Evidence of Improving Prognosis in Heart Failure

MacIntyre, Kate; Capewell, Simon; Stewart, Simon; Chalmers, James; Boyd, James H.; Finlayson, Alan; Redpath, Adam; Pell, Jill P.; McMurray, John J.V.

doi:10.1161/01.cir.102.10.1126

Cited by 511 publications

(111 citation statements)

References 25 publications

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“…In Montreal, in 1999, 85% of the hospitalizations for CHF were for people 65 years of age and older (33). Furthermore, the similarities in age distribution between men and women in these clinics is surprising, because epidemiological studies have shown that CHF develops later in life in women (30), who are older at diagnosis (34) and at first CHF hospitalization (13,35). We observed that only 27% of the patients in this study were women, even though the crude prevalence of CHF is similar between the sexes (28,(36)(37)(38).…”

Section: Discussionmentioning

confidence: 64%

“…Women represent more than one-half of these CHF hospitalizations (2); thus, it is important to determine whether there are sex-related inequities in the referral and follow-up of CHF patients. A sex-related bias in access to services has been documented in coronary artery disease (3-8) and, to a lesser extent, in CHF (9-12).In the past decade, new developments in treatment have led to improvements in CHF survival, decreased hospital admissions and improved quality of life (13,14). To implement these new treatment regimens, and to account for the growing number of cases and hospitalizations, specialized, multidisciplinary CHF clinics have been established.…”

mentioning

confidence: 99%

“…In the past decade, new developments in treatment have led to improvements in CHF survival, decreased hospital admissions and improved quality of life (13,14). To implement these new treatment regimens, and to account for the growing number of cases and hospitalizations, specialized, multidisciplinary CHF clinics have been established.…”

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Are there sex-related differences in specialized, multidisciplinary congestive heart failure clinics?

Houde

Feldman

Pilote

et al. 2007

Canadian Journal of Cardiology

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C ongestive heart failure (CHF) is the most common cause of hospital admissions in people 65 years of age and older (1). Women represent more than one-half of these CHF hospitalizations (2); thus, it is important to determine whether there are sex-related inequities in the referral and follow-up of CHF patients. A sex-related bias in access to services has been documented in coronary artery disease (3-8) and, to a lesser extent, in CHF (9-12).In the past decade, new developments in treatment have led to improvements in CHF survival, decreased hospital admissions and improved quality of life (13,14). To implement these new treatment regimens, and to account for the growing number of cases and hospitalizations, specialized, multidisciplinary CHF clinics have been established. Benefits of these clinics include reduction in emergency room visits, hospitalization frequency and length of stay, together with reduced cost of care and improvement in quality of life; moreover, there is now some evidence to support their impact on survival (15-20). However, it is unclear whether men and women are equally enrolled in such case management programs, and whether they derive the same benefits. Thus, the purpose of the present study was to evaluate possible sex-related BACKGROUND: Specialized, multidisciplinary clinics improve service provision and reduce morbidity for patients with congestive heart failure (CHF). Although sex-related differences in access to cardiac health services have been reported, it remains unclear whether there are sex-related differences in the use of these specialized services. OBJECTIVES: To evaluate possible sex-related differences in severity at entry into specialized, multidisciplinary clinics, and compare prescription patterns between male and female patients at these clinics. METHODS: Data were obtained from the electronic clinical files of 765 CHF patients newly admitted to any of three main CHF clinics in Montreal, Quebec. Univariate and multivariate models were used to compare differences between sexes. RESULTS: Only 27.1% of patients were female. The mean age (± SD) of the women in the present study was similar to that of the men (64±16 years versus 65±13 years, respectively). Left ventricular ejection fraction at entry for patients with reduced systolic function was comparable between sexes. The New York Heart Association functional class at entry was similar among men and women with systolic dysfunction. However, among patients with preserved systolic function, women were more symptomatic, with a higher functional class at entry (adjusted OR 2.52, 95% CI 1.18 to 5.38). Prescription profiles were similar for men and women. CONCLUSION: Entry into a clinic may be delayed for women with preserved systolic function CHF. However, clinic referral patterns and disease management appeared to be similar among both men and women with systolic dysfunction CHF.

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Section: Discussionmentioning

confidence: 64%

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confidence: 99%

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Are there sex-related differences in specialized, multidisciplinary congestive heart failure clinics?

Houde

Feldman

Pilote

et al. 2007

Canadian Journal of Cardiology

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“…HF is a complex clinical syndrome and it is the final and most severe manifestation of nearly every form of heart disease (4,5). The prognosis of HF is particularly poor, with fewer than 50% of subjects remaining alive by 5 years, and only 10% by 10 years following the initial diagnosis (14)(15)(16)(17). Likewise, we recently found that HF is an important contributor to the excess overall mortality in RA (Crow- …”

Section: Discussionmentioning

confidence: 99%

How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?

