Sex-Specific Trends in Incidence and Mortality for Urban and Rural Ambulatory Patients with Heart Failure in Eastern Ontario from 1994 to 2013

Sun, Louise Y.; Tu, Jack V.; Sherrard, Heather; Rodger, N. W.; Coutinho, Thais; Turek, Michèle; Chan, Elizabeth; Tulloch, Heather; McDonnell, Lisa; Mielniczuk, Lisa

doi:10.1016/j.cardfail.2018.07.465

Cited by 19 publications

(25 citation statements)

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“…Patients who had hospital-diagnosed heart failure had significantly worse outcome rates over time compared with the community-diagnosed group; a finding shared by previous reports 28, 29. Our findings reveal an exponential increase in the number of patients diagnosed with heart failure in hospital, accounting for 74% of the population admitted for heart failure by 2017.…”

Section: Discussionsupporting

confidence: 79%

“…Previous heart failure studies have shown worse outcomes for men than women 6, 33. Our findings show that faster increases in rates of admission to hospital due to heart failure and non-cardiovascular disease and slower decreases in mortality in women than men has resulted in similar outcomes between the sexes over the past decade; a finding also reported in Denmark 26 and Ontario 28 . These patterns likely reflect the increasing prevalence of non-cardiovascular disease comorbidities in women.…”

Section: Discussionsupporting

confidence: 75%

“…6,33 Our findings show that faster increases in rates of admission to hospital due to heart failure and non-cardiovascular disease and slower decreases in mortality in women than men has resulted in similar outcomes between the sexes over the past decade; a finding also reported in Denmark 26 and Ontario. 28 These patterns likely reflect the increasing prevalence of noncardiovascular disease comorbidities in women. However, the attenuation of sex differences over time, even after accounting for comorbidities, and a greater increase in the rate of hospitalisations due to heart failure over time in women than in men suggest worsening severity of heart failure or a lack of effective therapies for heart failure in women compared with men.…”

Section: Discussionmentioning

confidence: 99%

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

Lawson

Zaccardi

Squire

et al. 2019

The Lancet Public Health

108

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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...

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

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

Lawson

Zaccardi

Squire

et al. 2019

The Lancet Public Health

108

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“…Our findings corroborate with our previous study of HF incidence and 1-year mortality in rural and urban Eastern Ontario from 1994 to 2013. 24 They also corroborate the work of Tu et al 7 who used similar administrative databases to report on the HF incidence and mortality of Ontario patients≥20 years of age from 1997 to 2007. Tu et al evaluated both admitted and ambulatory HF patients and reported declines in HF incidence over this time period, a finding that was most evident in the older cohorts.…”

Section: Trends In Hf Incidence and Mortalitysupporting

confidence: 80%

“…Other comorbidities were identified using Discharge Abstract Database, Same Day Surgery and Ontario Health Insurance Plan databases based on International Classification of Diseases 10th Revision codes within 5 years of HF diagnosis, using previously described methods. [17][18][19][20][21][22][23][24][25][26][27][28][29] Frailty was identified using the Johns Hopkins Adjusted Clinical Groups frailtydefining diagnoses indicator, which is an instrument designed and validated for research of frailty-related outcomes and resource utilisation using administrative data. 25 28 30-34 Statistical analysis Analyses were stratified by sex.…”

