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      Trends in Hospitalizations and Survival of Acute Decompensated Heart Failure in Four US Communities (2005–2014) : ARIC Study Community Surveillance

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          Abstract

          Community trends of acute decompensated heart failure (ADHF) in diverse populations may differ by race and sex.

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          Trends in heart failure incidence and survival in a community-based population.

          Véronique L Roger, Susan A Weston, Margaret M. Redfield … (2004)
          The epidemic of heart failure has yet to be fully investigated, and data on incidence, survival, and sex-specific temporal trends in community-based populations are limited. To test the hypothesis that the incidence of heart failure has declined and survival after heart failure diagnosis has improved over time but that secular trends have diverged by sex. Population-based cohort study using the resources of the Rochester Epidemiology Project conducted in Olmsted County, Minnesota. Patients were 4537 Olmsted County residents (57% women; mean [SD] age, 74 [14] years) with a diagnosis of heart failure between 1979 and 2000. Framingham criteria and clinical criteria were used to validate the diagnosis Incidence of heart failure and survival after heart failure diagnosis. The incidence of heart failure was higher among men (378/100 000 persons; 95% confidence interval [CI], 361-395 for men; 289/100 000 persons; 95% CI, 277-300 for women) and did not change over time among men or women. After a mean follow-up of 4.2 years (range, 0-23.8 years), 3347 deaths occurred, including 1930 among women and 1417 among men. Survival after heart failure diagnosis was worse among men than women (relative risk, 1.33; 95% CI, 1.24-1.43) but overall improved over time (5-year age-adjusted survival, 43% in 1979-1984 vs 52% in 1996-2000, P<.001). However, men and younger persons experienced larger survival gains, contrasting with less or no improvement for women and elderly persons. In this community-based cohort, the incidence of heart failure has not declined during 2 decades, but survival after onset of heart failure has increased overall, with less improvement among women and elderly persons.
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            National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008.

            Jersey Chen, Sharon-Lise Normand, Yun Wang … (2011)
            It is not known whether recent declines in ischemic heart disease and its risk factors have been accompanied by declines in heart failure (HF) hospitalization and mortality. To examine changes in HF hospitalization rate and 1-year mortality rate in the United States, nationally and by state or territory. From acute care hospitals in the United States and Puerto Rico, 55,097,390 fee-for-service Medicare beneficiaries hospitalized between 1998 and 2008 with a principal discharge diagnosis code for HF. Changes in patient demographics and comorbidities, HF hospitalization rates, and 1-year mortality rates. The HF hospitalization rate adjusted for age, sex, and race declined from 2845 per 100,000 person-years in 1998 to 2007 per 100,000 person-years in 2008 (P < .001), a relative decline of 29.5%. Age-adjusted HF hospitalization rates declined over the study period for all race-sex categories. Black men had the lowest rate of decline (4142 to 3201 per 100,000 person-years) among all race-sex categories, which persisted after adjusting for age (incidence rate ratio, 0.81; 95% CI, 0.79-0.84). Heart failure hospitalization rates declined significantly faster than the national mean in 16 states and significantly slower in 3 states. Risk-adjusted 1-year mortality decreased from 31.7% in 1999 to 29.6% in 2008 (P < .001), a relative decline of 6.6%. One-year mortality rates declined significantly in 4 states but increased in 5 states. The overall HF hospitalization rate declined substantially from 1998 to 2008 but at a lower rate for black men. The overall 1-year mortality rate declined slightly over the past decade but remains high. Changes in HF hospitalization and 1-year mortality rates were uneven across states.
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              Community surveillance of coronary heart disease in the Atherosclerosis Risk in Communities (ARIC) Study: methods and initial two years' experience.

              Alice D. White, Aaron Folsom, Lloyd E. Chambless … (1996)
              The community surveillance component of the Atherosclerosis Risk in Communities (ARIC) Study is designed to estimate patterns and trends of coronary heart disease (CHD) incidence, case fatality, and mortality in four U.S. communities. Community surveillance involves ongoing review of death certificates and hospital discharge records to identify CHD events in community residents aged 35-74 years. Interviews with next of kin and questionnaires completed by physicians and medical examiners or coroners were used to collect information on deaths, and review and abstraction of hospital records were used to collect information on possible fatal and nonfatal myocardial infarctions (MIs). Events were classified using standardized criteria. The initial 2-years' experience with case ascertainment and availability of information needed for classification of events is described. Average annual age-adjusted attack rates of definite MI and CHD mortality rates for blacks in two communities and whites in the four communities are presented and compared with rates based on unvalidated hospital discharge data and vital statistics. Age-adjusted rates based on ARIC classification of definite MI were lower than those based on hospital discharge diagnosis code 410 (e.g., 5.60/1000 and 11.50/1000 among Forsyth County white men, respectively). Age-adjusted rates of definite fatal CHD based on ARIC classification were similarly lower than rates based on underlying cause of death code 410; for example, Jackson black men had rates of 2.82/1000 and 4.52/1000 for definite fatal CHD and UCOD 410-414 or 429.2, respectively.
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                Author and article information

                Journal
                Title: Circulation
                Abbreviated Title: Circulation
                Publisher: Ovid Technologies (Wolters Kluwer Health)
                ISSN (Print): 0009-7322
                ISSN (Electronic): 1524-4539
                Publication date Created: July 03 2018
                Publication date (Print): July 03 2018
                Volume: 138
                Issue: 1
                Pages: 12-24
                Affiliations
                [1 ]Departments of Medicine (P.P.C., J.S.R.)
                [2 ]Duke Clinical Research Institute, Duke University, Durham, NC (L.M.W.)
                [3 ]Department of Epidemiology and Biostatistics, University of Arizona, Tucson (E.S.)
                [4 ]Epidemiology (L.R.L., W.D.R.), University of North Carolina, Chapel Hill
                [5 ]Department of Medicine, Johns Hopkins University, Baltimore, MD (S.D.R.)
                [6 ]Department of Medicine, Mount Sinai Health Systems, New York (S.K.A.)
                [7 ]Department of Medicine, University of Minnesota, Minneapolis (S.H.K.)
                [8 ]Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC (C.J.R.).
                Article
                DOI: 10.1161/CIRCULATIONAHA.117.027551
                PMC ID: 6030442
                PubMed ID: 29519849
                SO-VID: 987bc6f2-3e58-4dd9-bbe4-0b7f7274648e
                Copyright © © 2018
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