia
- Hunter Medical Research InstituteNewcastleNSWAustralia
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Mortality and Readmission Following Hospitalisation for Heart Failure in Australia: A Systematic Review and Meta-Analysis. Heart Lung Circ 2018. [PMID: 29519691 DOI: 10.1016/j.hlc.2018.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Heart failure (HF) is a common, costly condition with an increasing burden on Australian health care system resources. Knowledge of the burden of HF on patients and on the health system is important for resource allocation. This study is the first systematic review to estimate the mortality and readmission rates after hospitalisation for HF in the Australian population. METHODS We searched for studies of HF hospitalisation in Australia published between January 1990 and May 2016, using a systematic search of PubMed, Medline, Scopus, Web of Science, EMBASE and Cochrane Library databases. Studies reporting 30-day and/or 1-year outcomes for mortality or readmission following hospitalisation were eligible and included in this study. RESULTS Out of 2889 articles matching the initial search criteria, a total of 13 studies representing 67,255 patients were included in the final analysis. The pooled mean age of heart failure patients was 76.3 years and 51% were male (n=34,271). The pooled estimated 30-day and 1-year all-cause mortality were 8% and 25% respectively. The pooled estimated 30-day and 1-year all-cause readmission rates were 20% and 56% respectively. There is a high prevalence of comorbidities in heart failure patients. There were limited data on readmission and mortality in rural patients and Indigenous people. CONCLUSIONS Heart failure hospitalisations in Australia are followed by substantial readmission and mortality rates.
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29
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Risk and predictors of readmission for heart failure following a myocardial infarction between 2004 and 2013: A Swedish nationwide observational study. Int J Cardiol 2017; 248:221-226. [DOI: 10.1016/j.ijcard.2017.05.086] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/07/2017] [Accepted: 05/20/2017] [Indexed: 11/17/2022]
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30
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Wong CM, Hawkins NM, Ezekowitz JA, Jhund PS, Savu A, MacDonald MR, Kristensen SL, Petrie MC, McMurray JJ, McAlister FA, Kaul P. Heart Failure in Young Adults Is Associated With High Mortality: A Contemporary Population-Level Analysis. Can J Cardiol 2017; 33:1472-1477. [DOI: 10.1016/j.cjca.2017.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/07/2017] [Accepted: 05/12/2017] [Indexed: 10/19/2022] Open
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Franzon J, Berry NM, Ullah S, Versace VL, McCarthy AL, Atherton J, Roder D, Koczwara B, Coghlan D, Clark RA. Heart failure following blood cancer therapy in pediatric and adult populations. Asia Pac J Clin Oncol 2017; 14:224-230. [PMID: 29024474 DOI: 10.1111/ajco.12782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/20/2017] [Indexed: 01/31/2023]
Abstract
AIM The link between chemotherapy treatment and cardiotoxicity is well established, particularly for adults with blood cancers. However, it is less clear for children. This analysis aimed to compare the trajectory and mortality of children and adults who received chemotherapy for blood cancers and were subsequently hospitalized for heart failure. METHODS Linked data from the Queensland Cancer Registry, Death Registry and Hospital Administration records for initial chemotherapy and later heart failure were reviewed (1996-2009). Of all identified blood cancer patients (N = 23 434), 8339 received chemotherapy, including 817 children (aged ≤18 years at time of cancer diagnosis) and 7522 adults. Time-varying Cox proportional hazards regression models were used to compare the characteristics and survival between the two groups. RESULTS Of those who were subsequently hospitalized for heart failure, 70% of children and 46% of adults had the index admission within 12 months of their cancer diagnosis. Of these, 53% of the pediatric heart failure population and 71% of the adult heart failure population died within the study period. Following adjustment for age, sex and chemotherapy admissions, children with heart failure had an increased mortality risk compared to their non-heart failure counterparts, a difference which was much greater than that between the adult groups. CONCLUSION The impact of heart failure on children previously treated for blood cancer is more severe than for adults, with earlier morbidity and greater mortality. Improved strategies are needed for the prevention and management of cardiotoxicity in this population.
