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HF across the decades

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While the prevalence of heart failure in the 65-and-over age group rose from the 1970s to the 1990s, survival also went up- signs that together herald accelerating growth in the overall HF health and cost burden, suggests a report in the February 7, 2006 issue of Circulation A comparison of Medicare data from those periods supports the idea that advances in medical therapy contributed to the improved outcomes, which, along with the increased HF incidence, were seen more in men than in women.

The analysis, from Dr William H Barker (University of Rochester, NY) and colleagues, encompassed data from each of two elderly cohorts, 9272 persons followed from 1970 through 1974 and 31 399 followed from 1990 through 1994, who were members of the Kaiser Permanente Northwest Region health maintenance organization in Portland, OR. The group found that:- New-onset HF was confirmed in or out of the hospital in 387 and 1555 patients from the two respective five-year periods, a 14% age-adjusted increase. – The older the patient group, the greater the jump in HF incidence. – The age-adjusted cumulative mortality at 30 days, one year, and five years fell substantially for men but not for women. Similarly, the men’s overall mortality hazard ratio dropped by 30%, but the corresponding risk among women didn’t change. – In multivariate analysis controlling for age and a range of comorbidities, the mortality hazard ratio decreased a significant 33% for men and a borderline significant 24% for women. – Both adjusted risk reductions were attenuated when ACE-inhibitor and beta-blocker therapies were added as covariates, falling to 23% and 14% in men and women, respectively. “We found statistical trends that suggested a modest association of ACE inhibitors and a substantial association of beta blockers with improved survival,” write Barker et al. “Although confounding between drug and period effects could not be controlled completely, our results suggest that these medications, particularly beta blockers, may have contributed to the observed decline in mortality in 1990 to 1994.” The group cautions that their data sets were drawn from a “predominantly white metropolitan” population and so may not apply to other demographic settings.Click here to see a table showing age-adjusted mortality five years after HF for elderly men and women, 1970-1974 and 1990-1994 (Source: Barker WH, Mullooly JP, Getchell W. Changing incidence and survival for heart failure in a well-defined older population, 1970-1974 and 1990-1994. Circulation 2006; DOI: 10.1161/CIRCULATIONAHA.104.492033. Available at: http://circ.ahajournals.org: The Heart: February 2006.)


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Posted On: 28 February, 2006
Modified On: 16 January, 2014

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