Trends in long-term cardiovascular mortality and morbidity in men and women with heart failure of ischemic versus non-ischemic aetiology in Western Australia between 1990 and 2005

• Published in: International journal of cardiology 2012-07, Vol.158 (3), p.405-410
• Main Authors: Teng, Tiew-Hwa Katherine, Hung, Joseph, Knuiman, Matthew, Stewart, Simon, Arnolda, Leonard, Jacobs, Ian, Hobbs, Michael, Sanfilippo, Frank, Geelhoed, Elizabeth, Finn, Judith
• Format: Article
• Language: English
• Subjects: Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Databases, Factual - statistics & numerical data; Female; Gender; Heart; Heart failure; Heart Failure - etiology; Heart Failure - mortality; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospitalization; Hospitalization - statistics & numerical data; Humans; Incidence; Male; Medical sciences; Middle Aged; Morbidity; Mortality - trends; Multivariate Analysis; Myocardial Ischemia - complications; Myocardial Ischemia - mortality; Proportional Hazards Models; Risk Factors; Sex Distribution; Survival; Western Australia - epidemiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2011.01.061

Abstract Background It is uncertain if improvements in long-term cardiovascular (CV) mortality have occurred in both men and women with ischemic and non-ischemic forms of heart failure (HF). Methods The Western Australia Hospital Morbidity Database was used to identify all index (first-ever) hospitalizations for HF between 1990 and 2005. Patients were followed until death attributed to cardiovascular causes or censored on December 31, 2006 to determine 5-year survival. Cox proportional hazards models were used to compare the adjusted mortality hazard ratio (HR) during the study follow-up (4-year periods). Results A total of 21,507 patients (mean age 73.9 years, 49.1% women) were identified. Women were significantly older than men, and less likely to have ischemic HF (38.8% versus 46.1%). Over the period, age-standardized incidence of first HF hospitalization declined but with the least decline in women with non-ischemic HF (− 13.3%) compared to other subgroups. Risk-adjusted 5-year CV mortality declined over the study period, with HR 0.64 (95% CI 0.60–0.68) for patients admitted in 1998–2001 compared to 1990–1993, with significant improvement in both forms of HF, and in both sexes and across age groups. However, overall total HF hospitalizations increased (+ 26.7%) over the period, particularly for non-ischemic HF (+ 43.7%), of which elderly women formed the predominant group. Conclusions Risk-adjusted long-term survival improved similarly in men and women, including the elderly, with ischemic and non-ischemic forms of HF during 1990–2005 in Western Australia. However, there was a growing burden of HF hospitalizations particularly for HF of non-ischemic aetiology.