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Affiliation(s)
- Julie Franzon
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Narelle M Berry
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Shahid Ullah
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Vincent L Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | | | - John Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital and University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - David Roder
- Cancer Epidemiology and Population Health, Centre for Population Health Research, University of South Australia, Adelaide, Australia
| | - Bogda Koczwara
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Douglas Coghlan
- Molecular Medicine and Pathology, Haematology, Flinders University, Adelaide, South Australia, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar-Rodríguez JA, Soria-Arcos F, Pascual-Figal DA. Tendencia y características de la hospitalización por insuficiencia cardiaca en un marco poblacional durante el periodo 2003-2013. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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34
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Clark RA, Berry NM, Chowdhury MH, McCarthy AL, Ullah S, Versace VL, Atherton JJ, Koczwara B, Roder D. Heart failure following cancer treatment: characteristics, survival and mortality of a linked health data analysis. Intern Med J 2017; 46:1297-1306. [PMID: 27502031 DOI: 10.1111/imj.13201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/31/2016] [Accepted: 07/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiotoxicity resulting in heart failure is a devastating complication of cancer therapy. A patient may survive cancer only to develop heart failure (HF), which has a higher mortality rate than some cancers. AIM This study aimed to describe the characteristics and outcomes of HF in patients with blood or breast cancer after chemotherapy treatment. METHODS Queensland Cancer Registry, Death Registry and Hospital Administration records were linked (1996-2009). Patients were categorised as those with an index HF admission (that occurred after cancer diagnosis) and those without an index HF admission (non-HF). RESULTS A total of 15 987 patients was included, and 1062 (6.6%) had an index HF admission. Median age of HF patients was 67 years (interquartile range 58-75) versus 54 years (interquartile range 44-64) for non-HF patients. More men than women developed HF (48.6% vs 29.5%), and a greater proportion in the HF group had haematological cancer (83.1%) compared with breast cancer (16.9%). After covariate adjustment, HF patients had increased mortality risk compared with non-HF patients (hazard ratios 1.67 (95% confidence interval, 1.54-1.81)), and 47% of the index HF admission occurred within 1 year from cancer diagnosis and 70% within 3 years. CONCLUSION Cancer treatment may place patients at a greater risk of developing HF. The onset of HF occurred soon after chemotherapy, and those who developed HF had a greater mortality risk.
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Affiliation(s)
- R A Clark
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia.
| | - N M Berry
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - M H Chowdhury
- School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia
| | - A L McCarthy
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - S Ullah
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - V L Versace
- Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, Victoria, Australia
| | - J J Atherton
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - B Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, South Australia, Australia
| | - D Roder
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Rodriguez Flores M, Aguilar Salinas C, Piché ME, Auclair A, Poirier P. Effect of bariatric surgery on heart failure. Expert Rev Cardiovasc Ther 2017; 15:567-579. [PMID: 28714796 DOI: 10.1080/14779072.2017.1352471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Obesity increases the risk of heart failure (HF), which continues to be a significant proportion of all cardiovascular diseases and affects increasingly younger populations. The cross-talk between adipose and the heart involves insulin resistance, adipokine signaling and inflammation, with the capacity of adipose tissue to mediate hemodynamic signals, promoting progressive cardiomyopathy. Areas covered: From a therapeutic perspective, there is not yet a single obesity-related pathway that when addressed, can ameliorate cardiomyopathy in obese patients and this is a matter of ongoing research. There is poor evidence of the beneficial long-term effect of small nonsurgical intentional weight loss on HF outcomes, in contrast to the field of HF accompanying severe obesity where observational studies have shown that bariatric surgery is associated with improved cardiac structure/function in severely obese patients with HF and preserved ejection fraction (HFpEF) as well as with improved cardiac structure/function in those with HF and reduced ejection fraction (HFrEF). Few studies report positive outcomes in subjects with obesity and HF, both severe, who underwent bariatric surgery as a rescue treatment, including bridge to heart transplantation. Expert commentary: The fast growing prevalence of obesity will continue to require the development of appropriate interventions directed at controlling or slowing pathways of cardiac damage in these patients, but at present, bariatric surgery should be considered an option to try to decrease morbidity associated with HF in severely obese adults.
