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Secular trends of heart failure among US male physicians
Luc Djoussé1, Jinesh Kochar, J Michael Gaziano
1Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02120, USA. ldjousse@rics.bwh.harvard.edu
Insights
Heart failure (HF) incidence remained stable in US male physicians over 20 years. However, mortality risk after developing HF significantly decreased during this period.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Heart failure (HF) is a significant public health concern.
- Limited data exists on long-term trends in HF incidence and survival rates.
Purpose of the Study:
- To investigate long-term trends in heart failure incidence.
- To examine changes in survival rates after the onset of heart failure.
Main Methods:
- Prospective cohort study of 21,906 male physicians from 1985 to 2004.
- Analysis of 909 incident heart failure cases and 457 deaths over an average follow-up of 16.8 years.
Main Results:
- No substantial change in heart failure incidence rates was observed across four study periods (P for trend = .29).
- All-cause mortality risk after heart failure onset significantly decreased over time (P for trend <.0001).
- This survival improvement was consistent across various subgroups and after adjusting for multiple clinical factors.
Conclusions:
- The incidence of heart failure among US male physicians has remained stable over the past two decades.
- A significant reduction in all-cause mortality following heart failure diagnosis was observed.
Background:
Heart failure (HF) remains a major public health issue. Data on long-term trends in the incidence of HF and survival after its onset are limited.
Methods:
A prospective cohort study conducted between 1985 and 2004 in 21,906 participants of the Physicians' Health Study I who were alive and free of HF on January 1, 1985.
Results:
After an average follow-up of 16.8 years, a total of 909 incident cases of HF occurred in this cohort. There was no evidence for a substantial change in the incidence rate of HF across the 4 periods (P for trend .29). From 1985 through 2004, there were 457 deaths among 909 subjects with HF. Compared with the period of 1985 to 1989, the age-adjusted hazard ratio of all-cause mortality after onset of HF was 0.61 (0.46-0.81), 0.37 (0.28-0.48), and 0.10 (0.07-0.15) in the second, third, and fourth period, respectively (P for trend <.0001). Additional adjustment for treatment arm, diabetes, myocardial infarction, hypertension, atrial fibrillation, coronary angioplasty or bypass, valvular heart disease, and left ventricular hypertrophy did not alter these results. Similar findings were seen in subjects with HF with and without antecedent myocardial infarction (P for trend <.0001 each).
Conclusions:
Over the past 20 years, we observed a lower risk of all-cause mortality after onset of HF whereas no major change in the incidence of HF was seen among US male physicians.
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