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Trends in Heart Failure Incidence and Survival in a Community-Based Population
Véronique L. Roger, MD, MPH;
Susan A. Weston, MS;
Margaret M. Redfield, MD;
Jens P. Hellermann-Homan, MD;
Jill Killian, BS;
Barbara P. Yawn, MD, MSc;
Steven J. Jacobsen, MD, PhD
JAMA. 2004;292:344-350.
ABSTRACT
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Context 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.
Objective 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.
Design, Setting, and Participants 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
Main Outcome Measures Incidence of heart failure and survival after heart failure diagnosis.
Results 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.
Conclusion 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.
INTRODUCTION
The burden of heart failure and its societal cost are staggering. Approximately 4.9 million Americans have been diagnosed with the disease.1 Hospital discharges for heart failure increased by 155% during the last 20 years, and heart failure is the most frequent cause of hospitalization in persons aged 65 years or older. Within this context, heart failure constitutes a public health problem1 singled out as an emerging epidemic.2 Although the clinical and public health importance of heart failure is undisputed, this epidemic is not adequately understood. Data on the incidence of heart failure are relatively sparse and lack consistency. Most data are derived from hospital discharge records or self-report and thus do not reflect incidence, have uncertain validity caused by documented shifts in coding practices because of reimbursement incentives,3 and cannot fully capture the burden of the disease because of the shift of care toward outpatient settings. Thus, little is known about temporal trends in the incidence of heart failure and on survival after its onset.
In the Framingham Heart Study, the incidence of heart failure between 1950 and 1999 changed little among men but declined in women, whereas survival improved in both sexes.4 These findings require replication in other settings because the design of the Framingham Heart Study, as acknowledged by the authors, may impose a "healthy participant" effect.5 Furthermore, although using consistent research standards is necessary, such as the Framingham criteria to assess secular trends, it is important to examine their relationship to clinical diagnoses.
This study was designed to estimate the secular trends in the incidence of heart failure and in survival after its onset in a geographically defined community by using 2 sets of criteria: the Framingham criteria and clinical criteria. We hypothesized that, over time, the incidence of heart failure increased and that survival after its onset improved but that the trends in incidence and survival differed by age and sex.
METHODS
The Heart Failure Incidence Cohort
The study was conducted among the population of Olmsted County, Minnesota, the characteristics of which are similar to those of US non-Hispanic whites. The Mayo Clinic and Olmsted Medical Center provide the majority of medical care for this population. Both organizations use a unit medical record system in which information is collected by health care clinicians in a single record, regardless of site of care. These records are easily retrievable because the Mayo Clinic has maintained extensive indices of diagnoses and procedures, which were extended through the Rochester Epidemiology Project to the records of other clinicians to county residents, resulting in the linkage of all medical records from all sources of care through a centralized system.6-7
All persons with a first diagnosis of heart failure were identified with codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), similar to those used in other studies.8 These codes included 428 (heart failure), 402.01 (hypertensive heart disease malignant with congestive heart failure), 402.11 (hypertensive heart disease benign with congestive heart failure), 425 (cardiomyopathy), 429.3 (cardiomegaly), and 514 (pulmonary congestion). Codes 402.91 (hypertensive heart disease unspecified with congestive heart failure), 404.01 (malignant hypertensive heart and renal disease with heart failure), 404.11 (benign hypertensive heart and renal disease with congestive heart failure), and 404.91 (unspecified hypertensive heart and renal disease with congestive heart failure) were queried but not used as part of the coding practices during the study.
The codes, which are not based on hospital billing codes, were assigned by coders primarily according to physician diagnoses for outpatient visits and on discharge diagnoses for hospitalizations. Samples of each code were reviewed to determine their respective yield toward validated heart failure. Because of the predominant use of code 428 and its frequent association with other codes, other codes were reviewed only if not associated with code 428. Nonresidency in Olmsted County was an exclusion criterion. The yield of each code toward a validated diagnosis of heart failure was examined in aggregate, as well as according to time, age, and sex by using logistic regression. The resulting model was used to construct the validated heart failure incidence cohort, with 2 sets of criteria.
The Framingham criteria,9 which have been used consistently in various settings and can provide qualitative comparisons with results from other studies, were used as 1 standard (Box). A second criterion, defined by a physician's diagnosis of heart failure, was used to assess these trends in clinical practice. Three experienced abstractors reviewed the records, masked to the study hypothesis. Clinical characteristics, including comorbidity defined by the Charlson index,10 were collected in a stratified random sample of 11% of code 428 and 8% of each of codes 425, 429.3, and 514. Overt coronary disease was defined as history of myocardial infarction, angiographic coronary disease, or coronary artery bypass graft surgery. Myocardial infarction was defined by epidemiologic criteria.11-12 Angiographic coronary disease was defined as stenosis greater than 75% of the left anterior descending, left circumflex, or right coronary artery or 50% of the left main coronary artery.13 Clinical diagnoses of valvular diseases as documented by attending physician were also recorded.
