Is the prognosis of heart failure improving?

Background and Methods. Heart failure is common and effective therapy exist s but as yet there is little evidence that the overall prognosis is improvi ng in clinical practice. We sought to determine if mortality, re-admission with heart failure and re-admission for any cause, had changed between coho rts of first-time admissions for heart failure identified in 1984, 1988 and 1992 using linked hospital discharge and mortality data from Scotland (pop ulation approximately 5 million). Findings. The number of first-time admiss ions for heart failure increased by 30% between 1984 and 1992, from 9716 to 12 640. Their mean age was 74 years and 54% were women. Over the same peri od 3-year mortality declined in patients < 65 years from 53 to 41% (reducti on in risk 12% (95% confidence interval 9-15%. Log-rank 70.0; P < 0.001) an d for patients greater than or equal to 65 years from 71% to 66% (reduction in risk 5% (95% confidence interval 3-6%. Log-rank 74.5; P < 0.0001). Time to death or first re-admission with heart failure also improved but not ti me to death or first re-admission for any cause. The total number of re-adm issions increased between 1984 and 1992 but bed-days occupancy for heart fa ilure and for any cause, adjusted for days alive, declined due to a reducti on in length of stay. Interpretation. These data suggest that the prognosis of patients with a first admission for heart failure is improving. The tim ing of improvement coincides with the gradual increase in the use of angiot ensin converting enzyme inhibitors for heart failure although a causal link cannot be proved from these data. (C) 1999 European Society of Cardiology. All rights reserved.