Improving survival in the 6 months after diagnosis of heart failure in the past decade: Population-based data from the UK
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 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.
Available from: Rebecca Lucas
- "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.
Available from: Derrick A Bennett
- "The increasing prevalence of heart failure is a recognized major public health issue in most high-income countries
[1,2]. For instance, in the UK, about 1% of the population suffers from chronic heart failure but the prevalence increases rapidly with age, affecting about 7% of the population aged 75 years or more
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Setting priorities for the prevention and management of heart failure requires an empirical understanding of the pattern of disease burden. We aim to describe the methods for a systematic review of the literature on burden of heart failure in low- and middle-income countries (LMIC) and how this information will be synthesized to produce useful estimates that can inform policy and practice.
We will conduct a comprehensive search strategy for articles published between 1995 and April 2012 related to incidence, prevalence and treatment of heart failure in LMIC. Populations will be coded as urban, rural, or combined and studies classified as national, sub-national, healthcare system-based, or community level. Details from eligible studies will be extracted independently by two reviewers using a pre-designed data extraction form that will cover information on demographics, diagnostic criteria including disease incidence and prevalence, medical history, medication history, and hospital- or community-based management and outcomes. We will assess the reporting and methodological quality of the included studies and conduct a quantitative summary of reported outcomes where appropriate.
Currently, there are important gaps in our knowledge on the burden of heart failure in LMIC and this systematic review aims to provide useful information that improves our knowledge in this field. Results are expected to be publicly available in early 2013.
Available from: create.canterbury.ac.uk
- "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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