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Affiliation(s)
- Marcela Rodriguez Flores
- a Endocrinology Department , Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico
| | - Carlos Aguilar Salinas
- a Endocrinology Department , Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" , Mexico
| | - Marie-Eve Piché
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada.,c Faculty of Medicine , Laval University , Québec , Canada
| | - Audrey Auclair
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada
| | - Paul Poirier
- b Cardiology Department , Institut Universitaire de Cardiologie et de Pneumologie de Québec , Québec , Canada.,d Faculty of Pharmacy , Laval University , Québec , Canada
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Herber OR, Bücker B, Metzendorf MI, Barroso J. A qualitative meta-summary using Sandelowski and Barroso’s method for integrating qualitative research to explore barriers and facilitators to self-care in heart failure patients. Eur J Cardiovasc Nurs 2017; 16:662-677. [DOI: 10.1177/1474515117711007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Individual qualitative studies provide varied reasons for why heart failure patients do not engage in self-care, yet articles that aggregated primary studies on the subject have methodological weaknesses that justified the execution of a qualitative meta-summary. Aim: The aim of this study is to integrate the findings of qualitative studies pertaining to barriers and facilitators to self-care using meta-summary techniques. Methods: Qualitative meta-summary techniques by Sandelowski and Barroso were used to combine the findings of qualitative studies. Meta-summary techniques include: (1) extraction of relevant statements of findings from each report; (2) reduction of these statements into abstracted findings and (3) calculation of effect sizes. Databases were searched systematically for qualitative studies published between January 2010 and July 2015. Out of 2264 papers identified, 31 reports based on the accounts of 814 patients were included in the meta-summary. Results: A total of 37 statements of findings provided a comprehensive inventory of findings across all reports. Out of these statements of findings, 21 were classified as barriers, 13 as facilitators and three were classed as both barriers and facilitators. The main themes relating to barriers and facilitators to self-care were: beliefs, benefits of self-care, comorbidities, financial constraints, symptom recognition, ethnic background, inconsistent self-care, insufficient information, positive and negative emotions, organizational context, past experiences, physical environment, self-initiative, self-care adverse effects, social context and personal preferences. Conclusion: Based on the meta-findings identified in this study, future intervention development could address these barriers and facilitators in order to further enhance self-care abilities in heart failure patients.
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Affiliation(s)
- Oliver Rudolf Herber
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- School of Health and Population Sciences, University of Birmingham, Edgbaston, England
| | - Bettina Bücker
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Cochrane Metabolic and Endocrine Disorders Group, Düsseldorf, Germany
| | - Julie Barroso
- Medical University of South Carolina, College of Nursing, Charleston, USA
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Fernández Gassó ML, Hernando-Arizaleta L, Palomar-Rodríguez JA, Soria-Arcos F, Pascual-Figal DA. Trends and Characteristics of Hospitalization for Heart Failure in a Population Setting From 2003 to 2013. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:720-726. [PMID: 28363708 DOI: 10.1016/j.rec.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Population-based studies in other countries have reported a reduction of standardized rates of hospitalization for heart failure (HF) but data from a well-defined population are lacking in Spain. METHODS All hospitalizations with a principal diagnosis of HF between 2003 and 2013 were obtained from the Minimum Basic Data Set, which includes all hospitals in the Region of Murcia. Health care episodes were identified by the individual health card (27 158 episodes). For each year, we studied the following parameters: crude, age-standardized and sex-standardized hospitalization rates for HF, length of stay, mortality, clinical variables, and the Elixhauser index. Time trends were analyzed using joinpoint regression. RESULTS Hospitalization rates increased by 76.7%, from 1.28‰ to 2.26‰ (crude) and 1.06‰ to 1.77‰ (standardized); the mean annual percentage of change (APC) was 8.2% until 2007 and was subsequently 1.9% (P < .05). Rates doubled in persons ≥ 75 years, reaching 19.9‰ in those aged 75 to 84 years (APC, 5.4%) and 32.5‰ in those aged ≥ 85 years (APC, 11.7%) but were unchanged in persons aged < 75 years. The hospitalization rate was 36% higher in women than in men but was equal after age-standardization and showed no temporal change. The Elixhauser comorbidity index increased by almost 1 point during the study period and episodes > 6 points increased by 2-fold. Length of stay and mortality were unchanged during the study period. CONCLUSIONS Between 2003 and 2013, there was a sustained increase in standardized rates of hospitalization for HF, which affected persons ≥ 75 years and was associated with a rise in comorbidity. There is a need for strategies focused on this population.
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Affiliation(s)
| | | | | | - Federico Soria-Arcos
- Servicio de Cardiología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Domingo A Pascual-Figal
- Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, El Palmar, Murcia, Spain.
