heart failure survival

    Are heart failure survival rates still stuck in the 1990s?

    10 February 2017

    Heart failure survival rates have not improved since 1998, a study at the University of Oxford has suggested. (But read our analysis below.)

    During the study, published in the journal Family Practice, researchers looked at medical records from 54,313 heart failure patients. They found that 81.3 per cent of them survived for one year, 51.5 per cent survived for five years, and 29.5 per cent survived for 10 years, following diagnosis with the condition.

    These figures remained static between 1998 and 2012 in people aged over 45.

    The patients were matched by age, sex and practice to patients without heart failure. By comparison, survival rates for these patients at one, five and 10 years were 94 per cent, 74 per cent and 54.1 per cent.

    Heart failure is the second most costly disease the NHS treats after stroke. The condition affects up to one in 50 people in Britain.

    The study’s lead author, Dr Clare Taylor, said: ‘Getting an accurate estimate of heart failure prognosis is vital for those who commission healthcare services, so resources can be allocated appropriately.

    ‘Perhaps more importantly, this allows patients to make more informed choices about treatments and possible end-of-life care. While the survival rates were better than other studies, we disappointingly didn’t see any improvement over time. We plan to do more work to examine why this might be the case and find ways to improve the outlook for patients with heart failure in the future.’

    Instant analysis
    Heart failure is the most common cause of hospitalisation for people over 65, with a six-month re-admission rate of 50 per cent and an average length of inpatient stay of two weeks. Hence in Britain it costs two per cent of the annual NHS budget — about £2 billion. Furthermore, the average five-year survival is only 50 per cent, which is worse than many cancers, for instance bladder, bowel, prostate and breast cancer.

    Heart failure is a syndrome that results from any structural or functional impairment of the heart filling with or ejecting blood, most commonly following a heart attack. Due to salt and water retention, patients typically complain of breathlessness, ankle swelling and fatigue. In short, heart failure is common, costly and deadly.

    This was a study of 54,313 adult patients (over 45 years of age) in primary care, following a first diagnosis of heart failure, over a 15-year period, from 1998 to 2012. The patients were all matched by age, sex and practice to people without heart failure. Their survival was assessed by analysing primary care records, with age-specific survival rates at one, five and 10 years for men and women.

    It found that mortality had not improved since the 1990s despite various ground-breaking drugs and devices being discovered and becoming incorporated into treatment.

    This is a large cross-section of patients in Britain, which is one of the paper’s strengths. However, it only included data from 587 out of 8,490 practices in Britain — about six per cent of the whole population. The population sampled may not be necessarily representative of the population at large.

    In the 15 years since the study’s inception the way that heart failure is diagnosed has changed and ultimately this study relies on the accuracy of GP coding. There is no data on whether patients were taking medication for heart failure or who had made the diagnosis and whether this was accurate. How the diagnosis was made is not clear.

    There is quite a lot of missing data too, which the researchers are explicit about.

    Most news reports compared the apparent lack of improvement in heart failure survival to the doubling of cancer survival rates over the past 40 years. This is odd. For a start, the study only covers 15 years. Patients who suffer heart failure are also older than those with cancer (average age of diagnosis is 76, compared to about 70 for cancer). Comorbidity (the presence of an additional disease) is common in heart failure patients and this was also not accounted for.

    The study, while thought provoking, is therefore found significantly wanting in terms of the quality of the data and usefulness of the findings.
    Research score: 2/5