Prevalence of heart failure and trends in its pharmacological treatment between 2000 and 2017 among very old people
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SUBMITTER: Svahn S
PROVIDER: S-EPMC11344298 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:AimsTo understand gender differences in the prognosis of women and men with heart failure, we compared mortality, cause of death and survival trends over time.Methods and resultsWe analysed UK primary care data for 26 725 women and 29 234 men over age 45 years with a new diagnosis of heart failure between 1 January 2000 and 31 December 2017 using the Clinical Practice Research Datalink, inpatient Hospital Episode Statistics and the Office for National Statistics death registry. Age-specific overall survival and cause-specific mortality rates were calculated by gender and year. During the study period 15 084 women and 15 822 men with heart failure died. Women were on average 5 years older at diagnosis (79.6 vs. 74.8 years). Median survival was lower in women compared to men (3.99 vs. 4.47 years), but women had a 14% age-adjusted lower risk of all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.84-0.88]. Heart failure was equally likely to be cause of death in women and men (HR 1.03, 95% CI 0.96-1.12). There were modest improvements in survival for both genders, but these were greater in men. The reduction in mortality risk in women was greatest for those diagnosed in the community (HR 0.83, 95% CI 0.80-0.85).ConclusionsWomen are diagnosed with heart failure older than men but have a better age-adjusted prognosis. Survival gains were less in women over the last two decades. Addressing gender differences in heart failure diagnostic and treatment pathways should be a clinical and research priority.
| S-EPMC8287578 | biostudies-literature
Project description:Objective: Pharmacological management of heart failure and comorbidities may result in polypharmacy, but there are few population-based studies that portray the use of medications over time. We aimed to describe the trends in polypharmacy and medication use in older adults with heart failure. Methods: We performed a study including all adults >65 years with heart failure between 2000 and 2017 using health administrative databases in Quebec, Canada. Medication use was ascertained by the presence of at least one claim in each year. We defined three levels of polypharmacy: ⩾10, ⩾15 and ⩾20 different medications/year, and evaluated the use of guideline-recommended and potentially inappropriate medications. We calculated age- and sex-standardized proportions of users each year. Results: The use of ⩾10, ⩾15 and ⩾20 medications increased from 62.2%, 30.6% and 12.2% in 2000 to 71.9%, 43.9% and 22.7%, respectively, in 2017. The combination of β-blocker and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) was used by 30.4% of individuals in 2000 and 45.5% in 2017. ACEI/ARB users decreased from 65.8% in 2000 to 62.1% in 2017. Potentially inappropriate medication use decreased over time. Conclusion: Polypharmacy is significant among older adults with heart failure. Implications of such medication burden should be investigated.
| S-EPMC9310220 | biostudies-literature
Project description:ObjectivesTo report reliable estimates of short term and long term survival rates for people with a diagnosis of heart failure and to assess trends over time by year of diagnosis, hospital admission, and socioeconomic group.DesignPopulation based cohort study.SettingPrimary care, United Kingdom.ParticipantsPrimary care data for 55 959 patients aged 45 and overwith a new diagnosis of heart failure and 278 679 age and sex matched controls in the Clinical Practice Research Datalink from 1 January 2000 to 31 December 2017 and linked to inpatient Hospital Episode Statistics and Office for National Statistics mortality data.Main outcome measuresSurvival rates at one, five, and 10 years and cause of death for people with and without heart failure; and temporal trends in survival by year of diagnosis, hospital admission, and socioeconomic group.ResultsOverall, one, five, and 10 year survival rates increased by 6.6% (from 74.2% in 2000 to 80.8% in 2016), 7.2% (from 41.0% in 2000 to 48.2% in 2012), and 6.4% (from 19.8% in 2000 to 26.2% in 2007), respectively. There were 30 906 deaths in the heart failure group over the study period. Heart failure was listed on the death certificate in 13 093 (42.4%) of these patients, and in 2237 (7.2%) it was the primary cause of death. Improvement in survival was greater for patients not requiring admission to hospital around the time of diagnosis (median difference 2.4 years; 5.3 v 2.9 years, P<0.001). There was a deprivation gap in median survival of 0.5 years between people who were least deprived and those who were most deprived (4.6 v 4.1 years, P<0.001) [corrected].ConclusionsSurvival after a diagnosis of heart failure has shown only modest improvement in the 21st century and lags behind other serious conditions, such as cancer. New strategies to achieve timely diagnosis and treatment initiation in primary care for all socioeconomic groups should be a priority for future research and policy.