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Christiansen MN, Køber L, Weeke P, Vasan RS, Jeppesen JL, Smith JG, Gislason GH, Torp-Pedersen C, Andersson C. Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012. Circulation 2017; 135:1214-1223. [DOI: 10.1161/circulationaha.116.025941] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/26/2017] [Indexed: 02/06/2023]
Abstract
Background:
The cumulative burden and importance of cardiovascular risk factors have changed over the past decades. Specifically, obesity rates have increased among younger people, whereas cardiovascular health has improved in the elderly. Little is known regarding how these changes have impacted the incidence and the mortality rates of heart failure. Therefore, we aimed to investigate the age-specific trends in the incidence and 1-year mortality rates following a first-time diagnosis of heart failure in Denmark between 1995 and 2012.
Methods:
We included all Danish individuals >18 years of age with a first-time in-hospital diagnosis of heart failure. Data were collected from 3 nationwide Danish registries. Annual incidence rates of heart failure and 1-year standardized mortality rates were calculated under the assumption of a Poisson distribution.
Results:
We identified 210 430 individuals with a first-time diagnosis of heart failure between 1995 and 2012; the annual incidence rates per 10 000 person-years declined among older individuals (rates in 1995 versus 2012: 164 versus 115 in individuals >74 years, 63 versus 35 in individuals 65–74 years, and 20 versus 17 in individuals 55–64 years;
P
<0.0001 for all) but increased among the younger (0.4 versus 0.7 in individuals 18–34 years, 1.3 versus 2.0 in individuals 35–44 years, and 5.0 versus 6.4 in individuals 45–54 years;
P
<0.0001 for all). The proportion of patients with incident heart failure ≤50 years of age doubled from 3% in 1995 to 6% in 2012 (
P
<0.0001). Sex- and age-adjusted incidence rate ratios for 2012 versus 1996 were 0.69 (95% confidence interval, 0.67–0.71;
P
<0.0001) among people >50 years of age, and 1.52 (95% confidence interval, 1.33–1.73;
P
<0.0001) among individuals ≤50 years of age; it remained essentially unchanged on additional adjustment for diabetes mellitus, ischemic heart disease, and hypertension. Standardized 1-year mortality rates declined for middle-aged patients with heart failure but remained constant for younger (<45 years) and elderly (≥65 years) patients. The prevalence of comorbidities (including diabetes mellitus, hypertension, and atrial fibrillation) increased, especially in younger patients with heart failure.
Conclusions:
Over the past 2 decades, the incidence of heart failure in Denmark declined among older individuals (>50 years), but increased among younger (≤50 years) individuals. These observations may portend a rising burden of heart failure in the community.
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Affiliation(s)
- Mia N. Christiansen
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Lars Køber
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Peter Weeke
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Ramachandran S. Vasan
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Jørgen L. Jeppesen
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - J. Gustav Smith
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Gunnar H. Gislason
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Christian Torp-Pedersen
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Charlotte Andersson
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
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39
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Korda RJ, Du W, Day C, Page K, Macdonald PS, Banks E. Variation in readmission and mortality following hospitalisation with a diagnosis of heart failure: prospective cohort study using linked data. BMC Health Serv Res 2017; 17:220. [PMID: 28320381 PMCID: PMC5359909 DOI: 10.1186/s12913-017-2152-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Hospitalisation for heart failure is common and post-discharge outcomes, including readmission and mortality, are often poor and are poorly understood. The purpose of this study was to examine patient- and hospital-level variation in the risk of 30-day unplanned readmission and mortality following discharge from hospital with a diagnosis of heart failure. Methods Prospective cohort study using data from the Sax Institute’s 45 and Up Study, linking baseline survey (Jan 2006-April 2009) to hospital and mortality data (to Dec 2011). Primary outcomes in those admitted to hospital with heart failure included unplanned readmission, mortality and combined unplanned readmission/mortality, within 30 days of discharge. Multilevel models quantified the variation in outcomes between hospitals and examined associations with patient- and hospital-level characteristics. Results There were 5074 participants with a heart failure admission discharged from 251 hospitals; 1052 (21%) had unplanned readmissions, 186 (3.7%) died, and 1146 (23%) had either/both outcomes within 30 days of discharge. Crude outcomes varied across hospitals, but between-hospital variation explained little of the total variation in outcomes (intraclass correlation coefficients (ICC) after inclusion of patient factors: 30-day unplanned readmission ICC = 0.0125 (p = 0.24); death ICC = 0.0000 (p > 0.99); unplanned readmission/death ICC = 0.0266 (p = 0.07)). Patient characteristics associated with a higher risk of unplanned readmission included: being male (male vs female, adjusted odds ratio (aOR) = 1.18, 95% CI: 1.00–1.37); prior hospitalisation for cardiovascular disease (aOR = 1.44, 1.08–1.91) and for anemia (aOR = 1.36, 1.14–1.63); comorbidities at admission (severe vs none: aOR = 1.26, 1.03–1.54); lower body-mass-index (obese vs normal weight: aOR = 0.77, 0.63–0.94); and lower social interaction scores. Similarly, risk of 30-day mortality was associated with patient- rather than hospital-level factors, in particular age (≥85y vs 45–< 75y: aOR = 3.23, 1.93–5.41) and comorbidity (severe vs none: aOR = 2.68, 1.82–3.94). Conclusions The issue of high readmission and mortality rates in people with heart failure appear to be system-wide, with the variation in these outcomes essentially attributable to variation between patients rather than hospitals. The findings suggest that there are limitations in using these outcomes as hospital performance measures in this patient population and support the need for patient-centred strategies to optimise heart failure management and outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2152-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.
