Survival following a diagnosis of heart failure in primary care

Abstract

Background. Heart failure is a common long term condition affecting around 900 000 people in the UK and patients commonly present to primary care. The prognosis of patients with a code of heart failure in their primary care record is unknown.Objective. The study sought to determine the overall survival rates for patients with heart failure in a primary care population from the time of diagnosis.Methods. Survival analysis was carried out using UK primary care records from The Health Improvement Network (THIN) between 1 January 1998 and 31 December 2012. Patients age 45 or over with a first diagnostic label of heart failure were matched by age, sex and practice to people without heart failure. Outcome was death in the heart failure and no heart failure cohorts. Kaplan-Meier curves were used to compare survival. Age-specific survival rates at 1, 5 and 10 years were determined for men and women with heart failure. Survival rates by year of diagnosis and case definition were also calculated.Results. During the study period, 54313 patients had a first diagnostic code of heart failure. Overall survival rates for the heart failure group were 81.3% (95%CI 80.9–81.6), 51.5% (95%CI 51.0–52.0) and 29.5% (95%CI 28.9–30.2) at 1, 5 and 10 years respectively and did not change over time.Conclusions. In a primary care population, the survival of patients diagnosed with heart failure did not improved over time. Further research is needed to explain these trends and to find strategies to improve outlook.

Survival of patients with chronic heart failure in the community: a systematic review and meta‐analysis

“…The 1‐month, and 1‐, 2‐, and 5‐year survival rates for these groups were 95.2% (92.1–97.6), 89.3% (87.9–90.6), 78.9% (74.2–83.2) and 59.7% (54.7–64.6), respectively, slightly better than the overall pooled survival. Only one study reported 10‐year follow‐up data for participants post‐2000 with a survival rate of 29.5% (28.9–30.2) …”

“…An acute decompensation is itself a poor prognostic sign and therefore these survival estimates are not directly applicable to people with 'chronic' HF, who have had an extended period of symptom stability . Previous research suggests 1‐year survival in acute HF is between 55% and 65%, compared to 80% to 90% in chronic HF …”

“…7 Previous research suggests 1-year survival in acute HF is between 55% and 65%, 8,9 compared to 80% to 90% in chronic HF. 10,11 The majority of patients have chronic HF and are treated in ambulatory settings. 12 This chronic phase should be a time to discuss advanced care planning and anticipated disease progression with patients and their families.…”

Routes to diagnosis of heart failure: observational study using linked data in England

“…Diagnosis and management of HF in primary care has been criticised, with evidence of both underdiagnosis12 13 and overdiagnosis,14 and no improvement in survival over nearly 15 years 15. Professionals may fail to adhere to guidance and lack confidence in investigations and treatments 12 16 17.…”

Survival rates in elderly patients with heart failure: reply

“…Individual studies demonstrate that older people with heart failure have a significantly worse prognosis than age and sex‐matched controls, even when co‐morbidity is common in both groups. A recent observational study found the 1, 5 and 10‐year survival rates amongst people with chronic heart failure aged between 75 and 84 years were 81.9% (95% confidence interval 81.3–82.4), 49.5% (48.7–50.3) and 23.8% (22.8–24.9) compared to respective survival in age and sex‐matched controls of 94.2% (94.0–94.3), 71.9% (71.6–72.2) and 46.0% (45.5–46.6) …”