| Box. Framingham Criteria for Heart Failure9
Major Criteria
Paroxysmal nocturnal dyspnea or orthopnea
Neck vein distension
Rales
Cardiomegaly
Acute pulmonary edema
S3 gallop
Increased venous pressure  16 cm H2O
Circulation time 25 seconds
Hepatojugular reflux
Minor Criteria
Ankle edema
Night cough
Dyspnea on exertion
Hepatomegaly
Pleural effusion
Vital capacity decreased one third from maximum
Tachycardia rate 120/min
Major or Minor Criterion
Weight loss 4.5 kg in 5 days in response to treatment
Heart failure present with 2 major or 1 major criterion plus 2 minor criteria
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The feasibility of applying the Framingham criteria was assessed by determining the frequency with which the required components were characterized in the medical record. Missing values were rare, and the Framingham criteria could be applied in 98% of cases. The records of 30 patients were reabstracted to examine interabstractor variability and assess the reliability of ascertainment of heart failure. There was 100% interabstractor agreement for both classifications, indicating that these ascertainment methods are highly reproducible.
Ascertainment of Death
Follow-up was performed through 2003 by using the inpatient and outpatient medical records. The ascertainment of death includes several procedures. In addition to the deaths noted during clinical care, all death certificates for Olmsted County residents are obtained every year from the county office. The Mayo Clinic registration office records the obituaries and notices of deaths in the local newspapers. Finally, data on all Minnesota deaths are obtained from the State of Minnesota every year. The county population is overall stable, and health status has little influence on migration.14
Statistical Analyses
Characteristics of patients with validated heart failure are presented as frequencies or mean values with SDs. Differences between men and women were tested with  2 tests for categorical variables and t tests for continuous variables.
Age-, sex-, and year-specific incidence rates of validated heart failure were calculated. The counts of validated heart failure were used as the numerators, and the denominators were the Olmsted County population, as determined by census data for 1970, 1980, 1990, and 2000, with linear interpolation for the intracensus years.15 The rates were adjusted directly to the age distribution of the 2000 US total population. Standard errors and 95% confidence intervals (CIs) around the point estimates were calculated assuming a Poisson error distribution.
A Poisson regression model (SAS GENMOD procedure, version 8; SAS Institute, Inc, Cary, NC) was used to examine the temporal trends in the incidence of validated heart failure, with categorical year variables and adjustment for age. Results are summarized by presenting the relative risk (RR) of validated heart failure for men and women in each year group, using 1979 to 1984 as the referent.
Proportional hazards modeling was used to examine the association between year of heart failure diagnosis and survival while adjusting for age. Results are summarized by presenting the RR of validated heart failure in the various year groups compared with the 1979 to 1984 period for men and women at different ages. Sex-specific 30-day, 1-year, and 5-year mortality rates were estimated from the proportional hazards regression models and are presented for patients 75 years of age.
All analyses were stratified by sex. In the modeling, year was modeled categorically, and a nonlinear effect of age was assessed by testing the quadratic term. Comparison of time trends across age groups was accomplished by including interaction terms between year groups and age. P = .05 was selected for the threshold of statistical significance, except when an interaction was tested for, when P = .10 was used. All analyses were replicated in 1000 random samples to ensure that results were robust.
RESULTS
Between 1979 and 2000, 7298 cases of first diagnosis of heart failure identified by code 428 and 1877 cases of first diagnosis of heart failure identified by other codes in isolation without a code 428 occurred. Code 428 constituted the majority (80%) of heart failure codes. This proportion increased over time (77% in 1979-1984 vs 83% in 1996-2000; P for trend <.001).
Eighty-two percent of the cases coded as 428 met Framingham criteria for heart failure, whereas cases with other codes used in isolation without a code 428 met Framingham criteria in 14% to 30% of the cases. The proportion of code 428 cases meeting Framingham criteria did not change over time: 80% in 1979-1984 vs 79% in 1996-2000 (P for trend = .69). The validation rate for each of the target codes adjusted for age, sex, and time were combined with residency status in Olmsted County and incident nature of the event, allowing an incidence cohort of 4537 cases of validated heart failure to be assembled. Among these, 57% were women. The mean (SD) age at the diagnosis of heart failure was 74 (14) years, and 58% were aged 75 years or older.
Incidence of Heart Failure
According to the Framingham criteria, the age-adjusted incidence of heart failure was higher among men (378/100 000 persons; 95% CI, 361 to 395) than women (289/100 000 persons; 95% CI, 277 to 300) (P<.001). The incidence of heart failure did not change over time (Table 1). When analyzed with year as a continuous variable, the estimated annual percent increase was 0.15% (95% CI, –0.55 to 0.85) or 3% (95% CI, –11 to 20) for 1979 to 2000 for men and 0.37% (95% CI, –0.25 to 0.98) annually or 8% (95% CI, –5 to 23) for 1979 to 2000 for women.