| | - Wei Du
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Cathy Day
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Karen Page
- Deakin University, School of Nursing and Midwifery, Melbourne, Australia
| | - Peter S Macdonald
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.,The Sax Institute, Sydney, Australia
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40
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Frigerio M, Mazzali C, Paganoni AM, Ieva F, Barbieri P, Maistrello M, Agostoni O, Masella C, Scalvini S. Trends in heart failure hospitalizations, patient characteristics, in-hospital and 1-year mortality: A population study, from 2000 to 2012 in Lombardy. Int J Cardiol 2017; 236:310-314. [PMID: 28262349 DOI: 10.1016/j.ijcard.2017.02.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study was undertaken to evaluate trends in heat failure hospitalizations (HFHs) and 1-year mortality of HFH in Lombardy, the largest Italian region, from 2000 to 2012. METHODS Hospital discharge forms with HF-related ICD-9 CM codes collected from 2000 to 2012 by the regional healthcare service (n=699797 in 370538 adult patients), were analyzed with respect to in-hospital and 1-year mortality; Group (G) 1 included most acute HF episodes with primary cardiac diagnosis (70%); G2 included cardiomyopathies without acute HF codes (17%); and G3 included non-cardiac conditions with HF as secondary diagnosis (13%). Patients experiencing their first HFH since 2005 were analyzed as incident cases (n=216782). RESULTS Annual HFHs number (mean 53830) and in-hospital mortality (9.4%) did not change over the years, the latter being associated with increasing age (p<0.0001) and diagnosis Group (G1 9.1%, G2 5.6%, G3 15.9%, p<0.0001). Incidence of new cases decreased over the years (3.62 [CI 3.58-3.67] in 2005 to 3.13 [CI 3.09-3.17] in 2012, per 1000 adult inhabitants/year, p<0.0001), with an increasing proportion of patients aged ≥85y (22.3% to 31.4%, p<0.0001). Mortality lowered over time in <75y incident cases, both in-hospital (5.15% to 4.36%, p<0.0001) and at 1-year (14.8% to 12.9%, p=0.0006). CONCLUSIONS The overall burden and mortality of HFH appear stable for more than a decade. However, from 2005 to 2012, there was a reduction of new, incident cases, with increasing age at first hospitalization. Meanwhile, both in-hospital and 1-year mortality decreased in patients aged <75y, possibly due to improved prevention and treatment.
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Affiliation(s)
- Maria Frigerio
- De Gasperis Cardiocenter, Niguarda-Ca'Granda Hospital, Milan, Italy
| | - Cristina Mazzali
- Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | | | - Francesca Ieva
- MOX - Department of Mathematics, Politecnico di Milano, Milan, Italy
| | | | | | - Ornella Agostoni
- Cardiovascular Department, Santi Paolo e Carlo, Presidio San Carlo, Milan, Italy
| | - Cristina Masella
- Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Simonetta Scalvini
- Rehabilitation Cardiology Department and Continuity Care Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Lumezzane, Brescia, Italy.
