[ad_1]
British patients who have been diagnosed with heart failure since 2000 have been modest and lag behind other serious diseases such as cancer, warns British clinicians, who advocate for an investment increased in heart failure services.
Clare Taylor, Nuffield's Department of Health Sciences in Primary Health Care at Oxford University, has studied nearly 56,000 patients aged 45 and over who have been diagnosed with heart failure, which is more than 278,000 witnesses.
The research, published by the BMJ February 13, showed that in 2017, nearly 31,000 patients with heart failure had died.
The team found that over the study period, one-year survival of heart failure patients improved by 6.6%, 5.2% at 5 years, and 6.4% at 10 years.
Patients who were admitted to the hospital at the time of diagnosis, which may indicate more advanced disease, were significantly worse than other heart failure patients not needing to be hospitalized, their survival having been reduced by just over 2 years.
A similar trend was observed when comparing the most disadvantaged and the least disadvantaged heart failure patients, who also had an average survival difference of about 2 years.
Progressive improvements
The team writes that the incremental improvements in survival observed in their study are "encouraging", but that "the prospects after a new diagnosis of heart failure, especially for those requiring hospitalization, remain poor.
They point out that, in contrast, "there has been a sustained improvement in cancer survival rates following the introduction of the Cancer Plan in 2000, which included investments and changes in infrastructure to improve diagnosis and the treatment".
"The lack of substantial progress in improving survival rates for heart failure should sensitize decision makers to the need to invest more in heart failure services," focusing on earlier diagnosis in primary care.
Taylor said Medscape News UK that the guidelines already recommend to patients who consult their general practitioner to present symptoms suggestive of heart failure should undergo a natriuretic peptide blood test.
"If this is raised, the patient needs an echocardiogram and an examination by a cardiologist."
She believes that "better access to natriuretic peptide tests for GPs and quick referral pathways for echocardiography and revision by a specialist, similar to the lanes of waiting cancer waiting two weeks, could lead to a faster diagnosis in primary care. "
Taylor added, "The NHS's long-term plan is once again focusing on cardiovascular disease, so I'm confident that heart failure will become a more important priority over the next decade."
Important study
Dr. Paul Kalra, president of the British Society for Heart Failure (BSHF), said the study was "important" and "useful".
However, he said Medscape News UK that the reasons why all-cause mortality in patients with heart failure has not improved as much as that observed in cancer are complex, and "we should be relatively proud" of this increase.
Dr. Kalra noted that the average age of patients, at age 77, means that they have "a lot of comorbidity." If you treat heart failure, the only thing you'll probably reduce is the cardiovascular death, but there are clearly other competitors. " causes of death that you can not influence ".
He added: "I think we should be aware of this when we compare it to other conditions where the average age may be lower and comorbidities may be fewer.
Another essential aspect lies in the fact that there is an "obvious database" for heart failure treatments with a reduced ejection fraction that can improve the prognosis of patients.
In contrast, nearly half of heart failure patients have an ejection fraction preserved and "we still have no single treatment that improves a person's life span".
For Dr. Kalra, however, the greatest concern is the large proportion of patients in the hospital-diagnosed study, as well as recent research suggesting that patients may experience symptoms for more than two-and-a-half years before being diagnosed. diagnosed.
In addition, he stated that there were UK regions in 2018 in which patients did not have access to the natriuretic peptide test.
Dr. Kalra would therefore like heart failure to be "a top priority" to educate patients and health professionals because "patients are often subjected to other avenues of investigation before think about heart failure ".
The National Heart Failure Audit of BSHF also showed that "if you are admitted to hospital with heart failure, one of the most important determinants of your success is whether your care is taken care of. charge by a multidisciplinary team of heart failure and if are followed by a team of specialists in heart failure ".
Prevalence of heart failure
The prevalence of heart failure has increased in recent years due to the increase in cardiovascular risk factors, improved survival after ischemic heart disease and the aging of the population.
It is estimated that in the UK, the number of people living with heart failure increased by 23% between 2002 and 2014 to reach 920,616, or 1.4% of the population.
In addition, direct costs of health care and indirect costs to society are thought to cost the global economy up to £ 84.2 billion a year.