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Table 1. Temporal Trends in the Age-Adjusted Incidence of Heart Failure
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Patients with validated heart failure diagnosis were elderly, particularly women who were also less likely to be overweight but more likely to be hypertensive than men (Table 2). Men were more likely to be current or past smokers. Forty-two percent of the cases were diagnosed in the outpatient setting. Among these cases, 74% were hospitalized within 1.7 (3.1) years of the diagnosis, whereas 26% were never hospitalized.
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Table 2. Characteristics of Validated Cases of Heart Failure Stratified by Sex*
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The use of angiotensin-converting enzyme inhibitors and  -blockers at diagnosis increased significantly between the first and last time period, from 0% to 51% for angiotensin-converting enzyme inhibitors and from 10% to 30% for -blockers (both P for trend <.001).
Survival After Heart Failure Diagnosis
After a follow-up of 4.2 years (range, 0-23.8 years), 3347 deaths occurred, 1930 among women, 1417 among men, 1127 among patients younger than 75 years, and 2220 among patients aged 75 years or older. Mortality rates after the onset of heart failure, adjusted for age, was higher among men, irrespective of the period (RR for men vs women, 1.33; 95% CI, 1.24-1.43, P<.001) (Table 3).
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Table 3. Mortality Estimates After Onset of Heart Failure Among Men and Women Aged 75 Years*
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Mortality declined over time, with an overall improvement from 57% in 1979 to 1984 to 48% in 1996 to 2000 for the age-adjusted 5-year mortality estimates (P<.01) (Figure 1). However, there were age and sex differences in the degree of improvement in survival (P<.001 for year-by-age interaction and year-by-sex interaction) (Table 4). Men in their 60s experienced a 52% improvement in survival between the first and the last period. Survival also improved, although to a lesser degree, among older men. Among women, survival improved in younger ages but to a lesser extent than it did among men and did not change in older age groups.
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Figure. Temporal Trends in 5-Year Mortality After the Diagnosis of Heart Failure by Sex
The curves represent the survival for 75-year-olds, the mean age of this cohort.
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Table 4. Relative Risk for Death After Onset of Heart Failure Defined by the Framingham Criteria
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Framingham Heart Failure vs Clinical Heart Failure
All analyses were repeated with the clinical diagnosis. The yield of code 428 toward clinical heart failure was 90%, whereas that of other codes used in isolation without a code 428 ranged from 14% to 36%. According to the clinical diagnosis, 4962 cases of heart failure were identified, representing a 14% increment over those identified by the Framingham criteria. This increment was constant over time (P for trend = .80). The age and sex distributions of the clinical cases were similar. Compared with patients who met Framingham criteria, those who did not were more likely to be overweight or obese and to have had a previous myocardial infarction and were less likely to be hospitalized at diagnosis (P<.05 for all comparisons). Although the incidence of clinical heart failure was higher than that defined by the Framingham criteria, survival was similar. The secular trends in incidence and survival were similar, irrespective of the criteria used.
Analyses replicated in 1000 samples yielded similar results.
COMMENT
In this large geographically defined community, the incidence of heart failure has remained stable during the past 2 decades in men and women. The incidence of heart failure is higher among men, and survival after its onset is worse among men. Although survival after the onset of heart failure improved over time, there were disparities in the magnitude of the improvement, which was greater among men and younger individuals.
The clinical diagnostic criteria identified slightly more cases of heart failure than the Framingham criteria, but the secular trends were similar, irrespective of the criteria, attesting to their robustness.
Information on the incidence of heart failure and how it may have changed over time is limited. Studies of hospital discharges are event based, not person based, with multiple hospitalizations for the same individuals counted so that incidence cannot be measured. Furthermore, standardized diagnostic criteria are seldom used, and case ascertainment is affected by shifts in hospital discharge diagnoses preferences.3, 16-17 Patients diagnosed and treated for heart failure in the outpatient setting constitute an increasingly important component of the cases but are seldom included. Given these limitations, it should not be unexpected that published data on the incidence of heart failure lack consistency. For instance, using Medicare hospital claims in 1986 and 1993, Croft et al18 reported an increase in the initial hospitalization for heart failure. Conversely, Stewart et al19-20 suggested that trends in hospitalization in Scotland in the 1990s had "leveled off."
