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	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Redfield, M. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Heart failure is a major public health problem. Long-term trends in the incidence of heart failure and survival after its onset in the community have not been characterized.

Methods We used statistical models to assess temporal trends in the incidence of heart failure and Cox proportional-hazards regression to evaluate survival after the onset of heart failure among subjects in the Framingham Heart Study. Cases of heart failure were classified according to the date of onset: 1950 through 1969 (223 cases), 1970 through 1979 (222), 1980 through 1989 (307), and 1990 through 1999 (323). We also calculated 30-day, 1-year, and 5-year age-adjusted mortality rates for each period.

Results Heart failure occurred in 1075 subjects (51 percent of whom were women). As compared with the rate for the period from 1950 through 1969, the incidence of heart failure remained virtually unchanged among men in the three subsequent periods but declined by 31 to 40 percent among women (rate ratio for the period from 1990 through 1999, 0.69; 95 percent confidence interval, 0.51 to 0.93). The 30-day, 1-year, and 5-year age-adjusted mortality rates among men declined from 12 percent, 30 percent, and 70 percent, respectively, in the period from 1950 through 1969 to 11 percent, 28 percent, and 59 percent, respectively, in the period from 1990 through 1999. The corresponding rates among women were 18 percent, 28 percent, and 57 percent for the period from 1950 through 1969 and 10 percent, 24 percent, and 45 percent for the period from 1990 through 1999. Overall, there was an improvement in the survival rate after the onset of heart failure of 12 percent per decade (P=0.01 for men and P=0.02 for women).

Conclusions Over the past 50 years, the incidence of heart failure has declined among women but not among men, whereas survival after the onset of heart failure has improved in both sexes. Factors contributing to these trends need further clarification.

Source Information

From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass. (D.L., S.K., M.G.L., E.J.B., M.J.K., J.M.M, R.S.V.); the Sections of Preventive Medicine (D.L., E.J.B., R.S.V.), General Internal Medicine (J.M.M.), and Cardiology (E.J.B., R.S.V.), Boston University School of Medicine, Boston; the Cardiology Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston (D.L., K.K.L.H.); the Harvard Clinical Research Institute, Boston (K.K.L.H.); and the National Heart, Lung, and Blood Institute, Bethesda, Md. (D.L.).

Full Text of this Article

Related Letters:

Heart Failure — Incidence and Survival
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Extract | Full Text | PDF  
N Engl J Med 2003; 348:660, Feb 13, 2003. Correspondence

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