Abstract

Aims

To determine the incidence and aetiology of heart failure in the general population.

Methods and Results

New cases of heart failure were identified from a population of 151000 served by 82 general practitioners in Hillingdon, West London through surveillance of acute hospital admissions and through a rapid access clinic to which general practitioners referred all new cases of suspected heart failure. On the basis of clinical assessment, electrocardiography, chest radiography and transthoracic echocardiography, a panel of three cardi-ologists decided that 220 patients met the case definition of new heart failure over a 20 month period (crude incidence rate of 1·3 cases per 1000 population per year for those aged 25 years or over). The incidence rate increased from 0·02 cases per 1000 population per year in those aged 25–34 years to 11·6 in those aged 85 years and over. The incidence was higher in males than females (age-adjusted incidence ratio 1·75 [95% confidence interval 1·34–2·29,P<0·0001]). The median age at presentation was 76 years. The primary aetiologies were coronary heart disease (36%), unknown (34%), hypertension (14%), valve disease (7%), atrial fibrillation alone (5%), and other (5%).

Conclusions

Within the general population, new cases of heart failure largely occur in the elderly, and the incidence is higher in men than women. The single most common aetiology is coronary heart disease, but in a third of cases the aetiology cannot be determined on the basis of non-invasive investigation alone. To be relevant to clinical practice, future clinical trials in heart failure should not exclude the elderly.

Falk, RHPodrid, PJ

f1
Correspondence: Dr Martin R. Cowie, Department of Medicine & Therapeutics, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, U.K.

References

1
McMurray
J
, McDonagh T, Morrison CE, Dargie HJ. Trends in hospitalisation for heart failure in Scotland 1980–1990.
Eur Heart J
 .
1993
;
14
:
1158
–1162
2
Cowie
MR
, Mosterd A, Wood DA. The epidemiology of heart failure.
Eur Heart J
 .
1997
;
18
:
208
–215
3
Wheeldon
NM
, MacDonald TM, Flucker CJ, McKendrick AD, McDevitt DG, Struthers AD. Echocardiography in chronic heart failure in the community.
Quart J Med
 .
1993
;
86
:
17
–20
4
Remes
J
, Miettinen H, Reunanen A, Pyorala K. Validity of clincial diagnosis of heart failure in primary health care.
Eur Heart J
 .
1991
;
12
:
315
–321
5
Sutton
GC
. Epidemiologic aspects of heart failure.
Am Heart J
 .
1990
;
6
:
1538
–1540
6
Cameron
HM
, McGoogan E. A prospective study of 1152 hospital autopsies. 1. Inaccuracies in death certification.
J Pathology
 .
1981
;
133
:
273
–283
7
Love, MP, Davie, AP, Cowen, SJ, McMurray, J, Mortality from heart failure in Scotland. Heart Failure ’95, April 1995, Amsterdam, The Netherlands
8
Wabeke
E
, Derks A, Hoekstra GR, Sipsma DH. Autopsies at a nursing home.
Ned Tijdschr Geneeskd
 .
1989
;
133
:
765
–767
9
Devereux
RB
, Liebson PR, Horan MJ. Recommendations concerning use of echocardiography in hypertension and general population research.
Hypertension
 .
1987
;
9
:
97
–104
10
Sahn
DJ
, DeMaria A, Kisslo J, Weyman A. The Committee on M-mode standardization of the American Society of Echocardiography. Recommendations regarding quantitation in M-mode echocardiographic measurements.
Circulation
 .
1978
;
58
:
1072
–1082
11
Henry
WL
, DeMaria A, Gramiak R. Report of the American Society of Echocardiography Committee on Nomenclature and Standrads in two-dimensional echocardiography.
Circulation
 .
1980
;
62
:
212
–217
12
Eur Heart J
 .
1995
;
16
:
741
–751
13
Bland
JM
, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement.
Lancet
 .
1986
;
i
:
307
–310
14
Cowie
MR
, Struthers AD, Wood DA. Value of natri-uretic peptides in assessment of patients with possible new heart failure in primary care.
Lancet
 .
1997
;
350
:
1349
–1351
15
Cohn
JN
, Archibald DG, Ziesche S. Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administration Cooperative Study.
N Engl J Med
 .
1986
;
314
:
1547
–1552
16
N Engl J Med
 .
1987
;
316
:
1429
–1435
17
N Engl J Med
 .
1991
;
325
:
293
–302
18
Packer
M
, Bristow MR, Cohn JN. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure.
N Engl J Med
 .
1996
;
334
:
1349
–1355
19
Remes
J
, Reunanen A, Aromaa A, Pyorala K. Incidence of heart failure in Eastern Finland: a population-based surveillance study.
Eur Heart J
 .
1992
;
13
:
588
–593
20
McKee
PA
, Castelli WP, McNamara PM, Kannel WB. The natural history of congestive heart failure: the Framingham Study.
N Engl J Med
 .
1971
;
285
:
1441
–1446
21
Carlson
KJ
, Lee DC, Goroll AH, Leahy M, Johnson RA. An analysis of physicians’ reasons for prescribing long-term digitalis therapy in outpatients.
J Chronic Dis
 .
1985
;
38
:
733
–739
22
Mosterd
A
, Deckers JW, Hoes AW, Linker DT, Grobbee DE. Classification of heart failure in population based research. An assessment of six heart failure scores.
Eur J Epidemiol
 .
1997
;
13
:
491
–502
23
World Health Statistics Annual 1993, 1994, Geneva, World Health Organisation
24
Eriksson
H
, Svarsudd K, Larsson B. Risk factors for heart failure in the general population: the study of men born in 1913.
Eur Heart J
 .
1989
;
10
:
647
–656
25
Eriksson
H
, Caidahl K, Larsson B. Cardiac and pulmonary causes of dyspnoea - validation of a scoring test for clinical-epidemiological use: The Study of Men Born in 1913.
Eur Heart J
 .
1987
;
8
:
1007
–1014
26
Ho
KK
, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study.
J Am Coll Cardiol
 .
1993
;
22
:
6A
–13A
27
Hardman
SMC
. Ventricular function in atrial fibrillation. Atrial fibrillation: mechanisms and management, 2nd edn. New York: Raven Press; 1997. p. 91–108
28
Van Gelder
IC
, Crijns HJGM, Blanksma PK. Time course of hemodynamic changes and improvement of exercise tolerance after cardioversion of chronic atrial fibrillation unassociated with cardiac valve disease.
Am J Cardiol
 .
1993
;
72
:
560
–566
29
Morley
JE
, Reese SS. Clinical implications of the aging heart.
Am J Med
 .
1989
;
86
:
77
–86
30
Kannel
WB
, Pinsky J. Trends in cardiac failure—incidence and causes over three decades in the Framingham Study (Abstr).
J Am Coll Cardiol
 .
1991
;
17
:
87A

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