Although these data are limited by the lack of validation and restriction to inpatient data, they prompt the question of whether the stabilization of heart failure hospitalization rates could be offset by increasing outpatient care patterns. Few studies included outpatient data.21-24 The present study underscores the importance of doing so because 42% of the cases were diagnosed as outpatients, and among these, 26% were never hospitalized and thus would not have been identified by using hospital-based surveillance. Data from the Henry Ford Health system, a managed care organization,23 indicated that the prevalence of heart failure was increasing over time but did not report a secular change in the incidence of heart failure or mortality after its onset. In addition, the Framingham Heart Study recently reported a decline in the incidence of heart failure in women but not among men and an improvement in survival in both sexes.24 As acknowledged by the authors, these data could be affected by the healthy participant effect.5
The absolute magnitude of the incidence of heart failure cannot be compared qualitatively between the 2 studies because of different age-adjustment strategies. However, the use of identical criteria and the inclusion of outpatient cases in both studies facilitate the qualitative comparison of trends. The Framingham Heart Study reported no change in the incidence of heart failure among men but found a decline in women, primarily in the earlier periods. Conversely, our study did not detect a change in either sex. Our sample size, larger than that of the Framingham Heart Study, provided power to detect a change (either increase or decrease) in the incidence of heart failure of 0.8% per year, or 18% during the 22 years of the study. Thus, although we cannot exclude smaller changes, the size of our cohort was adequate to detect changes of clinical and public health significance.
Our study supports and extends the concept brought forth by Framingham investigators that the heart failure epidemic is not related to an increase in incidence but also challenges the notion that further progress is being made in preventing heart failure in the community. Because heart failure is a disease of the elderly, the stagnation of incidence rates among an aging and growing population will increase the number of cases of heart failure and its public health burden.
Estimates of the prevalence of coronary disease in studies of heart failure vary from 68% among clinical trial enrollees25 to 36% in a population-based study, relying on physician adjudication.26 Our study reports a prevalence of coronary disease of 28% by using rigorous criteria for overt disease that are conceivably conservative. However, determining the etiology of heart failure is complex, particularly in the community, given the nonuniform use of coronary angiography and that several of the putative etiologies of heart failure, such as hypertension, diabetes, and coronary disease, may coexist. Thus, their respective responsibility in the genesis of heart failure may be difficult to establish.
Several studies have reported on improved inhospital mortality of heart failure.27-28 However, these studies are fraught with biases related to lack of consistent criteria over time and the ensuing differences in case mix; decreasing length of hospital stay, which in turn confound trends in outcomes; and lack of inclusion of outpatient cases. These factors limit generalizability of these data to a large number of persons with heart failure.
Among studies including outpatient cases, previous data from Olmsted County reported no temporal trends in heart failure survival but were powered to detect only large trends.22 The Framingham Heart Study4 reported improvement in the survival of heart failure in both sexes. Because this improvement applies to a closed cohort, it is unclear how much of this change reflects survivor bias vs true improvement in outcome.30
The present results from a larger community-based population indicated a substantial improvement in survival after heart failure in younger men, contrasting with less improvement in women and the elderly.
The hypothetical explanations for these trends are likely multifactorial. Treatment effectiveness may play a role. Trials that demonstrated the efficacy of angiotensin-converting enzyme inhibitors were published in the late 1980s.31 The ensuing clinical practice changes could have participated in the improved survival after the onset of heart failure noted in most recent years. Our observed increase in use of angiotensin-converting enzyme inhibitors at heart failure diagnosis would support this construct.
The improvement in heart failure survival could also be related to earlier diagnosis as the use of cardiac diagnostic procedures increases over time, resulting in lead-time bias.30 While this factor may play a role, it could not by itself explain contrasting sex-specific trends in survival. The mechanism of heart failure may differ by sex and could affect outcomes. A greater proportion of women with heart failure also have hypertension, suggesting that diastolic heart failure may play a greater role in women, which in turn may explain why less improvement in outcome was noted among women because there is no effective therapy for diastolic heart failure. Irrespective of these hypothetical explanations, these differences in improvement in survival according to age and sex call for additional studies to identify the reasons for these disparities.
Potential limitations of the study include the racial and ethnic composition of Olmsted County, which limits the generalizibility of these data to groups underrepresented in the population. Although no single community can completely represent the nation as a whole, studies of chronic diseases in Olmsted County indicate that results from the county can be extrapolated to a large part of the population, and the characteristics of the Olmsted County population are similar to those of US whites, with the exception of slightly higher income and education.6 This study should, however, be replicated in other racial and ethnic groups.
Medication use in heart failure in Olmsted County has been reported32-33 to be similar to that in other settings. Providing detailed information on medications used in this cohort is beyond the scope of this article; however, we observed an increase over time in the use of -blockers and angiotensin-converting enzyme inhibitors at diagnosis. -Blockers were not recognized as improving survival in heart failure until the late 1990s, so the period covered by the cohort largely precedes this evidence. Furthermore, to gain relevant insight into the use of medications, data on the introduction or withdrawal of drugs during follow-up would be needed but are unavailable for this cohort. Finally, because this is an observational study, adjustment for medication use would not indicate causality.
Our study, conducted in a community-based population, has several important strengths. We used 2 sets of criteria to classify heart failure, adding clinical ascertainment to the Framingham criteria and thereby providing a robust connection with clinical practice. Second, we include outpatient data. Third, the size of our cohort confers additional power to detect effect modification and thus identify disparities such as the ones presented here. Finally, our study reports on the experience of an open cohort and thus reflects the experience of a community without the survivor bias that might affect results in a closed cohort.30
CONCLUSION
This community-based cohort study demonstrates no substantial reduction in the incidence of heart failure during more than 2 decades. Moreover, women and the elderly experienced less improvement in survival after the onset of heart failure, suggesting that the apparent gains in secondary prevention have not been achieved equally. These findings highlight the increasing population burden of heart failure mediated by stagnating incidence and unequal improvement in survival within the context of an aging and growing population.
