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A Population-Based Study

Philip Jong, MD; Erika Vowinckel, MD; Peter P. Liu, MD; Yanyan Gong, MSc; Jack V. Tu, MD, PhD

Arch Intern Med. 2002;162:1689-1694.

Background  The prognosis in unselected community-dwelling patients with heart failure has not been widely studied.

Objective  To determine the short- and long-term mortality of patients after first hospitalizations for heart failure and to examine how age, sex, and comorbidities influence survival.

Methods  We used the Canadian Institute for Health Information database to construct a retrospective population-based cohort of 38 702 consecutive patients with first-time admissions for heart failure from April 1994 through March 1997 in Ontario, Canada. Prognostic variables were collected from hospital discharge abstracts. Vital status at 30 days and 1 year was determined through linkage with the Ontario Registered Persons Database. Regression analyses were used to identify the relationships among survival, age, sex, and comorbidities.

Results  The crude 30-day and 1-year case-fatality rates after first admissions for heart failure were 11.6% and 33.1%, respectively. Advancing age, male sex, and the presence of comorbidities as identified by the Charlson Index were independently associated with poorer survival. The 30-day and 1-year mortality ranged from 2.3% and 7.6%, respectively, in the youngest subgroup with minimal comorbidity to 23.8% and 60.7%, respectively, in the oldest comorbidity-laden subgroup. Complex interactions among age and sex, sex and comorbidities, and age and comorbidities were observed in models of short- and long-term survival.

Conclusions  The prognosis of unselected community-dwelling patients with heart failure remains poor, despite advances in treatment, with substantial variation seen across different subgroups. Although age, sex, and comorbidities were confirmed to be independent prognostic indicators of heart failure, their complex interaction with survival should be considered in future studies.

From the Heart & Stroke/Richard Lewar Centre of Excellence and the Toronto General Hospital, University Health Network (Drs Jong, Vowinckel, and Liu), and the Departments of Medicine, Public Health Sciences, and Health Administration (Ms Gong and Dr Tu), University of Toronto; the Institute for Clinical Evaluative Sciences (Ms Gong and Dr Tu), and the Division of General Internal Medicine and the Clinical Epidemiology and Health Care Research Program, Sunnybrook and Women's College Health Sciences Centre (Ms Gong and Dr Tu), Toronto, Ontario.

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