Trends in survival after a diagnosis of heart failure in the United Kingdom 2000-2017: population based cohort study
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l223 (Published 13 February 2019) Cite this as: BMJ 2019;364:l223Linked Opinion
Heart failure is not the immediate death sentence that the term implies, but we need to do a lot better
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- Clare J Taylor, NIHR academic clinical lecturer1,
- José M Ordóñez-Mena, medical statistician1,
- Andrea K Roalfe, senior researcher in medical statistics1,
- Sarah Lay-Flurrie, senior data scientist1,
- Nicholas R Jones, Wellcome Trust doctoral research fellow1,
- Tom Marshall, professor of public health and primary care2,
- F D Richard Hobbs, professor of primary care1
- 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
- 2Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Correspondence to: C J Taylor clare.taylor{at}phc.ox.ac.uk (or @clarejtaylor on Twitter)
- Accepted 8 January 2019
Abstract
Objectives To report reliable estimates of short term and long term survival rates for people with a diagnosis of heart failure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group.
Design Population based cohort study.
Setting Primary care, United Kingdom.
Participants Primary care data for 55 959 patients aged 45 and overwith a new diagnosis of heart failure and 278 679 age and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data.
Main outcome measures Survival rates at one, five, and 10 years and cause of death for people with and without heart failure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group.
Results Overall, one, five, and 10 year survival rates increased by 6.6% (from 74.2% in 2000 to 80.8% in 2016), 7.2% (from 41.0% in 2000 to 48.2% in 2012), and 6.4% (from 19.8% in 2000 to 26.2% in 2007), respectively. There were 30 906 deaths in the heart failure group over the study period. Heart failure was listed on the death certificate in 13 093 (42.4%) of these patients, and in 2237 (7.2%) it was the primary cause of death. Improvement in survival was greater for patients not requiring admission to hospital around the time of diagnosis (median difference 2.4 years; 5.3 v 2.9 years, P<0.001). There was a deprivation gap in median survival of 0.5 years between people who were least deprived and those who were most deprived (4.6 v 4.1 years, P<0.001).
Conclusions Survival after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer. New strategies to achieve timely diagnosis and treatment initiation in primary care for all socioeconomic groups should be a priority for future research and policy.
Footnotes
Contributors: CJT, FDRH, and TM conceived the study. CJT, AKR, and SL-F wrote the protocol. SL-F extracted the data from the Clinical Practice Research Datalink (CPRD). JMOM carried out the statistical analysis. AKR provided guidance on statistical analysis. NRJ conducted the literature search. TM provided critical input to the analysis plan. All authors contributed to the interpretation of results and revisions of the manuscript. CJT wrote the manuscript and is the guarantor. CJT and FDRH are joint corresponding authors. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: The study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust and the Wellcome Institutional Strategic Fund. The funders did not have any role in the design of the study, analysis and interpretation of the data, or writing of the results for publication. CJT is a NIHR academic clinical lecturer. AKR, SL-F, and JMOM are supported by the NIHR Biomedical Research Centre Oxford (BRC) Oxford University Hospitals NHS Foundation Trust. JMOM is also supported by the NIHR Community Healthcare Medtech and In Vitro Diagnostics Cooperative. NRJ is a Wellcome Trust doctoral research fellow (grant number 203921/Z/16/Z). TM is funded by the CLAHRC West Midlands. FDRH acknowledges support from the NIHR School for Primary Care Research, NIHR CLAHRC Oxford, the NIHR Oxford BRC and Harris Manchester College, Oxford. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: All authors report grants from NIHR CLAHRC Oxford during the conduct of the study; CJT reports speaker fees from Vifor and Novartis and non-financial support from Roche outside the submitted work. JMOM, AKR, and SL-F report grants from the NIHR BRC Oxford. NRJ reports a grant from the Wellcome Trust. TM reports a grant from CLAHRC West Midlands. FDRH reports personal fees and other from Novartis, personal fees and other from Boehringer Ingelheim, and grants from Pfizer outside the submitted work.
Ethical approval: The full study protocol was approved by the independent scientific advisory committee (ISAC) to the Medicine and Healthcare products Regulatory Authority (protocol number 18_061R). Ethical approval for observational research using CPRD with approval from ISAC has been granted by a national research ethics service committee (05/MRE04/87).
Data sharing: This study is based in part on data from CPRD obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data are provided by patients and collected by the NHS as part of their care and support. The Office for National Statistics provided the mortality data. The interpretation and conclusions contained in this study are those of the authors alone. The authors do not own these data and hence are not permitted to share the data in the original form.
The lead author (CJT) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspect of the study has been omitted; and that any discrepancies from the study as planned have been explained.
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