Study shows first progress in heart-failure survival

October 30, 2002

ROCHESTER, Minn. -- An article in this week's New England Journal of Medicine, "Long-term trends in the incidence of and survival with heart failure," shows the first improvement in heart-failure survival in a long-term community study. In that same issue, an accompanying editorial by Margaret Redfield, M.D., director of the Mayo Clinic Heart Failure Clinic, places the new findings in context, saying they highlight the need for patients to receive the medications - beta-blockers, ACE inhibitors and aldosterone antagonists - that have been proven effective for this lethal epidemic.

Heart failure, sometimes called congestive heart failure or CHF, is a clinical syndrome that is the end stage of various cardiovascular diseases, such as coronary-artery disease, valve disease, cardiac infection or hypertension. Whatever the underlying cause, in CHF the damage to the heart and blood vessels causes blood circulation to be poor. Symptoms include fatigue, shortness of breath, lack of energy and swelling of the legs or abdomen.

"The study found that heart-failure survival was essentially unchanged from the 1950s through the 1980s," says Dr. Redfield. "About 30 percent of heart-failure patients died within one year, and 60 percent within five years. In the 1990s, however, short- and long-term mortality declined to 25 percent and 50 percent respectively. This is a small but important improvement, and the most likely explanation is that treatments shown to be effective in clinical trials are being used in the broader population of heart-failure patients."

The data come from the Framingham Heart Study, which began in 1948 and has since followed the development of various forms of heart disease in 5,209 volunteers from Framingham, Mass. A second generation, which included 5,124 of the original participants' adult children and their spouses, was recruited in 1971.

In addition to the survival improvements, the Framingham investigators also found a slight downward trend in the annual number of new CHF cases. Since most of that reduction seems to have come in the 1970s, however, Dr. Redfield says the incidence findings "are less pertinent to the current epidemic than a more recent change would be."

Heart failure is the leading cause of hospitalization for people over age 65, and 80 percent of the 400,000 new patients diagnosed each year are elderly. With the senior population expected to double over the next four decades, the number of CHF patients will dramatically increase unless there are corresponding improvements in prevention, early detection and treatment.

This study has implications for people of all ages," says Dr. Redfield. "A person who reaches age 40 has a 20 percent chance of developing heart failure in his or her lifetime. Reducing heart disease risk factors is essential, and it is never too early to start regular physical activity, avoid tobacco exposure and keep blood pressure and lipids under control. Obesity is an American epidemic that is linked to an increase in Type II diabetes, and both obesity and diabetes raise the risk of heart disease and, eventually, heart failure.

"Patients who already have heart failure should be sure they are receiving the medications that have been proven effective in clinical trials: beta-blockers, ACE inhibitors and aldosterone antagonists. They should ask their doctors whether they are being given all of these medications, and if not, why not. Adjusting doses to prevent side effects may be complicated, and may require consultation with a cardiologist or heart failure clinic, but these medications can improve survival and quality of life," Dr. Redfield concludes.
Wed., Oct. 30, 2002

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