Improving survival in the six months after diagnosis of heart failure in the past decade: Population-based data from the UK

Imperial College, London, UK.
Heart (British Cardiac Society) (Impact Factor: 6.02). 08/2009; 95(22):1851-6. DOI: 10.1136/hrt.2008.156034
Source: PubMed

ABSTRACT To investigate the secular trend in survival after a new diagnosis of heart failure in the UK population.
Comparison of all-cause mortality in the 6 months after diagnosis of heart failure in population-based studies in the south east of England in 2004-5 (Hillingdon-Hastings Study) and 1995-7 (Hillingdon-Bromley Studies).
396 patients in the 2004-5 cohort and 552 patients in the 1995-7 cohort with incident (new) heart failure.
All-cause mortality.
All-cause mortality rates were 6% (95% CI 3% to 8%) at 1 month, 11% (8% to 14%) at 3 months and 14% (11% to 18%) at 6 months in the 2004-5 cohort compared with 16% (13% to 20%), 22% (19% to 25%) and 26% (22% to 29%), respectively, in the 1995-7 cohort (difference between the two cohorts, p<0.001). The difference in survival was not explained by any difference in the demographics or severity of heart failure at presentation. There was a difference at baseline and thereafter in the use of neurohormonal antagonists (beta-blockers and angiotensin-converting enzyme inhibitors).
Although early mortality remains high among patients with newly diagnosed heart failure in the UK general population, there is strong evidence of a marked improvement in survival from 1995-7 to 2004-5, perhaps partly explained by an increased usage of neurohormonal antagonists.

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    • "etal.2012).Inastudyof174patientsnewlydiagnosed withheartfailure,wereportedthatpatients'beliefsinthe curabilityoftheirillnessdecreasedoversixmonths.However,wealsoobservedastatisticallysignificantimprove- mentinqualityoflifeandareductioninanxietyoverthis timeperiod(Mehtaetal.2009,Mulliganetal.2012).We havereportedsimilarresultsinourstudyofpatientswith anexistingdiagnosisofheartfailurewhohadbeenadmittedtohospital(Goodmanetal.2012).Weobservedasta- tisticallysignificantimprovementinphysicalfunctioning oversixmonthsbutnochangeinemotionalfunctioningor theproportionofpeoplewithprobableanxietyordepression.Patients'beliefsthattheirmedicalorpersonaltreat- mentcouldcuretheirheartfailuredecreasedovertime. Itisagainstthisbackgroundthatwedesignedthisstudy toexplorewhetherroutinecontactwithaHFNinfluenced patients'beliefsabouttheirillnessanditstreatment,quality oflifeandmoodoverthecourseofsixmonthsinthese twoobservationalstudies. Methods Weperformedsecondaryanalysisontwoindependentdatasets .TheHillingdonHastingsdatasetrecruitedpatients fromtwolargegeneralhospitals(HillingdonHospitalin WestLondon,UK,andTheConquestHospital,EastSussex ,UK)(Mehtaetal.2009).Allpatientswhoreceiveda first-timediagnosisofheartfailurebetween2004–2005on theirattendanceatanoutpatientclinicorduringhospital admissionwereeligibleforthestudy.Heartfailurewas diagnosedaccordingtocontemporaryEuropeanSocietyof Cardiologycriteria(Remme&Swedberg2001). "
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    ABSTRACT: Aims and Objectives To explore the effect contact with a heart failure nurse can have on patients' illness beliefs, mood and quality of life.Background There is growing interest in patients' illness beliefs and the part they play in a patients understanding of chronic disease.DesignSecondary analysis on two independent datasets. Patients were recruited from five UK hospitals, four in London and one in Sussex. Patients were recruited from an inpatient and outpatient setting. The first dataset recruited 174 patients with newly diagnosed heart failure, whilst the second dataset recruited 88 patients with an existing diagnosis of heart failure.Methods Patients completed the Minnesota Living with Heart Failure Questionnaire, Hospital Anxiety and Depression Scale, Illness Perception Questionnaire and the Treatment Representations Inventory at baseline and six months. We used a linear regression model to assess the association that contact with a heart failure nurse had on mood, illness beliefs and quality of life over a six-month period.ResultsPatients who had contact with a heart failure nurse were more satisfied with their treatment and more likely to believe that their heart failure was treatable. Contact with a heart failure nurse did not make a statistically significant difference to mood or quality of life.Conclusions This study has shown that contact with a heart failure nurse can improve patient satisfaction with treatment decisions but has less influence on a patient's beliefs about their personal control, treatment control and treatment concerns. With appropriate support, skills and training, heart failure nurses could play an important role in addressing individual patient's beliefs. There is a need to further investigate this.Relevance to clinical practiceExploring patients’ illness beliefs and mood could help to enhance person-centred care. Heart failure nurses would need additional training in the techniques used.
    Journal of Clinical Nursing 06/2014; 24(1-2). DOI:10.1111/jocn.12616 · 1.23 Impact Factor
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    • "The prognosis for heart failure is poor . The Hillingdon Heart Study ( Cowie et al , 1999 ) found that 40% of people died within the first year following diagnosis although there is evidence of an improving picture with six month mortality falling from 26% in 1995 to 14% in 2005 ( Mehta et al , 2009 ) . Mortality is less than 10% per year , thereafter ( Hobbs et al , 2007 ) . "
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    ABSTRACT: Adverse left ventricular (LV) remodelling after myocardial infarction (MI) frequently leads to congestive heart failure (CHF). We have previously shown that myocardial beta-adrenoceptor density (beta-ARD) is reduced soon after acute MI and correlates with LV dilatation in the short term. The aim of the present study was to determine whether myocardial beta-ARD measured early after MI was associated with progression to CHF in the long term. We prospectively included 61 consecutive patients (mean age, 52 +/- 11 years, 10 female) in whom MI was the first manifestation of coronary artery disease. Two to 4 weeks after MI, patients underwent positron emission tomography with S-[(11)C]CGP 12177 to measure beta-ARD and (15)O-labelled water to measure myocardial blood flow and coronary flow reserve. Patients were followed-up for a median of 12.7 years (interquartile range, 6.5-13.7 years) and incidence of CHF was recorded. Eleven patients (18%) developed CHF during follow-up. They had lower beta-ARD compared with those who did not (5.35 vs. 6.49 pmol/g, P < 0.001). In patients with myocardial beta-ARD < or =5.57 pmol/g, 10-year CHF incidence rates were higher than in patients with beta-ARD >5.57 pmol/g (57% vs. 9%, P < 0.001). In a Cox regression model, only whole-heart beta-ARD [hazard ratio (HR) 0.29; 95% confidence interval (CI), 0.15-0.58, P < 0.001] and beta-ARD in remote myocardium (HR 0.32; 95% CI, 0.16-0.61, P = 0.001) were significantly associated with the incidence of CHF at follow-up. Reduced myocardial beta-ARD early after MI is associated with the incidence of CHF on long-term follow-up.
    European Heart Journal 07/2010; 31(14):1722-9. DOI:10.1093/eurheartj/ehq138 · 14.72 Impact Factor
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