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41
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Youn JC, Han S, Ryu KH. Temporal Trends of Hospitalized Patients with Heart Failure in Korea. Korean Circ J 2016; 47:16-24. [PMID: 28154584 PMCID: PMC5287180 DOI: 10.4070/kcj.2016.0429] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/08/2016] [Accepted: 12/15/2016] [Indexed: 11/11/2022] Open
Abstract
Heart failure (HF) is an important cardiovascular disease because of its increasing prevalence, significant morbidity, high mortality and rapidly expanding health care costs. The number of HF patients is increasing worldwide and Korea is no exception. Temporal trends of four representative Korean hospitalized HF registries-the Hallym HF study, the Korean Multicenter HF study, the Korean Heart Failure (KorHF) registry and the Korean Acute Heart Failure (KorAHF) registry showed mild survival improvement reflecting overall HF patient care development in Korea despite the increased severity of enrolled patients with higher incidence of multiple comorbidities. Moreover, device therapies such as implantable cardioverter defibrillator and cardiac resynchronization therapy and definitive treatment such as heart transplantation have been increasing in Korea as well. To prevent HF burden increase, it is essential to set up long term effective prevention strategies for better control of ischemic heart disease, hypertension and diabetes, which might be risk factors for HF development. Moreover, proper HF guidelines, performance measures, and performance improvement programs might be necessary to limit HF burden as well.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Seongwoo Han
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyu-Hyung Ryu
- Division of Cardiology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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42
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Iyngkaran P, Kangaharan N, Zimmet H, Arstall M, Minson R, Thomas MC, Bergin P, Atherton J, MacDonald P, Hare DL, Horowitz JD, Ilton M. Heart Failure in Minority Populations - Impediments to Optimal Treatment in Australian Aborigines. Curr Cardiol Rev 2016; 12:166-79. [PMID: 27280307 PMCID: PMC5011191 DOI: 10.2174/1573403x12666160606115034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 01/30/2023] Open
Abstract
Chronic heart failure (CHF) among Aboriginal/Indigenous Australians is endemic. There are also grave concerns for outcomes once acquired. This point is compounded by a lack of prospective and objective studies to plan care. To capture the essence of the presented topic it is essential to broadly understand Indigenous health. Key words such as ‘worsening’, ‘gaps’, ‘need to do more’, ‘poorly studied’, or ‘future studies should inform’ occur frequently in contrast to CHF research for almost all other groups. This narrative styled opinion piece attempts to discuss future directions for CHF care for Indigenous Australians. We provide a synopsis of the problem, highlight the treatment gaps, and define the impediments that present hurdles in optimising CHF care for Indigenous Australians.
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Affiliation(s)
- Pupalan Iyngkaran
- Cardiologist and Senior Lecturer NT Medical School, Flinders University, Tiwi, NT 0811, Australia.
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43
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van den Berge JC, Akkerhuis MK, Constantinescu AA, Kors JA, van Domburg RT, Deckers JW. Temporal trends in long-term mortality of patients with acute heart failure: Data from 1985–2008. Int J Cardiol 2016; 224:456-460. [DOI: 10.1016/j.ijcard.2016.09.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/26/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
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44
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Qin X, Teng THK, Hung J, Briffa T, Sanfilippo FM. Long-term use of secondary prevention medications for heart failure in Western Australia: a protocol for a population-based cohort study. BMJ Open 2016; 6:e014397. [PMID: 27803111 PMCID: PMC5128762 DOI: 10.1136/bmjopen-2016-014397] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is a chronic, debilitating and progressive disease associated with high morbidity and mortality. Evidence-based medications (EBMs) are the cornerstone of management of patients with HF. In Australia, these EBMs are subsidised by the Commonwealth Government under the Pharmaceutical Benefits Scheme. Suboptimal dispensing and non-adherence to these EBMs have been observed in patients with HF. Our study will investigate trends in dispensing patterns, as well as adherence and persistence of EBMs for HF. We will also identify factors influencing these patterns and their impact on long-term clinical outcomes. METHODS AND ANALYSIS This whole population-based cohort study will use longitudinal data for people aged 65-84 years who were hospitalised for HF in Western Australia between 2003 and 2008. Linked state-wide and national data will provide patient-level information on medication dispensing, medical visits, hospitalisations and death. Drug dispensing trends will be described, drug adherence and persistence estimated and the association with all-cause/cardiovascular death and hospitalisations reported. ETHICS AND DISSEMINATION This project has received approvals from the Western Australian Department of Health Human Research Ethics Committee and the Western Australian Aboriginal Health Ethics Committee. Results will be published in relevant cardiology journals and presented at national and international conferences.
