Copyright © 1999 by the European Society of Cardiology.
Incidence and aetiology of heart failure; a population-based study
a Cardiac Medicine, Imperial College School of Medicine at the National Heart & Lung Institute, London
b Department of Medical Statistics and Evaluation, Imperial College School of Medicine at the Hammersmith Hospital, London
c Hillingdon Hospital, Uxbridge, Middlesex, U.K.
revised August 10, 1998; accepted August 18, 1998
Abstract
Aims
To determine the incidence and aetiology of heart failure in the general population.
Methods and Results
New cases of heart failure were identified from a population of 151000 served by 82 general practitioners in Hillingdon, West London through surveillance of acute hospital admissions and through a rapid access clinic to which general practitioners referred all new cases of suspected heart failure. On the basis of clinical assessment, electrocardiography, chest radiography and transthoracic echocardiography, a panel of three cardi-ologists decided that 220 patients met the case definition of new heart failure over a 20 month period (crude incidence rate of 1·3 cases per 1000 population per year for those aged 25 years or over). The incidence rate increased from 0·02 cases per 1000 population per year in those aged 25–34 years to 11·6 in those aged 85 years and over. The incidence was higher in males than females (age-adjusted incidence ratio 1·75 [95% confidence interval 1·34–2·29,P<0·0001]). The median age at presentation was 76 years. The primary aetiologies were coronary heart disease (36%), unknown (34%), hypertension (14%), valve disease (7%), atrial fibrillation alone (5%), and other (5%).
Conclusions
Within the general population, new cases of heart failure largely occur in the elderly, and the incidence is higher in men than women. The single most common aetiology is coronary heart disease, but in a third of cases the aetiology cannot be determined on the basis of non-invasive investigation alone. To be relevant to clinical practice, future clinical trials in heart failure should not exclude the elderly.
Key Words: Epidemiology, heart failure, incidence, aetiology
f1 Correspondence: Dr Martin R. Cowie, Department of Medicine & Therapeutics, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, U.K.
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S. De Geest, L. Scheurweghs, I. Reynders, W. Pelemans, W. Droogne, J. Van Cleemput, M. Leventhal, and J. Vanhaecke Differences in psychosocial and behavioral profiles between heart failure patients admitted to cardiology and geriatric wards Eur J Heart Fail, August 1, 2003; 5(4): 557 - 567. [Abstract] [Full Text] [PDF]
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F. Gustafsson, C. Torp-Pedersen, B. Brendorp, M. Seibaek, H. Burchardt, L. Kober, and for the DIAMOND study group Long-term survival in patients hospitalized with congestive heart failure: relation to preserved and reduced left ventricular systolic function Eur. Heart J., May 1, 2003; 24(9): 863 - 870. [Abstract] [Full Text] [PDF]
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R. S. Vasan, A. Beiser, R. B. D'Agostino, D. Levy, J. Selhub, P. F. Jacques, I. H. Rosenberg, and P. W. F. Wilson Plasma Homocysteine and Risk for Congestive Heart Failure in Adults Without Prior Myocardial Infarction JAMA, March 12, 2003; 289(10): 1251 - 1257. [Abstract] [Full Text] [PDF]
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J. Muntwyler, G. Abetel, C. Gruner, and F. Follath One-year mortality among unselected outpatients with heart failure Eur. Heart J., December 1, 2002; 23(23): 1861 - 1866. [Abstract] [Full Text] [PDF]
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M. Martinez-Selles, J. A. G. Robles, L. Prieto, J. A. Serrano, R. Munoz, E. Frades, and J. Almendral Annual rates of admission and seasonal variations in hospitalizations for heart failure Eur J Heart Fail, December 1, 2002; 4(6): 779 - 786. [Abstract] [Full Text] [PDF]
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D. W. Kitzman, W. C. Little, P. H. Brubaker, R. T. Anderson, W. G. Hundley, C. T. Marburger, B. Brosnihan, T. M. Morgan, and K. P. Stewart Pathophysiological Characterization of Isolated Diastolic Heart Failure in Comparison to Systolic Heart Failure JAMA, November 6, 2002; 288(17): 2144 - 2150. [Abstract] [Full Text] [PDF]
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S D Hutcheon, N D Gillespie, I K Crombie, A D Struthers, and M E T McMurdo Perindopril improves six minute walking distance in older patients with left ventricular systolic dysfunction: a randomised double blind placebo controlled trial Heart, October 1, 2002; 88(4): 373 - 377. [Abstract] [Full Text] [PDF]
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M. Zi, N. Wisniacki, J. Delaney, C. Donnellan, and M. Lye Autonomic function in elderly patients with chronic heart failure Eur J Heart Fail, October 1, 2002; 4(5): 605 - 611. [Abstract] [Full Text] [PDF]
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M R Cowie Best practice: evidence from the clinical trials Heart, October 1, 2002; 88(90002): ii2 - 4. [Full Text] [PDF]
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J G F Cleland Contemporary management of heart failure in clinical practice Heart, October 1, 2002; 88(90002): ii5 - 8. [Full Text] [PDF]
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F D R Hobbs Unmet need for diagnosis of heart failure: the view from primary care Heart, October 1, 2002; 88(90002): ii9 - 11. [Full Text] [PDF]
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D A Wood Preventing clinical heart failure: the rationale and scientific evidence Heart, October 1, 2002; 88(90002): ii15 - 22. [Full Text] [PDF]
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P. Jong, E. Vowinckel, P. P. Liu, Y. Gong, and J. V. Tu Prognosis and Determinants of Survival in Patients Newly Hospitalized for Heart Failure: A Population-Based Study Arch Intern Med, August 12, 2002; 162(15): 1689 - 1694. [Abstract] [Full Text] [PDF]
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F. Ceia, C. Fonseca, T. Mota, H. Morais, F. Matias, A. de Sousa, A. G. Oliveira, and on behalf of the EPICA Investigators Prevalence of chronic heart failure in Southwestern Europe: the EPICA study Eur J Heart Fail, August 1, 2002; 4(4): 531 - 539. [Abstract] [Full Text] [PDF]
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J.J.V McMurray and S Stewart The burden of heart failure Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D50 - D58. [Abstract] [PDF]
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