AUTHOR INFORMATION
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Corresponding Author: Véronique L. Roger, MD, MPH, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55095 (roger.veronique{at}mayo.edu).
Author Contributions: Dr Roger had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Roger, Weston, Jacobsen.
Acquisition of data: Roger, Weston, Hellermann, Killian, Jacobsen.
Analysis and interpretation of data: Roger, Weston, Redfield, Killian, Yawn,
Drafting of the manuscript: Roger, Killian, Jacobsen.
Critical revision of the manuscript for important intellectual content: Roger, Weston, Redfield, Hellermann, Yawn, Jacobsen.
Statistical analysis: Roger, Weston, Killian, Jacobsen.
Obtained funding: Roger, Jacobsen.
Administrative, technical, or material support: Roger, Jacobsen.
Study supervision: Roger, Hellermann.
Funding/Support: This study was supported by grants from the US Public Health Service and the National Institutes of Health (RO1 AR30582 and RO1 HL 72435). Dr Roger is an Established Investigator of the American Heart Association.
Role of the Sponsors: The funding sources for this study played no role in the design or conduct of the study; data management and analysis; or manuscript preparation, review, and authorization for submission.
Acknowledgment: We thank the following individuals for their outstanding support with data collection, data entry and analysis, and manuscript preparation: Kay A. Traverse, RN; Susan Stotz, RN; Diane M. Tri, RN; Ryan A. Meverden, BS; and Kristie K. Shorter.
Author Affiliations: Division of Cardiovascular Diseases and Internal Medicine (Drs Roger, Redfield, and Hellermann-Homan), Department of Health Sciences Research (Drs Roger and Jacobsen and Mss Weston and Killian), Mayo Clinic and Foundation, Rochester, Minn; and Department of Research, Olmsted Medical Center, Rochester, Minn (Dr Yawn).
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ABSTRACT
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Rationale and design of Ferinject(R) Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia
Anker et al.
Eur J Heart Fail 2009;11:1084-1091.
ABSTRACT
| FULL TEXT
Heart failure burden and therapy
Zannad et al.
Europace 2009;11:v1-v9.
ABSTRACT
| FULL TEXT
Hospitalizations after heart failure diagnosis a community perspective.
Dunlay et al.
J Am Coll Cardiol 2009;54:1695-1702.
ABSTRACT
| FULL TEXT
Gender differences in survival in patients with severe left ventricular dysfunction despite similar extent of myocardial scar measured on cardiac magnetic resonance
Kwon et al.
Eur J Heart Fail 2009;11:937-944.
ABSTRACT
| FULL TEXT
State of the Science: Promoting Self-Care in Persons With Heart Failure: A Scientific Statement From the American Heart Association
Riegel et al.
Circulation 2009;120:1141-1163.
FULL TEXT
Prognostic Value of Biomarkers in Heart Failure: Application of Novel Methods in the Community
Dunlay et al.
Circ Heart Fail 2009;2:393-400.
ABSTRACT
| FULL TEXT
Impact of Restrictive Prescription Plans on Heart Failure Medication Use
Thanassoulis et al.
Circ Cardiovasc Qual Outcomes 2009;2:484-490.
ABSTRACT
| FULL TEXT
Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis
Kane et al.
Nephrol Dial Transplant 2009;0:gfp393v1-gfp393.
ABSTRACT
| FULL TEXT
Heart failure in women: a need for prospective data.
Hsich and Pina
J Am Coll Cardiol 2009;54:491-498.
ABSTRACT
| FULL TEXT
What is the strength of evidence for heart failure disease-management programs?
Clark et al.
J Am Coll Cardiol 2009;54:397-401.
ABSTRACT
| FULL TEXT
Relation Between Modifiable Lifestyle Factors and Lifetime Risk of Heart Failure
Djousse et al.
JAMA 2009;302:394-400.
ABSTRACT
| FULL TEXT
Elevated glycated haemoglobin is a strong predictor of mortality in patients with left ventricular systolic dysfunction who are not receiving treatment for diabetes mellitus
Goode et al.
Heart 2009;95:917-923.
ABSTRACT
| FULL TEXT
Consistency With the DASH Diet and Incidence of Heart Failure
Levitan et al.
Arch Intern Med 2009;169:851-857.
ABSTRACT
| FULL TEXT
A genetic variant on chromosome 9p21 and incident heart failure in the ARIC study
Yamagishi et al.
Eur Heart J 2009;30:1222-1228.
ABSTRACT
| FULL TEXT
Understanding the 'epidemic of heart failure': a systematic review of trends in determinants of heart failure
Najafi et al.
