Decline in Heart Failure Mortality Rates Offset by Comorbidities

Mortality rate trends for newly diagnosed heart failure patients indicate that the overall reduction in mortality across all age groups is being hindered by high and increasing rates of noncardiovascular events, according to a study published online Sept. 3 in JAMA Cardiology. The research was published to coincide with the European Society of Cardiology Congress 2019, held from Aug. 31 to Sept. 4 in Paris.

In a population-based retrospective cohort study, Nathalie Conrad, of The George Institute for Global Health at the University of Oxford in the United Kingdom, and colleagues used Poisson regression models to analyze anonymous electronic health records of 86,833 individuals who received a new diagnosis of heart failure between January 2002 and December 2013. Among the participants, 42,581 (49 percent) were women, 51,215 (88 percent) were white, and the mean age was 76.6 years.

The researchers observed explicit trends indicating that a decline in cardiovascular mortality (rate ratio [RR], 0.73; 95 percent confidence interval [CI], 0.67 to 0.80) was offset by an increase in noncardiovascular deaths (RR, 1.22; 95 percent CI, 1.11 to 1.33). Among patients younger than 80 years of age, there was a noted decline in overall mortality rates (RR, 0.79; 95 percent CI, 0.71 to 0.88); however, there was no decline for patients older than 80 years (RR, 0.97; 95 percent CI, 0.90 to 1.06). The major causes of death in 2013 after cardiovascular causes (43 percent) were neoplasms (15 percent), respiratory conditions (12 percent), and infections (13 percent).

"Declining rates of cardiovascular mortality across all age groups show that progress in cardiovascular care has benefited young and old," the authors write. "However, unchanged survival among older patients highlights the importance of multimorbidity, frailty, and senescence rather than cardiac dysfunction as important [determinants] of prognosis."

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