Long-term trends in the incidence of and survival with heart failure
Long-term trends in the incidence of and survival with heart failure
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DOI：
10.1056/nejmoa020265
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发表时间：
2002-10-31
影响因子：
158.5
通讯作者：
Vasan, RS
中科院分区：
文献类型：
--
作者：
Levy, D;Kenchaiah, S;Vasan, RS
背景：心力衰竭是一个主要的公共卫生问题。心力衰竭的发病率和生存率的长期趋势，其发病后，在community.Methods：我们使用统计模型，以评估心力衰竭的发病率和考克斯比例风险回归的时间趋势，以评估在心脏病研究中的心力衰竭发病后的生存率。心力衰竭病例根据发病日期分类：1950年至1969年（223例）、1970年至1979年（222例）、1980年至1989年（307例）和1990年至1999年（323例）。我们还计算了30天，1年和5年的年龄调整的死亡率为每个periods.Results：心力衰竭发生在1075名受试者（其中51%是女性）。与1950年至1969年期间的发病率相比，在随后的三个时期，男性心力衰竭的发病率几乎保持不变，但女性的发病率下降了31%至40%（1990年至1999年期间的发病率比为0.69; 95%置信区间为0.51至0.93）。男性的30天、1年和5年年龄调整死亡率分别从1950年至1969年的12%、30%和70%下降到1990年至1999年的11%、28%和59%。1950年至1969年期间，妇女的相应比率分别为18%、28%和57%，1990年至1999年期间分别为10%、24%和45%。总体而言，心力衰竭发病后的生存率每十年提高12%（男性P=0.01，女性P=0.02）。结论：在过去50年中，女性心力衰竭的发病率有所下降，但男性则不然，而男性和女性心力衰竭发病后的生存率均有所提高。造成这些趋势的因素需要进一步澄清。
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.