Eur J Heart Fail 2009;11:472-479.
ABSTRACT
| FULL TEXT
Epidemiology of Incident Heart Failure in a Contemporary Elderly Cohort: The Health, Aging, and Body Composition Study
Kalogeropoulos et al.
Arch Intern Med 2009;169:708-715.
ABSTRACT
| FULL TEXT
Racial Differences in Incident Heart Failure among Young Adults
Bibbins-Domingo et al.
NEJM 2009;360:1179-1190.
ABSTRACT
| FULL TEXT
Resistin, Adiponectin, and Risk of Heart Failure: The Framingham Offspring Study
Frankel et al.
J Am Coll Cardiol 2009;53:754-762.
ABSTRACT
| FULL TEXT
Long-Term Trends in First Hospitalization for Heart Failure and Subsequent Survival Between 1986 and 2003: A Population Study of 5.1 Million People
Jhund et al.
Circulation 2009;119:515-523.
ABSTRACT
| FULL TEXT
BNP-Guided vs Symptom-Guided Heart Failure Therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) Randomized Trial
Pfisterer et al.
JAMA 2009;301:383-392.
ABSTRACT
| FULL TEXT
Utility of the Seattle heart failure model in patients with advanced heart failure.
Kalogeropoulos et al.
J Am Coll Cardiol 2009;53:334-342.
ABSTRACT
| FULL TEXT
Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS et al.
Circulation 2009;119:e21-e181.
FULL TEXT
Absolute and Attributable Risks of Heart Failure Incidence in Relation to Optimal Risk Factors
Folsom et al.
Circ Heart Fail 2009;2:11-17.
ABSTRACT
| FULL TEXT
Association of Multiple Anthropometrics of Overweight and Obesity With Incident Heart Failure: The Atherosclerosis Risk in Communities Study
Loehr et al.
Circ Heart Fail 2009;2:18-24.
ABSTRACT
| FULL TEXT
Is a higher blood pressure better in heart failure?
Thohan and Little
Heart 2009;95:4-5.
FULL TEXT
CHAPTER 23 Heart Failure
McMurray et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT
| FULL TEXT
Hospital-wide Code Rates and Mortality Before and After Implementation of a Rapid Response Team
Chan et al.
JAMA 2008;300:2506-2513.
ABSTRACT
| FULL TEXT
Successful treatment of heart failure with devices requires collaboration
Swedberg et al.
Eur J Heart Fail 2008;10:1229-1235.
ABSTRACT
| FULL TEXT
Heart Failure After Acute Myocardial Infarction: A Lost Battle in the War on Heart Failure?
Jhund and McMurray
Circulation 2008;118:2019-2021.
FULL TEXT
Cardiac Resynchronization in Patients With Atrial Fibrillation: A Meta-Analysis of Prospective Cohort Studies
Upadhyay et al.
J Am Coll Cardiol 2008;52:1239-1246.
ABSTRACT
| FULL TEXT
Coronary Artery Bypass Grafting With or Without Surgical Ventricular Restoration: A Comparison
Prucz et al.
Ann. Thorac. Surg. 2008;86:806-814.
ABSTRACT
| FULL TEXT
Late-onset heart failure after myocardial infarction: Trends in incidence and survival
Najafi et al.
Eur J Heart Fail 2008;10:765-771.
ABSTRACT
| FULL TEXT
Death in Heart Failure: A Community Perspective
Henkel et al.
Circ Heart Fail 2008;1:91-97.
ABSTRACT
| FULL TEXT
Incident Heart Failure Prediction in the Elderly: The Health ABC Heart Failure Score
Butler et al.
Circ Heart Fail 2008;1:125-133.
ABSTRACT
| FULL TEXT
Natural History of Asymptomatic Patients With Normally Functioning or Minimally Dysfunctional Bicuspid Aortic Valve in the Community
Michelena et al.
Circulation 2008;117:2776-2784.
ABSTRACT
| FULL TEXT
Effect of Short Call Admission on Length of Stay and Quality of Care for Acute Decompensated Heart Failure
Schuberth et al.
Circulation 2008;117:2637-2644.
ABSTRACT
| FULL TEXT
Prevention of Heart Failure: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group
Schocken et al.
Circulation 2008;117:2544-2565.
ABSTRACT
| FULL TEXT
Haemodynamics and left ventricular function in heart failure patients: Comparison of awake versus intra-operative conditions
ten Brinke et al.
Eur J Heart Fail 2008;10:467-474.
ABSTRACT
| FULL TEXT
Do we understand why the heart fails?
Brunner-La Rocca
Eur Heart J 2008;29:698-700.
FULL TEXT
Incidence and Prevalence of Heart Failure in Elderly Persons, 1994-2003
Curtis et al.
Arch Intern Med 2008;168:418-424.
ABSTRACT
| FULL TEXT
Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Writing Group Members et al.
Circulation 2008;117:e25-e146.
