Copyright © 2004 by the European Society of Cardiology.
Clinical research
Decreasing one-year mortality and hospitalization rates for heart failure in Sweden
Data from the Swedish Hospital Discharge Registry 1988 to 2000
a Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
b Centre for Epidemiology, National Board of Health and Welfare, Stockholm, Sweden
* Correspondence to: Maria Schaufelberger, MD, Department of Medicine, Sahlgrenska University Hospital/Östra, S-416 85 Göteborg, Sweden. Tel: +46 31 343 40 00; Fax: +46 31 25 89 33
E-mail address: maria.schaufelberger{at}hjl.gu.se
Received 28 June 2003;
revised 2 December 2003;
accepted 12 December 2003
See page 283, for the editorial comment on this article
Abstract
Aims To investigate if improved treatment of coronary heart disease and hypertension, the major causes of chronic heart failure (CHF), in the last 20 years has had an impact on the incidence of CHF and survival.
Methods National Swedish registers on hospital discharges and cause-specific deaths were used to calculate age- and sex-specific trends and sex ratios for heart failure admissions and deaths. The study included all men and women 45 to 84 years old hospitalized for the first time for heart failure in 19 Swedish counties between 1988 and 2000, a mean annual population 2.9 million. A total of 156 919 hospital discharges were included.
Result In 1988, a total of 267 men and 205 women per 100 000 inhabitants (age adjusted) were discharged for the first time with a principal diagnosis of heart failure. After 1993 a yearly decrease was observed, with 237 men and 171 women per 100 000 inhabitants discharged during 2000. The 30-day mortality decreased significantly. The decrease in 1-year mortality was more pronounced in the younger age groups, with a total reduction in mortality of 69% among men and 80% among women aged 45–54 years. The annual decrease was 9% among men and 10% among women aged 45–54 years (95% CI –7% to –12% and –6% to –14% respectively) and 4% among men and 5% among women (95% CI –4% to –5% for both) aged 75–84 years.
Conclusion The decrease in incidence and improved prognosis after a first hospitalization for heart failure coincides with the establishment of ACE-inhibitor therapy, the introduction of beta-blockers for treatment of heart failure, home-care programmes for heart failure, and more effective treatment and prevention of underlying diseases. Notwithstanding, despite considerable improvement, 1-year mortality after a first hospitalization for heart failure is still high.
Key Words: Heart failure • Mortality • Incidence
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