Approximately half the decline in U.S. deaths from coronary heart disease from 1980 through 2000 may be attributable to reductions in major risk factors and approximately half to evidence-based medical therapies.

Background: The prognostic impact of heart failure relative to that of 'high-profile' disease states such as cancer, within the whole population, is unknown. Methods: All patients with a first admission to any Scottish hospital in 1991 for heart failure, myocardial infarction or the four most common types of cancer specific to men and women were identified. Five-year survival rates and associated loss of expected life-years were then compared. Results: In 1991, 16 224 men had an initial hospitalisation Ž . Ž . for heart failure n s 3241 , myocardial infarction n s 6932 or cancer of the lung, large bowel, prostate or bladder Ž . Ž . Ž . n s 6051 . Similarly, 14 842 women were admitted for heart failure n s 3606 , myocardial infarction n s 4916 , or cancer of Ž . the breast, lung, large bowel or ovary n s 6320 . With the exception of lung cancer, heart failure was associated with the Ž . poorest 5-year survival rate approximately 25% for both sexes . On an adjusted basis, heart failure was associated with worse Ž . long-term survival than bowel cancer in men adjusted odds ratio, 0.89; 95% CI, 0.82᎐0.97; P-0.01 and breast cancer in Ž . women odds ratio, 0.59; 95% CI, 0.55᎐0.64; P-0.001 . The overall population rate of expected life-years lost due to heart failure in men was 6.7 yearsr1000 and for women 5.1 yearsr1000. Conclusion: With the notable exception of lung cancer, heart failure is as 'malignant' as many common types of cancer and is associated with a comparable number of expected life-years lost. ᮊ

Background-Coronary heart disease mortality rates have been decreasing in the United Kingdom since the 1970s. Our study aimed to examine how much of the decrease in England and Wales between 1981 and 2000 could be attributed to medical and surgical treatments and how much to changes in cardiovascular risk factors. Methods and Results-The IMPACT mortality model was used to combine and analyze data on uptake and effectiveness of cardiological treatments and risk factor trends in England and Wales. The main data sources were published trials and meta-analyses, official statistics, clinical audits, and national surveys. Between 1981 and 2000, coronary heart disease mortality rates in England and Wales decreased by 62% in men and 45% in women 25 to 84 years old. This resulted in 68 230 fewer deaths in 2000. Some 42% of this decrease was attributed to treatments in individuals (including 11% to secondary prevention, 13% to heart failure treatments, 8% to initial treatments of acute myocardial infarction, and 3% to hypertension treatments) and 58% to population risk factor reductions (principally smoking, 48%; blood pressure, 9.5%; and cholesterol, 9.5%). Adverse trends were seen for physical activity, obesity and diabetes. Conclusions-More than half the coronary heart disease mortality decrease in Britain between 1981 and 2000 was attributable to reductions in major risk factors, principally smoking. This emphasizes the importance of a comprehensive strategy that promotes primary prevention, particularly for tobacco and diet, and that maximizes population coverage of effective treatments, especially for secondary prevention and heart failure. These findings may be cautiously generalizable to the United States and other developed countries.

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The mortality rates for CHD among younger adults may serve as a sentinel event. Unfavorable trends in several risk factors for CHD provide a likely explanation for the observed mortality rates.

Background-We examined whether population-level hospitalization rates for heart failure (HF) and subsequent survival have continued to improve since the turn of the century. We also examined trends in the prescribing of evidence-based pharmacological treatment for HF.

BackgroundThe use of research evidence to underpin public health policy is strongly promoted. However, its implementation has not been straightforward. The objectives of this systematic review were to synthesise empirical evidence on the use of research evidence by public health decision makers in settings with universal health care systems.MethodsTo locate eligible studies, 13 bibliographic databases were screened, organisational websites were scanned, key informants were contacted and bibliographies of included studies were scrutinised. Two reviewers independently assessed studies for inclusion, extracted data and assessed methodological quality. Data were synthesised as a narrative review.Findings18 studies were included: 15 qualitative studies, and three surveys. Their methodological quality was mixed. They were set in a range of country and decision making settings. Study participants included 1063 public health decision makers, 72 researchers, and 174 with overlapping roles. Decision making processes varied widely between settings, and were viewed differently by key players. A range of research evidence was accessed. However, there was no reliable evidence on the extent of its use. Its impact was often indirect, competing with other influences. Barriers to the use of research evidence included: decision makers' perceptions of research evidence; the gulf between researchers and decision makers; the culture of decision making; competing influences on decision making; and practical constraints. Suggested (but largely untested) ways of overcoming these barriers included: research targeted at the needs of decision makers; research clearly highlighting key messages; and capacity building. There was little evidence on the role of research evidence in decision making to reduce inequalities.ConclusionsTo more effectively implement research informed public health policy, action is required by decision makers and researchers to address the barriers identified in this systematic review. There is an urgent need for evidence to support the use of research evidence to inform public health decision making to reduce inequalities.

We have recently shown that heart failure admission rates continue to increase in the UK ᎏ particularly in older age groups. As hospital activity represents the major cost component of healthcare expenditure related to heart failure, this study Ž . evaluated the current cost of this syndrome to the National Health Service NHS in the UK. We applied contemporary estimates of healthcare activity associated with heart failure to the whole UK population on an age and sex-specific basis to calculate its cost to the NHS for the year 1995. Direct components of healthcare included in these estimates were hospital admissions associated with a principal diagnosis of heart failure, associated outpatient consultations, general practice consultations and prescribed drug therapy. We also calculated the cost of nursing-home care following a primary heart failure admission and the cost of hospitalisations associated with a secondary diagnosis of heart failure. Adjusting for probable increases in hospital activity and the progressive ageing of the UK population, we have also projected the cost of heart failure to the NHS for the year 2000. We estimated that there were 988 000 individuals requiring treatment for heart failure in the UK during 1995. The 'direct' cost of healthcare for these patients was estimated to be £716 million, or 1.83% of total NHS expenditure. Hospitalisations and drug prescriptions accounted for 69 and 18% of this expenditure, respectively. The additional costs associated with long-term nursing home care and secondary heart failure admissions accounted for a further Ž . £751 million 2.0% of total NHS expenditure . By the year 2000, we estimated that the combined total direct cost of heart failure would have risen to £905 million ᎏ equivalent to 1.91% of total NHS expenditure. Using well-validated sets of data, these findings re-confirm the importance of heart failure as a major public health problem in the UK. The annual direct cost of heart failure to the NHS in 2000 is likely to be of the order of 1.9% of total expenditure ᎏ the predominant cost component being hospitalisation. ᮊ