Incidence, aetiology and prognosis of heart failure : a population-based study in Hillingdon district, West London
This population-based study was designed to determine the incidence, aetiology and prognosis of heart failure in a population of 151 000 in Hillingdon District, West London. All patients developing heart failure for the first time within the study population were identified by surveillance of acute hospital admissions and by the general practitioners involved in the study referring all suspected new cases of heart failure to a rapid access clinic. A standardised medical history was taken from all patients had a clinical examination performed. Electrocardiograph, chest radiography and transthoracic echocardiography were performed and blood samples drawn. The incidence of heart failure was found to be lower than in previous studies which had employed case definitions based on scoring systems. The incidence of heart failure increased steeply with age, and was higher in men than in women. The single most common aetiology was coronary artery disease, but in a third of patients the aetiology could not be determined on the basis of the non-invasive investigations performed. The prognosis of such unselected incident cases of heart failure was found to be poor: the 12 month survival was 64%. The factors most strongly associated with survival were: age; systolic blood pressure; extent of lung crackles on auscultation; and serum creatinine at presentation. This study provides unique insight into the population features of heart failure in a UK population. New cases of heart failure arise chiefly in the elderly, and the most common aetiology is coronary artery disease. The prognosis of this syndrome is poor despite recent advances in therapy. These findings should inform the planning of health care delivery to patients with heart failure and the design of preventative programmes. Randomised controlled trials of therapy should recruit patients more representative of all patients with heart failure.