Keele Research Repository

Background:
Heart failure (HF) is a global pandemic but contemporary trends in cause-specific outcomes among different population groups are unknown.

Methods:
In a retrospective cohort of incident HF patients between 1998 and 2017 (N=88,416, mean age 78-years, 49% female, median follow-up 2.4 years), cause-specific hospitalisation and mortality were investigated.

Findings: First-year age-adjusted hospitalisation rate increases were: all-cause 28% from 97.1 (95% CI 94.3,99.9) to 124.2 (120.9,127.5); HF-specific 28% from 17·2 (16·2,18·2) to 22·1 (20·9,23·2) and non-cardiovascular 42% from 59·2 (57·2,61·2) to 83·9 (81·3,86·5) per 100 person-years. Over 70% of all admissions were for non-cardiovascular causes and annual rate increases were faster for women (+3·9%; 2·8,4·9) than men (+1·4%; 0·6,2·1) (P<0·0001) and for HF patients diagnosed in hospital (+2.4%; 1·4,3.3) than in the community (+1·2%; 0·3,2·2). Annual increases for HF hospitalisations were 2·6% (1·9,3·4) for women and 1·6% (0·6,2·6) for the most deprived, compared to stable rates in men and the most affluent. Overall, the most deprived (adjusted Incident Rate Ratio 1·20; 1·17,1·24) and hospital-diagnosed groups (aIRR 1·52; 1·49,1·55) had significantly higher risk of all-cause admission, but women had significantly lower risk than men (aIRR 0·91; 0·90,0·92). All-cause first-year age-adjusted mortality rate reduction was 6% from 24·5 (23·4,39·2) to 23·0 (22·0,24·1). Annual rate reductions were -1·4% (-2·3, -0·5) in men but stable for women and -2·7% (-3·2, -2·2) for the community group compared to -1·1% (-1·8, -0·4) in the hospital-diagnosed group (p<0·0001). Overall, the most deprived (adjusted Hazard Ratio 1·17;1·14,1·21) and hospital-diagnosed groups (aHR 1·46;1·43,1·48) had significantly higher risk of all-cause mortality, but women had significantly lower risk than men (aHR 0·85;0·83,0·86).

Interpretation:
Tailored management strategies and specialist HF care are needed to address persisting and increasing inequalities for men, the most deprived and for HF patients diagnosed in hospital and to address the worrying trends in women.