| S-EPMC6372921 | biostudies-literature
Project description: Not available
| S-EPMC7044419 | biostudies-literature
Project description:ImportancePrevious studies have described the secular trends of overall heart failure (HF) hospitalizations, but the literature describing the national trends of unique index hospitalizations and readmission visits for the primary management of HF is lacking.ObjectivesTo examine contemporary overall and sex-specific trends of unique primary HF (grouped by number of visits for the same patient in a given year) and 30-day readmission visits in a large national US administrative database from 2010 to 2017.Design, setting, and participantsThis cohort study used data from all adult hospitalizations in the Nationwide Readmission Database from January 1, 2010, to December 31, 2017, with a primary diagnosis of HF. Data analyses were conducted from March to November 2020.ExposuresAdmission for a primary diagnosis of HF at discharge.Main outcomes and measuresUnique and overall hospitalizations with a primary diagnosis of HF and postdischarge readmissions. Unique primary HF hospitalizations were grouped by number of visits for the same patient in a given year.ResultsThere were 8 273 270 primary HF hospitalizations with a single primary HF admission present in 5 092 626 unique patients, and 1 269 109 had 2 or more HF hospitalizations. The mean age was 72.1 (95% CI, 72.0-72.3) years, and 48.9% (95% CI, 48.7-49.0) were women. The primary HF hospitalization rates per 1000 US adults declined from 4.4 in 2010 to 4.1 in 2013 and then increased from 4.2 in 2014 to 4.9 in 2017. The rates per 1000 US adults for postdischarge HF readmissions (1.0 in 2010 to 0.9 in 2014 to 1.1 in 2017) and all-cause 30-day readmissions (0.8 in 2010 to 0.7 in 2014 to 0.9 in 2017) had similar trends.Conclusions and relevanceIn this analysis of a nationally representative administrative data set, for primary HF admissions, crude rates of overall and unique patient hospitalizations declined from 2010 to 2014 followed by an increase from 2014 to 2017. Additionally, readmission visits after index HF hospitalizations followed a similar trend. Future studies are needed to verify these findings to improve policies for HF management.
| S-EPMC7876620 | biostudies-literature
Project description:BackgroundPeople in very old age (VOA) are expected to be confronted with particularly negative stereotypes. These influence societally shared behavior towards and judgements about them. Such external evaluations of individuals' lives are considered a crucial part of their quality of life (QoL).ObjectiveThe present study elaborated a) the societal appreciation perceived by people in VOA and b) the stereotypes about people in VOA held by stakeholders from key societal areas. The aim was to discuss possible connections between these external standards and individual life results.Material and methodsA parallel mixed methods design was employed. Cross-sectional data from a representative survey of people aged 80 years and older (n = 1863) were analyzed by means of χ2-tests and Kruskal-Wallis tests to examine differences in perceived societal appreciation (PSA) by characteristics of the person, their biography, and current lifestyle. Linear regression models were used to investigate the impact of these characteristics on PSA. Regarding stereotypes about people in VOA, semi-structured interviews with stakeholders from key societal areas (n = 22) were analyzed using qualitative content analysis. The quantitative and qualitative findings were juxtaposed for comparison.ResultsPSA was predicted by health-related variables and productive activities. Several societal stakeholders highlighted that age-related losses pose challenges on very old individuals, their families, and society, whereas remaining potentials in VOA can and should be used for the benefit of others; however, stakeholders' perceptions differed by the extent of their professional contact with (very) old people. Different pathways were proposed through which the observed stereotypes and determinants of PSA might be connected (e.g., stereotype internalization).ConclusionOur study illustrates the relevance of external standards for individual QoL and highlights the need for a normative perspective in the discussion about QoL and its enhancement.
| S-EPMC8551093 | biostudies-literature
Project description:AimsThe primary objective of this systematic review was to estimate the prevalence and temporal changes in chronic comorbid conditions reported in heart failure (HF) clinical trials.Methods and resultsWe searched MEDLINE for HF trials enrolling more than 400 patients published between 2001 and 2016.Trials were divided into HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), or trials enrolling regardless of ejection fraction. The prevalence of baseline chronic comorbid conditions was categorized according to the algorithm proposed by the Chronic Conditions Data Warehouse, which is used to analyse Medicare data. To test for a trend in the prevalence of comorbid conditions, linear regression models were used to evaluate temporal trends in prevalence of comorbidities. Overall, 118 clinical trials enrolling a cumulative total of 215 508 patients were included. Across all comorbidities examined, data were reported in a mean of 35% of trials, without significant improvement during the study period. Reporting of comorbidities was more common in HFrEF trials (51%) compared with HFpEF trials (27%). Among trials reporting data, hypertension (63%), ischaemic heart disease (44%), hyperlipidaemia (48%), diabetes (33%), chronic kidney disease (25%) and atrial fibrillation (25%) were the major comorbidities. The prevalence of comorbidities including hypertension, atrial fibrillation and chronic kidney disease increased over time while the prevalence of smoking decreased in HFrEF trials.ConclusionMany HF trials do not report baseline comorbidities. A more rigorous, systematic, and standardized framework needs to be adopted for future clinical trials to ensure adequate comorbidity reporting and improve recruitment of multi-morbid HF patients.