Crowson¹,

Nicola²,

Kremers³

et al. 2005

Arthritis & Rheumatism

144

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Objective. To compare the proportion of the risk for the development of heart failure (HF) that is attributable to traditional cardiovascular (CV) risk factors, ischemic heart disease (IHD), and alcohol abuse between subjects with and subjects without rheumatoid arthritis (RA).Methods. A population-based inception cohort of RA patients was assembled along with a similar cohort of subjects without RA. All individuals were followed up through their complete medical records, until HF incidence, death, migration, or January 1, 2001. The attributable risk of HF was estimated as the difference between the observed cumulative incidence of HF in each cohort (estimated from multivariable Cox models and adjusted for the competing risk of death) and the predicted cumulative incidence of HF in the absence of risk factors, with results expressed as a percentage of the observed cumulative incidence.Results. A total of 575 RA subjects and 583 non-RA subjects (mean age 57 years, 73% women) without HF at incidence/index date had a mean followup of 15.1 and 17.0 years, respectively. During that period, 165 RA and 115 non-RA subjects had a first episode of HF, with a cumulative incidence of 36.3% and 20.4%, respectively, at age 80 years. Among non-RA subjects, 77% of the HF at age 80 years was attributable to CV risk factors, IHD, and alcohol abuse combined, whereas among RA subjects, only 54% of the HF at age 80 years was attributable to these factors (P < 0.01). Conclusion. The excess risk of HF among RA patients is not explained by an increased frequency or effect of CV risk factors and IHD.Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown etiology, affecting ϳ1% of the adult general population (1,2). Patients with RA have twice the risk of heart failure (HF) when compared with individuals of the same age and sex without RA (3). The mechanism behind this increased risk is unknown. The etiology of HF can be multifactorial, with several clinical risk factors coexisting and interacting to produce this clinical syndrome (4,5). Ischemic heart disease (IHD) and hypertension have long been recognized as major risk factors for HF in the general population (6-9). Therefore, elimination of traditional cardiovascular (CV) risk factors and IHD is a recognized approach to prevent HF (9).However, we previously reported that the increased risk of HF in subjects with RA appears to be independent of the presence or effect of IHD and CV risk factors (3). Consequently, IHD and CV risk factors may play a different role with respect to the development and prevention of HF in RA subjects, compared with non-RA subjects. The aim of the present study was to compare the proportion of the risk for the development of HF that is attributable to traditional CV risk factors, IHD, and alcohol abuse between subjects with and subjects without RA.

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“…However, over the past two decades there has been a substantial reduction in mortality, probably due to more widespread use of renin-angiotensin aldosteron (RAAS) and beta-receptor blocking agents [2,4,5]. Studies from Sweden and from Scotland have shown that the prognosis has improved [6][7][8]. With an ageing population, however, the impact of HF on individual health and health care systems is still profound.…”

Section: Introductionmentioning

confidence: 99%

Are There Any Significant Differences Between Females and Males in the Management of Heart Failure? Gender Aspects of an Elderly Population With Symptoms Associated With Heart Failure

Alehagen

Ericsson

Dahlström

2009

Journal of Cardiac Failure

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An increasing interest has been shown in potential gender differences in treating patients with heart failure (HF), a serious condition for the individual. AimTo evaluate whether there are any differences in the prevalence of HF, cardiac function, biomarkers and the treatment of HF with respect to gender. MethodsAll persons age 70 to 80 in a rural municipality were invited to participate in the project; 876 persons accepted. Three cardiologists evaluated the patients including a new history, clinical examination, ECG, chest x-ray, blood samples, and Doppler echocardiography to assess both systolic and diastolic function. The patients were followed during a mean period of 8 years. Results and ConclusionFemales had hypertension more frequently and included fewer smokers than their male counterparts. A female preponderance was seen in those with preserved systolic function, whereas males predominated among those with systolic dysfunction. During the follow-up period, 20% of the males and 14% of the females died of cardiovascular diseases. The results did not show any inferior treatment of females with HF, but it clearly was more difficult to correctly classify female patients presenting with symptoms of HF.

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Evidence of Improving Prognosis in Heart Failure

Cited by 511 publications

References 25 publications

Are there sex-related differences in specialized, multidisciplinary congestive heart failure clinics?

Are there sex-related differences in specialized, multidisciplinary congestive heart failure clinics?

How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?

Are There Any Significant Differences Between Females and Males in the Management of Heart Failure? Gender Aspects of an Elderly Population With Symptoms Associated With Heart Failure

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