Sex-specific temporal trends in ambulatory heart failure incidence, mortality and hospitalisation in Ontario, Canada from 1994 to 2013: a population-based cohort study

• Published in: BMJ open 2020-11, Vol.10 (11), p.e044126-e044126
• Main Authors: Sun, Louise Y, Mielniczuk, Lisa M, Liu, Peter P, Beanlands, Rob S, Chih, Sharon, Davies, Ross, Coutinho, Thais, Lee, Douglas S, Austin, Peter C, Bader Eddeen, Anan, Tu, Jack V
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiovascular Medicine; Cohort analysis; Female; Gender differences; Health insurance; Heart failure; Heart Failure - epidemiology; Hospitalization; Humans; Incidence; Male; Middle Aged; Mortality; Ontario - epidemiology; Population-based studies; Retrospective Studies; Sex Factors
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-044126

ObjectivesTo examine the temporal trends in mortality and heart failure (HF) hospitalisation in ambulatory patients following a new diagnosis of HF.DesignRetrospective cohort studySettingOutpatientParticipantsOntario residents who were diagnosed with HF in an outpatient setting between 1994 and 2013.Primary and secondary outcome measuresThe primary outcome was all-cause mortality within 1 year of diagnosis and the secondary outcome was HF hospitalisation within 1 year. Risks of mortality and hospitalisation were calculated using the Kaplan-Meier method and the relative hazard of death was assessed using multivariable Cox proportional hazard models.ResultsA total of 352 329 patients were studied (50% female). During the study period, there was a greater decline in age standardised 1-year mortality rates (AMR) in men (33%) than in women (19%). Specifically, female AMR at 1 year was 10.4% (95% CI 9.1% to 12.0%) in 1994 and 8.5% (95% CI 7.5% to 9.5%) in 2013, and male AMR at 1 year was 12.3% (95% CI 11.1% to 13.7%) in 1994 and 8.3% (95% CI 7.5% to 9.1%) in 2013. Conversely, age standardised HF hospitalisation rates declined in men (11.4% (95% CI 10.1% to 12.9%) in 1994 and 9.1% (95% CI 8.2% to 10.1%) in 2013) but remained unchanged in women (9.7% (95% CI 8.3% to 11.3%) in 1994 and 9.8% (95% CI 8.6% to 11.0%) in 2013).ConclusionAmong patients with HF over a 20-year period, there was a greater improvement in the prognosis of men compared with women. Further research should focus on the determinants of this disparity and ways to reduce this gap in outcomes.