Aims To investigate trends in absolute numbers and prevalence from 1990 to 2007 of patients hospitalized with heart failure (HF) in Sweden. Methods and results National inpatient and cause‐specific death registers were used to calculate age‐ and sex‐specific trends in absolute numbers and prevalence from 1990 to 2007 of patients hospitalized with HF in Sweden. Absolute numbers increased from 105 449 in 1990 to 144 925 in 2007, with a 77% increase in patients aged 85–99 years. The overall age‐adjusted prevalence in 1990 was 1.73%, and this increased with an estimated annual percentage change (EAPC) of 4.3% [95% confidence interval (CI) 3.6–4.9%] from 1990 to 1995, with no further significant change until 2002. The single year with the highest prevalence was 1998, when it peaked at 2.13%. The prevalence then declined slowly from 2002 (EAPC –1.1, 95% CI −1.5% to −0.6%) to 1.99% in 2007. The decrease in prevalence was not found in persons <65 years, where, instead, an increase was found throughout the period. Conclusion Fears of an impending HF ‘epidemic’ could not be confirmed in this analysis of trends in prevalence for the period 1990–2007 of patients hospitalized with HF in Sweden. An overall slight decrease in age‐adjusted prevalence was observed from 2002. The prevalence in patients <65 years increased markedly. In absolute numbers, there was a substantial increase among the very old, consistent with demographic changes.

Diuretic treatment at hospital discharge was not associated with short-term mortality whereas it was associated with increased long-term mortality. Although we accounted for a wide range of clinical features, measured or unmeasured factors could still explain this increase in risk. However, our results suggest that diuretic treatment at hospital discharge may be regarded as a marker of increased long-term mortality.

PurposeLoop diuretics are recommended to treat congestive symptoms in patients with heart failure. However, observational studies have indicated that loop diuretic treatment in heart failure is associated with increased mortality. Therefore, loop diuretic discontinuation or dose reduction, when clinically possible, is recommended. Our aim was to study nationwide temporal trends in loop diuretic treatment from 2005 to 2014 in real-life patients with chronic heart failure.MethodsData from the nationwide Swedish National Patient, Prescribed Drug and Cause of Death Registers were linked. The annual proportions of patients with chronic heart failure treated with loop diuretics from 2005 to 2014 were calculated. In addition, the annual median loop diuretic doses (DDD) in patients with chronic heart failure treated with loop diuretics from 2005 to 2014 were calculated.ResultsThe proportion of real-life patients with chronic heart failure treated with loop diuretics decreased from 73.2% in 2005 to 65.7% in 2014 (p for trend < 0.001). The median loop diuretic DDD in real-life patients with chronic heart failure decreased from 2.13 (IQR 1.09–2.77) in 2005 to 1.63 (IQR 1.09–2.25) in 2014 (p = 0.001 for trend).ConclusionsLoop diuretic treatment decreased from 2005 to 2014 in real-life patients with chronic heart failure. The prognostic impact of changes in loop diuretic treatment in patients with heart failure remains unclear.Electronic supplementary materialThe online version of this article (10.1007/s00228-018-2574-6) contains supplementary material, which is available to authorized users.

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