The authors argue that, although reliable survival estimates are needed for both health service planning and shared decision-making at the patient level, the results of previous studies have been inconsistent.
For badysis, they used data from the Clinical Practice Research Datalink database, which contains electronic records from more than 700 GP practices in the UK.
The records of patients aged at least 45 years in whom heart failure was diagnosed between 2000 and 2017 were extracted, linking them to the Office for National Statistics for mortality data and to the Hospital Database. Episode Statistics for hospitalizations.
In addition, researchers collected data on demographic variables, cardiovascular risk factors and comorbidities such as angina pectoris, myocardial infarction, ischemic heart disease and diabetes.
They identified 55,959 patients with heart failure during the study period, of whom 24,125 (43.1%) were hospitalized at the time of diagnosis and compared them to 278,679 controls.
The average age at diagnosis was 77.1 years, which did not change during the study period. Women had a mean age at diagnosis of 79.6 years compared to 74.8 years for men.
The proportion of patients admitted to the hospital at the time of diagnosis increased from 28.9% in 2000 to 51.8% in 2010, and remained stable.
Hospitalizations were more frequent among women, the elderly and patients from the most disadvantaged social groups.
Hypertension was more common in patients with heart failure than other patients, at 57.7% versus 46.9%.
There were 30,906 deaths during the study period. Heart failure was found on the death certificate in 13,093 (42.4%) cases and was the leading cause of death in 2237 (7.2%).
Survival rates for heart failure increased from 75.9% at one year to 45.5% at five years, 24.5% at 10 years, and 12.7% at 15 years. Female survival was significantly worse at one year and at age 15 (p <0.001 for both).
The team found that one-year survival increased by 6.6%, from 74.2% in 2000 to 80.8% in 2016, while five-year survival improved by 7%. , 2%, from 41.0% to 48.2%.
The 10-year survival also increased from 19.8% in 2000 to 26.2% in 2016, a median improvement in survival of 6.4%.
Patients admitted to the hospital at the time of diagnosis had significantly worse survival than other patients with heart failure, at 5.3 years versus 2.9 years, or a median difference of 2.4 years (p <0.001 ).
The reduction in survival in patients admitted to the hospital has resulted in an inability to improve survival rates during the study period to the same degree as that of outpatients.
The most disadvantaged patients also had a significantly worse survival at 8.7 years, compared to 11.1 years for the least disadvantaged patients, or a median difference of 2.4 years (p <0.001).
The team noted that the study was observational in nature and that there were several limitations, including the potentially erroneous clbadification of heart failure patients and the inability to determine the type of heart failure.
They say nevertheless that "we are convinced that our conclusions are robust".
Worrying increase
Jeremy Pearson, badociate medical director at the British Heart Foundation, said "their research had revealed" a worrying increase in the number of people diagnosed with heart failure at the hospital, rather than spotted by their GP. "
"This study adds to this disturbing image of heart failure care in the UK, but identifying gaps is the first step to addressing it."
"We need communication between hospitals and primary care providers to ensure that heart failure patients are diagnosed and treated earlier to avoid hospitalizations, while admitted patients receive follow-up care afterwards. leave her in the hospital. "
The study was funded by the collaboration of the National Institute for Health Research (NIHR) for the Leadership in Applied Health Research and Health Care (CLAHRC) of Oxford at the Oxford Health Foundation NHS Trust and Wellcome Institutional Strategic Fund.
All authors report grants awarded by NIHR CLAHRC Oxford during the study; Clare J. Taylor reports the Vifor and Novartis speaker fees and Roche's non-financial support outside the submitted work. José M. Ordóñez-Mena, Andrea K. Roalfe and Sarah Lay-Flurrie report grants from the NIHR BRC Oxford. Nicholas R. Jones reports a grant from the Wellcome Trust. Tom Marshall reports a grant from CLAHRC West Midlands. D. Richard Hobbs reports personal and other costs of Novartis, personal and other costs of Boehringer Ingelheim, and grants from Pfizer outside the submitted work.
BMJ 2019; 364: l223. doi: 10.1136 / bmj.l223
[ad_2]
Source link
