Prognosis for patients newly admitted to hospital with heart failure: survival trends in 12 220 index admissions in Leicestershire 1993-2001

Abstract

Objective: To examine rates of, prognosis following, and the influences on first hospital admission with heart failure in Leicestershire during 1993-2001.

Design: Historical cohort study using record linked discharge and mortality data.

Setting: Leicestershire, England.

Patients: 12 220 individual patients newly hospitalised with heart failure between 1 April 1993 and 31 March 2001.

Main outcome measures: 30 day and one year survival, temporal trends in survival, and the influence on prognosis of age, sex, comorbidity, social deprivation, and year of hospital admission.

Methods and results: Between 1993/94 and 2000/01, rates of first hospitalisation increased by 62%, from 29 to 47/10 000 population, confined largely to those aged > 65 years. Rates did not increase after 1998. Median age at presentation increased from 74 years in 1993/94 to 77 years in 2000/01 for men but was unchanged (80 years) for women. Overall one and five year survival was 57% and 27%, respectively. There was a 43-45% increase in risk of death for each decade of age at admission and a 14-17% increase associated with male sex. There was a clear influence on outcome of comorbidity but no influence of social deprivation score. Both one month and one year survival were lower for patients whose first heart failure admission was concomitant with acute myocardial infarction. Between 1993/94 and 2000/01 postdischarge cardiovascular survival improved by 50% (p < 0.001).

Conclusions: Rates of first hospital admission with heart failure reached a plateau in the late 1990s. Case fatality rates remain high and prognosis poor, in particular for those of increasing age, for men, and for patients with concomitant acute myocardial infarction. However, clear trends to improved survival were seen over this time.

Figure 1

Trends in first heart failure admission rates between 1993 and 2001. (A) All diagnostic positions; (B) first diagnostic position. Rates for population older than 40, standardised for age and sex.

Figure 2

Estimated hazard ratios and their 95% confidence intervals for all cause and cardiovascular mortality in 12 220 patients, according to the year of first admission, adjusted for age, sex, comorbidity, and social deprivation. Probability (p) values represent the contribution of year of diagnosis to multivariate model. Dotted line indicates linear trend in hazard estimates.