Long-term trends in the incidence of and survival with heart failure
Open accessAbstract
BACKGROUND: Heart failure is a major public health problem. Long-term trends in the incidence of heart failure and survival after its onset in the community have not been characterized. METHODS: We used statistical models to assess temporal trends in the incidence of heart failure and Cox proportional-hazards regression to evaluate survival after the onset of heart failure among subjects in the Framingham Heart Study. Cases of heart failure were classified according to the date of onset: 1950 through 1969 (223 cases), 1970 through 1979 (222), 1980 through 1989 (307), and 1990 through 1999 (323). We also calculated 30-day, 1-year, and 5-year age-adjusted mortality rates for each period. RESULTS: Heart failure occurred in 1075 subjects (51 percent of whom were women). As compared with the rate for the period from 1950 through 1969, the incidence of heart failure remained virtually unchanged among men in the three subsequent periods but declined by 31 to 40 percent among women (rate ratio for the period from 1990 through 1999, 0.69; 95 percent confidence interval, 0.51 to 0.93). The 30-day, 1-year, and 5-year age-adjusted mortality rates among men declined from 12 percent, 30 percent, and 70 percent, respectively, in the period from 1950 through 1969 to 11 percent, 28 percent, and 59 percent, respectively, in the period from 1990 through 1999. The corresponding rates among women were 18 percent, 28 percent, and 57 percent for the period from 1950 through 1969 and 10 percent, 24 percent, and 45 percent for the period from 1990 through 1999. Overall, there was an improvement in the survival rate after the onset of heart failure of 12 percent per decade (P=0.01 for men and P=0.02 for women). CONCLUSIONS: Over the past 50 years, the incidence of heart failure has declined among women but not among men, whereas survival after the onset of heart failure has improved in both sexes. Factors contributing to these trends need further clarification.
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Framingham studies documented alterations in cardiac structure or function that precede overt heart failure.
“Other studies from Framingham documented alterations in cardiac structure or function that preceded overt heart failure.”
From The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective (2014) · cites this paper as [59]
In a 1997 Framingham study, increased left ventricular end-diastolic diameter predicted incident heart failure in individuals without myocardial infarction.
“A study in 1997 by Vasan and colleagues demonstrated that increased left ventricular end-diastolic diameter predicted incident heart failure in individuals free of myocardial infarction.59”
From The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective (2014) · cites this paper as [59]
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- Authors
- Levy, D., Kenchaiah, S., Larson, M. G., Benjamin, E. J., Kupka, M. J., Ho, K. K. L., Murabito, J. M., & Vasan, R. S.
- Affiliations
- Boston University (US)
- Beth Israel Deaconess Medical Center (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2002-10-31
- Volume
- 347
- Issue
- 18
- Pages
- 1397-1402
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2090544953
- Cited by
- 2,152
- References
- 40
- Citations by year
- 2026: 24 · 2025: 30 · 2024: 53 · 2023: 57 · 2022: 53 · 2021: 78 · 2020: 89 · 2019: 84 · 2018: 99 · 2017: 109 · 2016: 105 · 2015: 103 · 2014: 85 · 2013: 116 · 2012: 111
- FWCI
- 61.13
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (n01hc25195-41-0-1)
- National Heart, Lung, and Blood Institute (N01‐HC25195, 1K24HL04334, K24HL004334)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- heart failure, incidence trends, mortality rates, sex differences, temporal trends, Framingham Heart Study, community-based cohort, cardiovascular outcomes, women's health, mortality decline
- MeSH terms
- Adult, Aged, Female, Heart Failure, Humans, Longitudinal Studies, Male, Massachusetts, Middle Aged, Mortality, Risk, Incidence, Survival Rate, Proportional Hazards Models, Survivors
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