Section: Covariatesmentioning

confidence: 99%

Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

et al. 2020

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ObjectivesTo examine the temporal trends in mortality and heart failure (HF) hospitalisation in ambulatory patients following a new diagnosis of HF.DesignRetrospective cohort studySettingOutpatientParticipantsOntario residents who were diagnosed with HF in an outpatient setting between 1994 and 2013.Primary and secondary outcome measuresThe primary outcome was all-cause mortality within 1 year of diagnosis and the secondary outcome was HF hospitalisation within 1 year. Risks of mortality and hospitalisation were calculated using the Kaplan-Meier method and the relative hazard of death was assessed using multivariable Cox proportional hazard models.ResultsA total of 352 329 patients were studied (50% female). During the study period, there was a greater decline in age standardised 1-year mortality rates (AMR) in men (33%) than in women (19%). Specifically, female AMR at 1 year was 10.4% (95% CI 9.1% to 12.0%) in 1994 and 8.5% (95% CI 7.5% to 9.5%) in 2013, and male AMR at 1 year was 12.3% (95% CI 11.1% to 13.7%) in 1994 and 8.3% (95% CI 7.5% to 9.1%) in 2013. Conversely, age standardised HF hospitalisation rates declined in men (11.4% (95% CI 10.1% to 12.9%) in 1994 and 9.1% (95% CI 8.2% to 10.1%) in 2013) but remained unchanged in women (9.7% (95% CI 8.3% to 11.3%) in 1994 and 9.8% (95% CI 8.6% to 11.0%) in 2013).ConclusionAmong patients with HF over a 20-year period, there was a greater improvement in the prognosis of men compared with women. Further research should focus on the determinants of this disparity and ways to reduce this gap in outcomes.

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Association of Rurality With Risk of Heart Failure

Turecamo

Dixon

et al. 2023

JAMA Cardiol

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ImportanceRural populations experience an increased burden of heart failure (HF) mortality compared with urban populations. Whether HF incidence is greater among rural individuals is less known. Additionally, the intersection between racial and rural health inequities is understudied.ObjectiveTo determine whether rurality is associated with increased risk of HF, independent of cardiovascular (CV) disease and socioeconomic status (SES), and whether rurality-associated HF risk varies by race and sex.Design, Setting, and ParticipantsThis prospective cohort study analyzed data for Black and White participants of the Southern Community Cohort Study (SCCS) without HF at enrollment who receive care via Centers for Medicare &amp; Medicaid Services (CMS). The SCCS is a population-based cohort of low-income, underserved participants from 12 states across the southeastern United States. Participants were enrolled between 2002 and 2009 and followed up until December 31, 2016. Data were analyzed from October 2021 to November 2022.ExposuresRurality as defined by Rural-Urban Commuting Area codes at the census-tract level.Main Outcomes and MeasuresHeart failure was defined using diagnosis codes via CMS linkage through 2016. Incidence of HF was calculated by person-years of follow-up and age-standardized. Sequentially adjusted Cox proportional hazards regression models tested the association between rurality and incident HF.ResultsAmong 27 115 participants, the median (IQR) age was 54 years (47-65), 18 647 (68.8%) were Black, and 8468 (32.3%) were White; 5556 participants (20%) resided in rural areas. Over a median 13-year follow-up, age-adjusted HF incidence was 29.6 (95% CI, 28.9-30.5) per 1000 person-years for urban participants and 36.5 (95% CI, 34.9-38.3) per 1000 person-years for rural participants (P &lt; .001). After adjustment for demographic information, CV risk factors, health behaviors, and SES, rural participants had a 19% greater risk of incident HF (hazard ratio [HR], 1.19; 95% CI, 1.13-1.26) compared with their urban counterparts. The rurality-associated risk of HF varied across race and sex and was greatest among Black men (HR, 1.34; 95% CI, 1.19-1.51), followed by White women (HR, 1.22; 95% CI, 1.07-1.39) and Black women (HR, 1.18; 95% CI, 1.08-1.28). Among White men, rurality was not associated with greater risk of incident HF (HR, 0.97; 95% CI, 0.81-1.16).Conclusions and RelevanceAmong predominantly low-income individuals in the southeastern United States, rurality was associated with an increased risk of HF among women and Black men, which persisted after adjustment for CV risk factors and SES. This inequity points to a need for additional emphasis on primary prevention of HF among rural populations.

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Sex-Specific Trends in Incidence and Mortality for Urban and Rural Ambulatory Patients with Heart Failure in Eastern Ontario from 1994 to 2013

Cited by 19 publications

References 19 publications

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

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

Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

Association of Rurality With Risk of Heart Failure

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