Downward trend for heart failure in Canada

By Piriya Mahendra, medwireNews Reporter

The incidence of heart failure (HF) in Ontario, Canada, substantially decreased between 1997 and 2008, a study suggests.

However, the authors warn that the prognosis for HF patients is still poor and is associated with high mortality.

Jack Tu (University of Toronto, Canada) and colleagues found that the age- and gender-standardized incidence of HF decreased by a significant 32.7% between 1997 and 2007, from 454.7 to 306.1 per 100,000 people.

This translates to a 3% average annual decline, they say, which is similar to the rates of decline previously observed in overall cardiovascular disease mortality and ischemic heart disease incidence events in Canada. Moreover, the decreased incidence of HF was comparable between inpatient and outpatient settings.

As reported in the Canadian Medical Association Journal, the decline of gender-standardized HF incidence was highest among patients aged 85 years and over, from 5900 per 100,000 people in 1997 to 3800 per 100,000 people in 2007.

Mortality among these patients only showed modest improvements, however. The 1-year risk adjusted mortality decreased from 27.7% in 1997 to just 25.2% in 2007 among the patients. In addition, there were corresponding declines of 17.7%-16.2% among outpatients and 35.7%-33.8% among inpatients.

The authors say that the reasons for the decline in HF incidence are complex, and cannot be fully determined from their study. They suggest, however, that most of the decline is driven by a decrease in the incidence of ischemic heart disease events.

"Hypertension is the second most important cause of HF and other studies have shown that Ontario has one of the highest rates of blood pressure control in recent years, which may also contribute to fewer patients with incident HF," the authors add.

They conclude that although their findings are encouraging, the population continues to age and risk factors for HF such as diabetes and obesity are increasing, particularly in young people, "which may cause the downward trend in incidence of HF to plateau or reverse."

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