Department of Emergency Medicine; Department of Quantitative Health Sciences; Department of Medicine, Division of Cardiovascular Medicine; Meyers Primary Care Institute
Heart Failure; Survival Rate; Outcome Assessment (Health Care)
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Health Services Research | Public Health
BACKGROUND: Heart failure is a highly prevalent, morbid, and costly disease with a poor long-term prognosis. Evidence-based therapies utilized over the past 2 decades hold the promise of improved outcomes, yet few contemporary studies have examined survival trends in patients with acute heart failure. The primary objective of this population-based study was to describe trends in short- and long-term survival in patients hospitalized with acute decompensated heart failure (ADHF). A secondary objective was to examine patient characteristics associated with decreased long-term survival.
METHODS AND RESULTS: We reviewed the medical records of 9748 patients hospitalized with ADHF at all 11 medical centers in central Massachusetts during 1995, 2000, 2002, and 2004. Patients hospitalized with ADHF were more likely to be elderly and to have been diagnosed with multiple comorbidities in 2004 compared with 1995. Over this period, survival was significantly improved in-hospital, and at 1, 2, and 5 years postdischarge. Five-year survival rates increased from 20% in 1995 to 29% in 2004. Although survival improved substantially over time, older patients and patients with chronic kidney disease, chronic obstructive pulmonary disease, anemia, low body mass index, and low blood pressures had consistently lower postdischarge survival rates than patients without these comorbidities.
CONCLUSION: Between 1995 and 2004, patients hospitalized with ADHF have become older and increasingly comorbid. Although there has been a significant improvement in survival among these patients, their long-term prognosis remains poor, as fewer than 1 in 3 patients hospitalized with ADHF in 2004 survived more than 5 years.
Rights and Permissions
Copyright 2013 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley-Blackwell. This is an Open Access article under the terms of the Creative Commons Attribution Noncommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
DOI of Published Version
Joffe SW, Webster K, McManus DD, Kiernan MS, Lessard D, Yarzebski J, Darling C, Gore JM, Goldberg RJ. Improved survival after heart failure: a community-based perspective. J Am Heart Assoc. 2013 May 15;2(3):e000053. doi:10.1161/JAHA.113.000053. Link to article on publisher's site
Journal of the American Heart Association
Joffe, Samuel W.; Webster, Kristy T.; McManus, David D.; Kiernan, Michael S.; Lessard, Darleen M.; Yarzebski, Jorge L.; Darling, Chad E.; Gore, Joel M.; and Goldberg, Robert J., "Improved survival after heart failure: a community-based perspective" (2013). University of Massachusetts Medical School Faculty Publications. 16.