FULL TEXT
Impact of Septal Myocardial Infarction on Outcomes After Surgical Ventricular Restoration
Patel et al.
Ann. Thorac. Surg. 2008;85:135-146.
ABSTRACT
| FULL TEXT
Sodium Bicarbonate is Associated with an Increased Incidence of Contrast Nephropathy: A Retrospective Cohort Study of 7977 Patients at Mayo Clinic
From et al.
CJASN 2008;3:10-18.
ABSTRACT
| FULL TEXT
Risk Stratification for Heart Failure and Death in an Acute Coronary Syndrome Population Using Inflammatory Cytokines and N-Terminal Pro-Brain Natriuretic Peptide
Kavsak et al.
Clin. Chem. 2007;53:2112-2118.
ABSTRACT
| FULL TEXT
A Population-Based Study of the Incidence and Complication Rates of Herpes Zoster Before Zoster Vaccine Introduction
Yawn et al.
Mayo Clin Proc. 2007;82:1341-1349.
ABSTRACT
| FULL TEXT
Sex and Racial Differences in the Use of Implantable Cardioverter-Defibrillators Among Patients Hospitalized With Heart Failure
Hernandez et al.
JAMA 2007;298:1525-1532.
ABSTRACT
| FULL TEXT
Congestive Heart Failure in Older Women Treated With Adjuvant Anthracycline Chemotherapy for Breast Cancer
Pinder et al.
JCO 2007;25:3808-3815.
ABSTRACT
| FULL TEXT
Temporal trends in the frequency and longer-term outcome of heart failure complicating myocardial infarction
Najafi et al.
Eur J Heart Fail 2007;9:879-885.
ABSTRACT
| FULL TEXT
Clinical epidemiology of heart failure
Mosterd and Hoes
Heart 2007;93:1137-1146.
FULL TEXT
Improving end-of-life care for patients with chronic heart failure: "Let's hope it'll get better, when I know in my heart of hearts it won't"
Selman et al.
Heart 2007;93:963-967.
ABSTRACT
| FULL TEXT
Modelling services to meet the palliative care needs of chronic heart failure patients and their families: current practice in the UK
Selman et al.
Palliat Med 2007;21:385-390.
ABSTRACT
Cell-Based GATA4 Cardiac Gene Transfer Using Cell-Penetrating Peptide
Tang and Hammond
Circ. Res. 2007;100:1540-1542.
FULL TEXT
Mode of Death in Patients With Systolic Heart Failure
Patel and Heywood
J CARDIOVASC PHARMACOL THER 2007;12:127-136.
ABSTRACT
Impact of Lateral Wall Myocardial Infarction on Outcomes After Surgical Ventricular Restoration
Patel et al.
Ann. Thorac. Surg. 2007;83:2017-2028.
ABSTRACT
| FULL TEXT
Adult Bone Marrow-Derived Cells for Cardiac Repair: A Systematic Review and Meta-analysis
Abdel-Latif et al.
Arch Intern Med 2007;167:989-997.
ABSTRACT
| FULL TEXT
A comprehensive view of sex-specific issues related to cardiovascular disease
Pilote et al.
CMAJ 2007;176:S1-S44.
ABSTRACT
| FULL TEXT
Long-term Survival After Heart Failure: A Contemporary Population-Based Perspective
Goldberg et al.
Arch Intern Med 2007;167:490-496.
ABSTRACT
| FULL TEXT
Recent changes in heart failure hospitalisations in Australia
Najafi et al.
Eur J Heart Fail 2007;9:228-233.
ABSTRACT
| FULL TEXT
Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Rosamond et al.
Circulation 2007;115:e69-e171.
FULL TEXT
Outcome after redo coronary artery bypass grafting in patients with ischaemic cardiomyopathy and viable myocardium
Rizzello et al.
Heart 2007;93:221-225.
ABSTRACT
| FULL TEXT
Essential Features of a Surveillance System to Support the Prevention and Management of Heart Disease and Stroke: A Scientific Statement From the American Heart Association Councils on Epidemiology and Prevention, Stroke, and Cardiovascular Nursing and the Interdisciplinary Working Groups on Quality of Care and Outcomes Research and Atherosclerotic Peripheral Vascular Disease
Goff et al.
Circulation 2007;115:127-155.
FULL TEXT
Plasma B vitamins and their relation to the severity of chronic heart failure
Herrmann et al.
Am. J. Clin. Nutr. 2007;85:117-123.
ABSTRACT
| FULL TEXT
Systolic and diastolic heart failure in the community.
Bursi et al.
JAMA 2006;296:2209-2216.
ABSTRACT
| FULL TEXT
Effects of cardiac resynchronization therapy on overall mortality and mode of death: a meta-analysis of randomized controlled trials
Rivero-Ayerza et al.
Eur Heart J 2006;27:2682-2688.
ABSTRACT
| FULL TEXT
Statin therapy and risks for death and hospitalization in chronic heart failure.