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Affiliation(s)
- Xiwen Qin
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tiew-Hwa Katherine Teng
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
- National Heart Centre Singapore, Singapore, Singapore
| | - Joseph Hung
- Sir Charles Gairdner Hospital Unit, School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tom Briffa
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
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45
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Omersa D, Farkas J, Erzen I, Lainscak M. National trends in heart failure hospitalization rates in Slovenia 2004-2012. Eur J Heart Fail 2016; 18:1321-1328. [DOI: 10.1002/ejhf.617] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Daniel Omersa
- National Institute of Public Health; Ljubljana Slovenia
| | | | - Ivan Erzen
- National Institute of Public Health; Ljubljana Slovenia
| | - Mitja Lainscak
- Department of Cardiology, Department of Research and Education; General Hospital Celje; Celje Slovenia
- Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
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46
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Chan YK, Tuttle C, Ball J, Teng THK, Ahamed Y, Carrington MJ, Stewart S. Current and projected burden of heart failure in the Australian adult population: a substantive but still ill-defined major health issue. BMC Health Serv Res 2016; 16:501. [PMID: 27654659 PMCID: PMC5031369 DOI: 10.1186/s12913-016-1748-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/18/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Comprehensive epidemiological data to describe the burden of heart failure (HF) in Australia remain lacking despite its importance as a major health issue. Herewith, we estimate the current and future burden of HF in Australia using best available data. METHODS Australian-specific and the most congruent international epidemiological and health utilisation data were applied to the Australian population (adults aged ≥ 45 years, 8.9 of 22.7 million total population in 2014) on an age and sex-specific basis. We estimated the current incident and prevalent cases of clinically overt/symptomatic HF (predominately those with reduced ejection fraction), hospital activity (diagnosis of HF as a primary or secondary reason for admission) and health care costs in 2014 and future prevalence and burden of HF projected to 2030. RESULTS We estimated that over 61,000 (6.9 per 1000 person-years) adult Australians aged ≥ 45 years (58 % women) are diagnosed with HF with clinically overt signs and symptoms every year. On a conservative basis, 480,000 (6.3 %, 95 % CI 2.6 to 10.0 %) Australians (66 % men) are now affected by the syndrome with > 150,000 hospitalisations in excess of 1 million days in hospital per annum. The annual cost of managing HF in the community is approximately $900 million and nearly $2.7 billion ($1.5 versus $1.2 billion, men versus women) when considering the additional cost of in-patient care. We predict that the prevalence and future burden of HF will continue to increase over the next 10-15 years to nearly 750,000 people with an estimated annual health care cost of $3.8 billion. CONCLUSIONS Australia is not immune to the growing magnitude and implications of a sustained epidemic of HF in an ageing population. However, its public health and economic burden will remain ill-defined until more definitive Australian-specific data are generated.
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Affiliation(s)
- Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Camilla Tuttle
- Baker IDI Central Australia, Alice Springs, Northern Territory, 0870, Australia
| | - Jocasta Ball
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Tiew-Hwa Katherine Teng
- Western Australian Centre for Rural Health, University of Western Australia, Perth, Australia
| | - Yasmin Ahamed
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Melinda Jane Carrington
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, VIC, 3000, Australia.
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47
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Briffa T, Hung J, Knuiman M, McQuillan B, Chew DP, Eikelboom J, Hankey GJ, Teng THK, Nedkoff L, Weerasooriya R, Liu A, Stobie P. Trends in incidence and prevalence of hospitalization for atrial fibrillation and associated mortality in Western Australia, 1995–2010. Int J Cardiol 2016; 208:19-25. [DOI: 10.1016/j.ijcard.2016.01.196] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/18/2015] [Accepted: 01/15/2016] [Indexed: 12/21/2022]
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48
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Schmidt M, Ulrichsen SP, Pedersen L, Bøtker HE, Sørensen HT. Thirty-year trends in heart failure hospitalization and mortality rates and the prognostic impact of co-morbidity: a Danish nationwide cohort study. Eur J Heart Fail 2016; 18:490-9. [DOI: 10.1002/ejhf.486] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/23/2015] [Accepted: 12/12/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - Hans Erik Bøtker
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
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49
