20-year trends in cause-specific heart failure outcomes by sex, socioeconomic status, and place of diagnosis: a population-based study

Abstract

Summary Background Heart failure is an important public health issue affecting about 1 million people in the UK, but contemporary trends in cause-specific outcomes among different population groups are unknown. Methods In this retrospective, population-based study, we used the UK Clinical Practice Research Datalink and Hospital Episodes Statistics databases to identify a cohort of patients who had a diagnosis of incident heart failure between Jan 1, 1998, and July 31, 2017. Patients were eligible for inclusion if they were aged 30 years or older with a first code for heart failure in their primary care or hospital record during the study period. We assessed cause-specific admission to hospital (ie, hospitalisation) and mortality, by age, sex, socioeconomic status, and place of diagnosis (ie, hospital vs community diagnosis). We calculated outcome rates separately for the first year (first-year rates) and for the second-year onwards (subsequent-year rates). Patients were followed up until death or study end. This study is registered with Clinical Practice Research Datalink Independent Scientific Advisory Committee, protocol number 18_037R. Findings We identified 88 416 individuals with incident heart failure over the study period, of whom 43 461 (49%) were female. The mean age was 77·8 years (SD 11·3) and median follow-up was 2·4 years (IQR 0·5 to 5·7). Age-adjusted first-year rates of hospitalisation increased by 28% for all-cause admissions, from 97·1 (95% CI 94·3 to 99·9) to 124·2 (120·9 to 127·5) per 100 person-years; by 28% for heart failure-specific admissions, from 17·2 (16·2 to 18·2) to 22·1 (20·9 to 23·2) per 100 person-years; and by 42% for non-cardiovascular admissions, from 59·2 (57·2 to 61·2) to 83·9 (81·3 to 86·5) per 100 person-years. 167 641 (73%) of 228 113 hospitalisations were for non-cardiovascular causes and annual rate increases were higher for women (3·9%, 95% CI 2·8 to 4·9) than for men (1·4%, 0·6 to 2·1; p<0·0001); and for patients diagnosed with heart failure in hospital (2·4%, 1·4 to 3·3) than those diagnosed in the community (1·2%, 0·3 to 2·2). Annual increases in hospitalisation due to heart failure were 2·6% (1·9 to 3·4) for women compared with stable rates in men (0·6%, −0·9 to 2·1), and 1·6% (0·6 to 2·6) for the most deprived group compared with stable rates for the most affluent group (1·2%, −0·3 to 2·8). A significantly higher risk of all-cause hospitalisation was found for the most deprived than for the most affluent (incident rate ratio 1·34, 95% CI 1·32 to 1·35) and for the hospital-diagnosed group than for the community-diagnosed group (1·76, 1·73 to 1·80). Age-adjusted first-year rates of all-cause mortality decreased by 6% from 24·5 (95% CI 23·4 to 39·2) to 23·0 (22·0 to 24·1) per 100 person-years. Annual change in mortality was −1·4% (95% CI −2·3 to −0·5) in men but was stable for women (0·3%, −0·5 to 1·1), and −2·7% (–3·2 to −2·2) for the community-diagnosed g...

Cost‐effectiveness of dapagliflozin as a treatment for heart failure with reduced ejection fraction: a multinational health‐economic analysis of DAPA‐HF

“…It has been estimated that 1‐year costs related to HF in the European Union are around €29 billion, 9 with frequent, prolonged and repeat hospitalizations accounting for the majority of these costs 10 . The economic burden of HF is likely to increase substantially over the next decade, driven by the ageing of the population and an estimated 46% increase in HF prevalence by 2030 11,12 …”

Inequalities in heart failure care in a tax‐financed universal healthcare system: a nationwide population‐based cohort study

“…Inequity in HF care place socially deprived patients with HFrEF at double risk. Low socioeconomic status is a substantial risk factor of developing HF, 6 and recent studies indicate that income, poverty, and employment status is associated with a poor clinical outcome, for example, mortality and readmission among patients after being diagnosed with HF in universal healthcare systems 7–10,27 . Some studies have shown a relationship between HF care processes delivered (e.g.…”

“…Low socioeconomic status is a strong predictor for the development of HF 6 . In addition, differences in readmission risk and mortality according to a level of income and socioeconomic deprivation have been reported in several studies among patients with HF, even in tax‐financed well‐fare state settings, 7–11 while socioeconomic deprivation, defined with the Index of Multiple Deprivation 2007, have not been found to be associated with mortality in one study 12 . Socioeconomic disparities in HF care may potentially contribute to the observed differences in mortality and readmission risk according to socioeconomic status.…”

Decreasing mortality masks a growing morbidity gap in patients with heart failure

“…However, as the impact of this chronic condition increases on health services, the nature of living with, rather than dying from, heart failure is of increasing importance to patients and health services alike. Claire Lawson and colleagues' 4 Article in The Lancet Public Health provides one of the first studies of its scale to examine trends in secondary outcomes of heart failure and corresponding socioeconomic inequalities.…”

“…This previous work identified increases in age and multimorbidity at diagnosis of heart failure. Lawson and colleagues' study 4 builds on this previous work to characterise the patient journey and their outcomes from heart failure diagnosis onwards. By identifying incident cases in primary care and following them up, rather than relying on hospital diagnoses alone, this study provides a comprehensive overview on morbidity and cause-specific health service use through to ultimate cause of death.…”