| S-EPMC7906002 | biostudies-literature
Project description:Study objectiveTo describe the age, sex and racial disparities in mortality rates for heart disease (HD) and heart failure (HF) in the United States (US) between 2000 and 2020.DesignThis was an ecological study with trend analysis of mortality rates.SettingUnited States.ParticipantsAdults aged 18 years and above.Main outcomes measuresMortality rates per 100,000 for HD and HF.ResultsThere was a significant decrease in the age-standardized mortality rate for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases, p < 0.001). HD mortality rates were significantly higher in males (p < 0.001), non-Hispanic blacks (p < 0.001) and in adults aged 65+ (p < 0.001) and 75+ (p < 0.001). There was no significant change in the age-standardized mortality rate for HF (from 26.9 per 100,000 cases to 25.7 per 100,000 cases (p = 0.706)) due to a reversal in the trend beyond 2011. Though the HF mortality rates were significantly lower in males (p = 0.001), and not significantly different in non-Hispanic blacks and non-Hispanic whites, there were shifts in trends beyond 2016, with higher rates in males and in non-Hispanic blacks compared to non-Hispanic whites.ConclusionsIn summary, this study underscores significant reductions in heart disease mortality rates over the past two decades, alongside persistent disparities among different demographic groups. It also highlights emerging trends in heart failure mortality rates in particular population subgroups in recent years, necessitating further exploration to inform targeted interventions and policies.
| S-EPMC11415632 | biostudies-literature
Project description:AimsThe long-term outcome in patients with heart failure (HF) after hospitalization may vary substantially depending on their age and left ventricular ejection fraction (LVEF). We aimed to assess the relative rates of cardiovascular death (CVD) and non-CVD based on the age and how the rates differ under the updated LVEF classification system.Methods and resultsConsecutively registered hospitalized patients with HF (N = 3558; 39.7% women with a mean age of 73.9 ± 13.3 years) were followed for a median of 2 (interquartile range, 0.8-3.1) years. The CVDs and non-CVDs were evaluated based on age [young (<65 years), older (65-84 years), and very old (≥85 years)] and LVEF classification [HF with preserved EF (HFpEF; LVEF ≥50%) and non-HFpEF (LVEF <50%)]. The adverse clinical events were adjudicated independently by a central committee. Overall, 1505 (42.3%) had HFpEF [young: n = 182 (12.1%), older: n = 894 (59.4%), very old: n = 429 (28.5%)], and 2053 (57.7%) had non-HFpEF [young: n = 575 (28.0%), older: n = 1159 (56.5%), very old: n = 319 (15.5%)]. During the follow-up, the crude incidence of all-cause death was higher in non-HFpEF than in HFpEF across all age groups (non-HFpEF vs. HFpEF, young: 10.4% vs. 5.5%, log-rank P = 0.10; older: 26.6% vs. 20.9%, log-rank P = 0.002; very old: 36.7% vs. 31.7%, log-rank P = 0.043). CVDs accounted for more than half of all deaths in non-HFpEF (young 65.0%, older 64.2%, and very old 55.6%), whereas the proportion of CVDs remained less than half in HFpEF (young 50.0%, older 41.2%, very old 38.2%). HF readmission was associated with subsequent all-cause death in non-HFpEF [hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.41-2.09, P < 0.001], but not in HFpEF (HR: 1.12, 95% CI: 0.87-1.43, P = 0.39).ConclusionsThe probability of a non-CVD increases in both LVEF categories with advancing age, but that it is greater in the HFpEF category. The findings indicate that mitigating CV-related outcomes alone may be insufficient for treating HF in older population, particularly in the HFpEF category.
| S-EPMC9871708 | biostudies-literature
Project description:BackgroundThe increased risk of adverse drug reactions due to age-related altered pharmacokinetics and pharmacodynamics is a challenge when prescribing medications to older people, and especially among older people with major neurocognitive disorder who are particularly sensitive to drug effects. The aim of this study was to investigate the use of potential inappropriate medications (PIMs) in 2012 and 2017 among old people with major neurocognitive disorder. A secondary aim was to investigate factors associated with PIM use.MethodsThis register-study was based on the Swedish registry for cognitive/dementia disorders and the Swedish prescribed drug register. Criteria from the National Board of Health and Welfare were used to identify PIMs between 1 July-31 December 2012 and 1 July--31 December 2017 among people ≥ 65 years. Drug use was defined as one or more filled prescriptions during each timeframe.ResultsThe total use of PIMs declined significantly between 2012 (28.7%) and 2017 (21.7%). All PIMs and PIM groups declined between these years, except for antipsychotic drugs, which increased from 11.6% to 12.3%. The results from the multiple regression model found that PIM use was associated with younger age (OR: 0.97 CI: 0.96-0.97), a lower Mini Mental State Examination score (OR: 0.99 CI: 0.99-1.00), the use of multi-dispensed drugs (OR: 2.05 CI: 1.93-2.18), and compared to Alzheimer's disease, with the subtypes dementia with Lewy bodies and Parkinson's disease dementia (OR: 1.57 CI: 1.40-1.75), frontotemporal dementia (OR: 1.29 CI: 1.08-1.54) and vascular dementia (OR: 1.10 CI: 1.03-1.16).ConclusionsOverall, the use of PIMs decreased between the years 2012 and 2017. The increase of antipsychotic drugs and the association between PIM use and multi-dispensed drugs warrant concern.
| S-EPMC9245287 | biostudies-literature