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Survival after the onset of congestive heart failure in Framingham Heart Study subjects
K K Ho1, K M Anderson, W B Kannel
1Cardiovascular Division, Charles A. Dana Research Institute, Boston, MA.
Insights
Congestive heart failure (CHF) remains a lethal condition with better survival rates for women and younger individuals. Despite advances in cardiovascular treatments, overall survival after CHF onset has not significantly improved over four decades.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Limited epidemiological data exist on congestive heart failure (CHF) prognosis.
- Understanding temporal changes in survival post-CHF onset in population-based settings is crucial.
Purpose of the Study:
- To evaluate the prognosis of congestive heart failure (CHF).
- To assess temporal changes in survival rates after CHF onset.
- To identify clinical variables affecting survival post-CHF diagnosis.
Main Methods:
- Utilized proportional hazards models to analyze survival data.
- Included 652 Framingham Heart Study participants diagnosed with CHF between 1948 and 1988.
- Examined effects of age, sex, and calendar decade on mortality.
Main Results:
- Median survival was 1.7 years for men and 3.2 years for women.
- 1-year survival rates were 57% (men) and 64% (women); 5-year rates were 25% (men) and 38% (women).
- Mortality increased with age; survival was better in women. No significant temporal changes in CHF prognosis were observed over 40 years.
Conclusions:
- Congestive heart failure (CHF) continues to have a high mortality rate.
- Women and younger individuals exhibit a better prognosis for CHF.
- Despite therapeutic advances, overall survival post-CHF has not improved significantly in this population.
Background:
Relatively limited epidemiological data are available regarding the prognosis of congestive heart failure (CHF) and temporal changes in survival after its onset in a population-based setting.
Methods And Results:
Proportional hazards models were used to evaluate the effects of selected clinical variables on survival after the onset of CHF among 652 members of the Framingham Heart Study (51% men; mean age, 70.0 +/- 10.8 years) who developed CHF between 1948 and 1988. Subjects were older at the diagnosis of heart failure in the later decades of this study (mean age at heart failure diagnosis, 57.3 +/- 7.6 years in the 1950s, 65.9 +/- 7.9 years in the 1960s, 71.6 +/- 9.4 years in the 1970s, and 76.4 +/- 10.0 years in the 1980s; p < 0.001). Median survival after the onset of heart failure was 1.7 years in men and 3.2 years in women. Overall, 1-year and 5-year survival rates were 57% and 25% in men and 64% and 38% in women, respectively. Survival was better in women than in men (age-adjusted hazards ratio for mortality, 0.64; 95% CI, 0.54-0.77). Mortality increased with advancing age in both sexes (hazards ratio for men, 1.27 per decade of age; 95% CI, 1.09-1.47; hazards ratio for women, 1.61 per decade of age; 95% CI, 1.37-1.90). Adjusting for age, there was no significant temporal change in the prognosis of CHF during the 40 years of observation (hazards ratio for men for mortality, 1.08 per calendar decade; 95% CI, 0.92-1.27; hazards ratio for women for mortality, 1.02 per calendar decade; 95% CI, 0.83-1.26).
Conclusions:
CHF remains highly lethal, with better prognosis in women and in younger individuals. Advances in the treatment of hypertension, myocardial ischemia, and valvular heart disease during the four decades of observation did not translate into appreciable improvements in overall survival after the onset of CHF in this large, unselected population.