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Teng THK, Katzenellenbogen JM, Hung J, Knuiman M, Sanfilippo FM, Geelhoed E, Bessarab D, Hobbs M, Thompson SC. A cohort study: temporal trends in prevalence of antecedents, comorbidities and mortality in Aboriginal and non-Aboriginal Australians with first heart failure hospitalization, 2000-2009. Int J Equity Health 2015; 14:66. [PMID: 26265218 PMCID: PMC4533942 DOI: 10.1186/s12939-015-0197-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/29/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/OBJECTIVES Little is known about trends in risk factors and mortality for Aboriginal Australians with heart failure (HF). This population-based study evaluated trends in prevalence of risk factors, 30-day and 1-year all-cause mortality following first HF hospitalization among Aboriginal and non-Aboriginal Western Australians in the decade 2000-2009. METHODS Linked-health data were used to identify patients (20-84 years), with a first-ever HF hospitalization. Trends in demographics, comorbidities, interventions and risk factors were evaluated. Logistic and Cox regression models were fitted to test and compare trends over time in 30-day and 1-year mortality. RESULTS Of 17,379 HF patients, 1,013 (5.8%) were Aboriginal. Compared with 2000-2002, the prevalence (as history) of myocardial infarction and hypertension increased more markedly in 2006-2009 in Aboriginal (versus non-Aboriginal) patients, while diabetes and chronic kidney disease remained disproportionately higher in Aboriginal patients. Risk factor trends, including the Charlson comorbidity index, increased over time in younger Aboriginal patients. Risk-adjusted 30-day mortality did not change over the decade in either group. Risk-adjusted 1-year mortality (in 30-day survivors) was non-significantly higher in Aboriginal patients in 2006-2008 compared with 2000-2002 (hazard ratio (HR) 1.44; 95% CI 0.85-2.41; p-trend = 0.47) whereas it decreased in non-Aboriginal patients (HR 0.87; 95% CI 0.78-0.97; p-trend = 0.01). CONCLUSIONS Between 2000 and 2009, the prevalence of HF antecedents increased and remained disproportionately higher in Aboriginal (versus non-Aboriginal) HF patients. Risk-adjusted 1-year mortality did not improve in Aboriginal patients over the period in contrast with non-Aboriginal patients. These findings highlight the need for better prevention and post-HF care in Aboriginal Australians.
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Affiliation(s)
- Tiew-Hwa Katherine Teng
- Western Australian Centre for Rural Health, University of Western Australia (UWA), Perth, Australia.
| | | | - Joseph Hung
- School of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit, UWA, Perth, Australia
| | | | | | | | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, UWA, Perth, Australia
| | | | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia (UWA), Perth, Australia
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50
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Nedkoff L, Knuiman M, Hung J, Briffa TG. Improving 30-day case fatality after incident myocardial infarction in people with diabetes between 1998 and 2010. Heart 2015; 101:1318-24. [PMID: 26076939 DOI: 10.1136/heartjnl-2015-307627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/25/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare population-level trends in 30-day case fatality following incident myocardial infarction (MI) in people with diabetes and those without diabetes. METHODS We identified all hospitalised incident MIs in 35-84 year olds from the Western Australian Data Linkage System for 1998-2010, stratified by diabetes status. Crude and age- and sex-standardised 30-day case fatality were estimated, and age- and sex-adjusted trends were calculated from logistic regression. We calculated the trend in risk of 30-day death associated with diabetes from multivariable logistic regression, adjusting for demographics, comorbidities and MI type. RESULTS 26 610 hospitalised incident MI cases were identified, 24.8% of whom had diabetes. The prevalence of heart failure fell in people with diabetes, concurrent with increasing chronic kidney disease and prior coronary heart disease and increasing levels of evidence-based therapies. Case fatality in people with diabetes fell from 11.65%, in 1998-2001, to 3.96% by 2008-2010. Age- and sex-standardised case fatality declined at a greater rate in those with diabetes (-10.6%/year, 95% CI -12.8% to -8.2%) compared to non-diabetics (-6.9%/year, 95% CI -8.3% to -5.3%; interaction p=0.005). The adjusted risk of 30-day death after incident MI was 1.23 times higher in diabetics than non-diabetics in 1998-2001 (95% CI 1.01 to 1.50), but was lower by 2008-2010 (OR 0.64, 95% CI 0.46 to 0.88). CONCLUSIONS Greater improvements in 30-day case fatality following incident MI in people with diabetes during the 13-year study period has led to diabetes no longer being an independent predictor of early death following incident MI by 2008-2010.
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Affiliation(s)
- Lee Nedkoff
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
| | - Matthew Knuiman
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
| | - Joseph Hung
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia School of Medicine and Pharmacology (M503), Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tom G Briffa
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
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