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- Christiansen, Mia N., et al.
(författare)
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Age-specific Trends in Incidence, Mortality and Comorbidities of Heart Failure in Denmark 1995-2012
- 2017
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Ingår i: Circulation. - 0009-7322. ; 135:13, s. 1214-1223
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND—: The cumulative burden and importance of cardiovascular risk factors have changed over the last decades. Specifically, obesity rates have increased among younger people, whereas cardiovascular health has improved in the elderly. Little is known regarding how these changes have impacted the incidence and the mortality rates of heart failure. Therefore, we aimed to investigate the age-specific trends in the incidence and 1-year mortality rates following a first time diagnosis of heart failure in Denmark between 1995 and 2012. METHODS—: We included all Danish individuals over the age of 18 years with a first-time in-hospital diagnosis of heart failure. Data was collected from 3 nationwide Danish registries. Annual incidence rates of heart failure and 1-year standardized mortality rates were calculated under the assumption of a Poisson distribution. RESULTS—: We identified 210,430 individuals with a first-time diagnosis of heart failure between 1995 and 2012; the annual incidence rates per 10,000 person-years declined among older individuals (rates in 1995 vs. 2012: 164 vs. 115 in >74 years, 63 vs. 35 in 65-74 years, and 20 vs. 17 in 55-64 years, p<0.0001 for all) but increased among the younger (0.4 vs. 0.7 in 18-34 years, 1.3 vs. 2.0 in 35-44 years, and 5.0 vs. 6.4 in 45-54 years, p<0.0001 for all). The proportion of patients with incident heart failure below 51 years doubled from 3% in 1995 to 6% in 2012 (p<0.0001). Sex- and age-adjusted incidence rate ratios for 2012 vs. 1996 were 0.69 (95%CI 0.67-0.71; p <0.0001) among people >50 years, and 1.52 (95%CI 1.33-1.73; p<0.0001) among individuals ≤50 years; it remained essentially unchanged upon additional adjustment for diabetes, ischemic heart disease, and hypertension. Standardized 1-year mortality rates declined for middle-aged patients with heart failure but remained constant for younger (<45 years) and elderly (≥65 years). The prevalence of comorbidities (including diabetes, hypertension, and atrial fibrillation) increased, especially in younger patients with heart failure. CONCLUSIONS—: Over the last two decades, the incidence of heart failure in Denmark declined among older (>50 years), but increased among younger (≤50 years) individuals. These observations may portend a rising burden of heart failure in the community.
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| 2. |
- Kristensen, Søren L., et al.
(författare)
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Prevalence of Prediabetes and Undiagnosed Diabetes in Patients with HFpEF and HFrEF and Associated Clinical Outcomes
- 2017
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Ingår i: Cardiovascular Drugs and Therapy. - : Springer Science and Business Media LLC. - 0920-3206 .- 1573-7241. ; 31:5/6, s. 545-549
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 The Author(s) Purpose: The prevalence and consequences of prediabetic dysglycemia and undiagnosed diabetes is unknown in patients with heart failure (HF) and preserved ejection fraction (HFpEF) and has not been compared to heart failure and reduced ejection fraction (HFrEF). Methods: We examined the prevalence and outcomes associated with normoglycemia, prediabetic dysglycemia and diabetes (diagnosed and undiagnosed) among individuals with a baseline glycated hemoglobin (hemoglobin A1c, HbA1c) measurement stratified by HFrEF or HFpEF in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity programme (CHARM). We studied the primary outcome of HF hospitalization or cardiovascular (CV) death, and all-cause death, and estimated hazard ratios (HR) by use of multivariable Cox regression models. Results: HbA1c was measured at baseline in CHARM patients enrolled in the USA and Canada and was available in 1072/3023 (35%) of patients with HFpEF and 1578/4576 (34%) patients with HFrEF. 18 and 16% had normoglycemia (HbA1c < 6.0), 20 and 22% had prediabetes (HbA1c 6.0–6.4), respectively. Finally among patients with HFpEF 22% had undiagnosed diabetes (HbA1c > 6.4), and 40% had known diabetes (any HbA1c), with corresponding prevalence among HFrEF patients being 26 and 35%. The rates of both clinical outcomes of interest were higher in patients with undiagnosed diabetes and prediabetes, compared to normoglycemic patients, irrespective of HF subtype, and in general higher among HFrEF patients. For the primary composite outcome among HFpEF patients, the HRs were 1.02 (95% CI 0.63–1.65) for prediabetes, HR 1.18 (0.75–1.86) for undiagnosed diabetes and 2.75 (1.83–4.11) for known diabetes, respectively, p value for trend across groups < 0.001. Dysglycemia was also associated with worse outcomes in HFrEF. Conclusions: These findings confirm the remarkably high prevalence of dysglycemia in heart failure irrespective of ejection fraction phenotype, and demonstrate that dysglycemia is associated with a higher risk of adverse clinical outcomes, even before the diagnosis of diabetes and institution of glucose lowering therapy in patients with HFpEF as well as HFrEF.
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