Go et al.
JAMA 2006;296:2105-2111.
ABSTRACT
| FULL TEXT
Identification of a Common Gene Expression Signature in Dilated Cardiomyopathy Across Independent Microarray Studies
Barth et al.
J Am Coll Cardiol 2006;48:1610-1617.
ABSTRACT
| FULL TEXT
A review of homocysteine and heart failure
Herrmann et al.
Eur J Heart Fail 2006;8:571-576.
ABSTRACT
| FULL TEXT
Long-term Survival in Elderly Patients Hospitalized for Heart Failure: 14-Year Follow-up From a Prospective Randomized Trial.
Huynh et al.
Arch Intern Med 2006;166:1892-1898.
ABSTRACT
| FULL TEXT
Surgical ventricular restoration for advanced congestive heart failure: should pulmonary hypertension be a contraindication?
Patel et al.
Ann. Thorac. Surg. 2006;82:879-888.
ABSTRACT
| FULL TEXT
REMATCH and Beyond: The Cost of Treating Heart Failure Using an Implantable Left Ventricular Assist Device.
Dembitsky
SEMIN CARDIOTHORAC VASC ANESTH 2006;10:253-255.
ABSTRACT
Trends in prevalence and outcome of heart failure with preserved ejection fraction.
Owan et al.
NEJM 2006;355:251-259.
ABSTRACT
| FULL TEXT
Use of Ejection Fraction Tests and Coronary Angiography in Patients With Heart Failure
Kurtz et al.
Mayo Clin Proc. 2006;81:906-913.
ABSTRACT
| FULL TEXT
Role of Diuretics in the Prevention of Heart Failure: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
Davis et al.
Circulation 2006;113:2201-2210.
ABSTRACT
| FULL TEXT
Adiposity of the Heart*, Revisited
McGavock et al.
ANN INTERN MED 2006;144:517-524.
ABSTRACT
| FULL TEXT
Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: a community-based study over two decades
Miyasaka et al.
Eur Heart J 2006;27:936-941.
ABSTRACT
| FULL TEXT
Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Thom et al.
Circulation 2006;113:e85-e151.
FULL TEXT
Changing Incidence and Survival for Heart Failure in a Well-Defined Older Population, 1970-1974 and 1990-1994
Barker et al.
Circulation 2006;113:799-805.
ABSTRACT
| FULL TEXT
Heart Disease and Dementia: A Population-based Study
Bursi et al.
Am J Epidemiol 2006;163:135-141.
ABSTRACT
| FULL TEXT
Aldosterone antagonists in the treatment of heart failure
Marcy and Ripley
Am J Health Syst Pharm 2006;63:49-58.
ABSTRACT
| FULL TEXT
Surgical ventricular remodeling for multiterritory myocardial infarction: Defining a new patient population
Patel et al.
J. Thorac. Cardiovasc. Surg. 2005;130:1698-1706.
ABSTRACT
| FULL TEXT
Quality of Care and Outcomes of Older Patients With Heart Failure Hospitalized in the United States and Canada
Ko et al.
Arch Intern Med 2005;165:2486-2492.
ABSTRACT
| FULL TEXT
The Year in Epidemiology, Health Services, and Outcomes Research
Krumholz
J Am Coll Cardiol 2005;46:1362-1370.
FULL TEXT
Revascularization in Severe Left Ventricular Dysfunction: The Role of Viability Testing
Chareonthaitawee et al.
J Am Coll Cardiol 2005;46:567-574.
ABSTRACT
| FULL TEXT
Stem cells in the dog heart are self-renewing, clonogenic, and multipotent and regenerate infarcted myocardium, improving cardiac function
Linke et al.
Proc. Natl. Acad. Sci. USA 2005;102:8966-8971.
ABSTRACT
| FULL TEXT
Circulating Erythropoietin Levels and Prognosis in Patients With Congestive Heart Failure: Comparison With Neurohormonal and Inflammatory Markers
George et al.
Arch Intern Med 2005;165:1304-1309.
ABSTRACT
| FULL TEXT
Improving the Outcomes of Heart Failure Care: Putting Technology Second
Havranek
J Am Coll Cardiol 2005;45:1665-1666.
FULL TEXT
Epidemiology and management of heart failure and left ventricular systolic dysfunction in the aftermath of a myocardial infarction
Cleland et al.
Heart 2005;91:ii7-ii13.
ABSTRACT
| FULL TEXT
Patients with treatable malignant diseases -- including heart failure -- are entitled to specialist care
Cleland
CMAJ 2005;172:207-209.
FULL TEXT
Narrative Review: Pharmacotherapy for Chronic Heart Failure: Evidence from Recent Clinical Trials
Yan et al.
ANN INTERN MED 2005;142:132-145.
ABSTRACT
| FULL TEXT
Evidently...
Lehman
Evid. Based Med. 2004;9:167-167.
FULL TEXT
Other articles noted
Evid. Based Med. 2004;9:191-192.
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